Tagged The Health Law

How The Medicaid Battle Is Far From Over: Despite Some Red States Embracing Limited Expansion, Others Dig In Their Heels

Recent moves by red state Republicans to block voter-approved Medicaid expansion, as well as threats from some Republican governors to slash funding highlight the fact that both sides are still fighting the Medicaid expansion battle. Medicaid news comes out of Georgia and Texas, as well.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Did you guys get as big a kick out of the #healthpolicyvalentines hashtag as I did? (I feel I’m talking to the right crowd here.) They’re quite delightful, including this timely one from KHN’s own Rachel Bluth: “Not even a PBM could get in the middle of our love.”

On to the news from the week.

Thursday was a somber day for many as the country marked the anniversary of the Parkland, Fla., mass shooting at Marjory Stoneman Douglas High School that left 17 dead.

On the eve of the anniversary, the House Judiciary Committee approved two bills that would expand federal background checks for gun purchases. Although the legislation faces certain demise in the Senate, it is the first congressional action in favor of tightening gun laws in years. In the votes you see echoes of a recent trend: Lawmakers are no longer treating gun control as “the third rail in politics.” The difference is stark if you look at just over 10 years ago when then-candidate Barack Obama was sending out mailers assuring voters he supported the Second Amendment.

Politico: House Democrats Make First Major Move to Tighten Gun Laws

The Associated Press: Parkland Anniversary Highlights Democratic Shift on Guns

There were too many heartbreaking anniversary stories to highlight just one, but a project worth checking out is one from The Trace, a nonprofit news organization that reports on gun violence. In the year since Parkland, nearly 1,200 more children have lost their lives to guns. The Trace brought together more than 200 teen reporters from across the country to remember those killed not as statistics, but as human beings with rich histories.

14 Children Died in The Parkland Shooting. Nearly 1,200 Have Died From Guns Since.

A handy reference: The good people at The Tampa Bay Times and the AP put together a useful list of all the gun laws that have been enacted in the country since the shooting.

Tampa Bay Times and Associated Press: Here Is Every New Gun Law in the U.S. Since the Parkland Shooting


There are some lawmakers on the Hill who are almost giddy to hold hearings on “Medicare-for-all” — and they’re not Democrats. Republicans have been struggling to find a winning stance on health care, ever since Dems’ midterm victories, which were attributed in part to their stance on the issue.

For the previously floundering GOP lawmakers, MFA is practically a gift-wrapped present that fell right into their laps. They’re confident they can frame the idea as reckless, radical and expensive, and pick off moderate voters who want to keep their insurance the way it is. Democratic leadership blasted the GOP’s calls for hearings as “disingenuous,” but MFA supporters were raring to duke it out — verbally, of course. “They think it’s going to be a ‘gotcha’ moment,” said Rep. Pramila Jayapal (D-Wash.) in Politico’s coverage. “But they have been wrong on this and continue to be wrong on it.”

Politico: Republicans Can’t Wait to Debate ‘Medicare For All’

Meanwhile, Democrats introduced legislation this week that would allow people over 50 to buy in to Medicare. The measure is much more politically palatable than MFA, and its sponsors are selling it is a realistic and incremental step in the direction toward universal coverage.

Politico: Push for Medicare Buy-In Picks Up With ’50 and Over’ Bill


Here’s something you don’t hear every day: Republicans and Democrats maybe (just maybe!) have found some common ground on the health law. As part of a package of bills to shore up the Affordable Care Act, Democrats are proposing slapping some consumer warnings on short-term plans. The hint of bipartisanship in the air, though, was limited to the advisories — Republicans were not fans of the rest of the changes proposed.

Modern Healthcare: Short-Term Health Insurance Plans May Get Consumer Warnings


Advocates deem Utah’s move to limit voter-approved Medicaid expansion as a “dark day for Democracy.” The governor and lawmakers who rushed through the restrictions to the expansion, however, say the work requirements and caps are necessary to make it sustainable for the state.

The Associated Press: Utah Reduces Voter-Backed Medicaid Expansion in Rare Move


As 2020 comes into focus, the abortion debate is definitely on the front burner for President Donald Trump, who has seized on recent controversies over so-called late-term abortions. This week, Trump and White House officials met with advocates, including Susan B. Anthony List President Marjorie Dannenfelser. While the discussions weren’t open to journalists, Dannenfelser confirmed that Trump was keenly interested in the issue. “The national conversation about late-term abortion … has the power to start to peel away Democrats, especially in battle grounds,” Dannenfelser said in The Hill’s coverage.

The Hill: Trump Offers Preview of Abortion Message Ahead of 2020


There was some movement in the agencies this week that should be on your radar:

— The Food and Drug Administration has announced it’s cracking down on the $40 billion supplement industry, especially targeting diseases that really should require medical care. Right now, that landscape is pretty much the Wild Wild West, where anything goes. And consumers don’t realize that.

The New York Times: F.D.A. Warns Supplement Makers to Stop Touting Cures for Diseases Like Alzheimer’s

— The Environmental Protection Agency has released its plan to address long-lasting toxins in drinking water. Activists were not impressed, saying the “action plan” was quite short on action.

Reuters: U.S. Unveils Plan to Control Some Toxins in Drinking Water, Sets No Limits

— The Centers for Medicare & Medicaid Services released two major proposed regulations that are meant to help ease patients’ access to their health care records. Right now, many health care providers and hospitals offer patient portals, but they often lack material such as doctor notes, imaging scans and genetic-testing data. Sometimes they’ll even charge for the data. The rules would address restrictions such as those.

The Wall Street Journal: New Rules Could Ease Patients’ Access to Their Own Health Records


In a sign of the growing awareness about the United States’ maternal mortality problem, the task force that sets the standards insurers are required to follow is expanding its guidance when it comes to depression during and after pregnancy. The U.S. Preventive Services Task Force already recommends that doctors screen pregnant women and new mothers, but the old guidelines focused on patients who were experiencing symptoms. The new advice is more proactive about addressing women who may be at risk.

The Wall Street Journal: New Mothers at Risk of Depression to Get Counseling Services, Covered By Insurance, Under New Guidelines


It’s a well-established fact that doctors have an unconscious bias when it comes to race and pain — one that leaves many minority patients undertreated and undermedicated. What’s interesting is to see how that disparity has shaped the opioid epidemic in the country — the ones that wreaked havoc on white communities.

Los Angeles Times: Why Opioids Hit White Areas Harder: Doctors There Prescribe More Readily, Study Finds

While all eyes are on the massive consolidated opioid lawsuit in Ohio that’s being compared to the Big Tobacco reckoning of the ’90s, this little case in Oklahoma might steal its thunder.

Stateline: Pay Attention to This Little-Noticed Opioid Lawsuit in Oklahoma


In the miscellaneous file for the week:

• A powerful investigation from The Wall Street Journal and Frontline uncovers the history behind an Indian Health Service doctor who was accused of molesting Native Americans yet allowed to continue practicing for decades. Where did it go wrong?

The Wall Street Journal: HHS to Review Indian Health Service After Revelations on Pedophile Doctor

• Rural hospitals are collapsing everywhere, leaving vulnerable residents stranded in health deserts. It can be devastating for towns to watch their hospitals die. Ducktown, Tenn., offers a snapshot of what’s playing out in states all across the country.

Nashville Tennessean: Tennessee Rural Hospitals Are Dying. Welcome to Life in Ducktown

• Employer-sponsored health care is often held up as the gold standard. But is it really that great?

CNN: Employer Health Plans Cover Less Than You Think, Study Finds

• I vividly remember the global fear surrounding the bird flu back in the aughts. People were panicking and countries were stockpiling medical supplies, as everyone braced for an epidemic reminiscent of the catastrophic 1918 Spanish flu. But then nothing happened. So … where’d it go?

Stat: What Happened to Bird Flu? How a Threat to Human Health Faded From View


Early numbers show that the flu vaccine is doing a pretty good job this year, so remember it’s not too late to get your shot! And have a great weekend!

Podcast: KHN’s ‘What The Health?’ “Medicare-For-All” For Dummies

Republicans are still in charge of the White House and the Senate, but the “Medicare-for-all” debate is in full swing. Democrats of every stripe are pledging support for a number of variations on the theme of expanding health coverage to all Americans.

This week, KHN’s “What the Health?” podcast takes a deep dive into the often-confusing Medicare-for-all debate, including its history, prospects and terminology.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Paige Winfield Cunningham of The Washington Post and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • Medicare-for-all is a new rallying cry for progressives, but the current Medicare program has big limitations. It does not cover most long-term care expenses, and includes no coverage of hearing, dental, vision or foot care. Medicare also includes no stop-loss or catastrophic care limit that protects beneficiaries from massive bills.
  • Though recent comments by Sen. Kamala Harris on eliminating private insurance with a move to Medicare-for-all stirred controversy, private insurance is indeed involved in many aspects of the government program. Private companies provide the Medicare Advantage plans used by more than a third of beneficiaries, the Medicare drug plans and much of the bill processing for the entire program.
  • Many consumers — and politicians — are confused by the terms being thrown around in the current debate about Medicare-for-all. The plan offered by Sen. Bernie Sanders (I-Vt.) and some of his supporters would be a “single-payer” system, in which the government would be in charge of paying for all health care — although doctors, hospitals and other health care providers would remain private. Others often use the term Medicare-for-all to mean a much less drastic change to the U.S. health care system, such as a “public option” that would offer specific groups of people — perhaps those over age 50 or consumers purchasing coverage on the insurance marketplaces — the opportunity to buy into Medicare coverage.
  • Sanders’ vision of Medicare-for-all is based on Canada’s system. But even there, hospitals and doctors are private businesses, drugs are not covered everywhere, and benefits vary among the provinces.
  • The health care industry is nearly united in opposing the talk of moving to a Medicare-for-all program because of concerns about disruption to the system and less pay. Currently, Medicare reimbursements are about 40 percent lower than private insurance.

If you want to know more about the next big health policy debate, here are some articles to get you started:

Vox’s “Private Health Insurance Exists in Europe and Canada. Here’s How It Works,” by Sarah Kliff

The Washington Post’s “How Democrats Could Lose on Health Care in 2020,” by Ronald A. Klain

The American Prospect’s “The Pleasant Illusions of the Medicare-for-All Debate,” by Paul Starr

The Week’s “Why Do Democrats Think Expanding ObamaCare Would Be Easier Than Passing Medicare-for-All?” by Jeff Spross

Vox’s “How to Build a Medicare-for-All Plan, Explained By Somebody Who’s Thought About It for 20 Years,” by Dylan Scott

The New York Times’ “The Best Health Care System in the World: Which One Would You Pick?” By Aaron E. Carroll and Austin Frakt

The Nation’s “Medicare-for-All Isn’t the Solution for Universal Health Care,” by Joshua Holland

The New York Times’ “’Don’t Get Too Excited’ About Medicare for All,” by Elisabeth Rosenthal and Shefali Luthra

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

Julie Rovner: Yahoo News’ “What Trump Got Wrong About ‘Right to Try,’” by Kadia Tubman

Joanne Kenen: STAT News’ “The Modern Tragedy of Fake Cancer Cures,” by Matthew Herper

Rebecca Adams: The Texas Tribune’s “Thousands of Texans Were Shocked By Surprise Medical Bills. Their Requests for Help Overwhelmed the State,” by Jay Root and Shannon Najmabadi

Paige Winfield Cunningham: STAT News’ “The ‘Big Pharma’ Candidate? As He Runs for President, Cory Booker Looks to Shake His Reputation for Drug Industry Coziness,” by Lev Facher

To hear all our podcasts, click here.

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

Podcast: KHN’s ‘What The Health?’ “Medicare-For-All” For Dummies

Republicans are still in charge of the White House and the Senate, but the “Medicare-for-all” debate is in full swing. Democrats of every stripe are pledging support for a number of variations on the theme of expanding health coverage to all Americans.

This week, KHN’s “What the Health?” podcast takes a deep dive into the often-confusing Medicare-for-all debate, including its history, prospects and terminology.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Paige Winfield Cunningham of The Washington Post and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • Medicare-for-all is a new rallying cry for progressives, but the current Medicare program has big limitations. It does not cover most long-term care expenses, and includes no coverage of hearing, dental, vision or foot care. Medicare also includes no stop-loss or catastrophic care limit that protects beneficiaries from massive bills.
  • Though recent comments by Sen. Kamala Harris on eliminating private insurance with a move to Medicare-for-all stirred controversy, private insurance is indeed involved in many aspects of the government program. Private companies provide the Medicare Advantage plans used by more than a third of beneficiaries, the Medicare drug plans and much of the bill processing for the entire program.
  • Many consumers — and politicians — are confused by the terms being thrown around in the current debate about Medicare-for-all. The plan offered by Sen. Bernie Sanders (I-Vt.) and some of his supporters would be a “single-payer” system, in which the government would be in charge of paying for all health care — although doctors, hospitals and other health care providers would remain private. Others often use the term Medicare-for-all to mean a much less drastic change to the U.S. health care system, such as a “public option” that would offer specific groups of people — perhaps those over age 50 or consumers purchasing coverage on the insurance marketplaces — the opportunity to buy into Medicare coverage.
  • Sanders’ vision of Medicare-for-all is based on Canada’s system. But even there, hospitals and doctors are private businesses, drugs are not covered everywhere, and benefits vary among the provinces.
  • The health care industry is nearly united in opposing the talk of moving to a Medicare-for-all program because of concerns about disruption to the system and less pay. Currently, Medicare reimbursements are about 40 percent lower than private insurance.

If you want to know more about the next big health policy debate, here are some articles to get you started:

Vox’s “Private Health Insurance Exists in Europe and Canada. Here’s How It Works,” by Sarah Kliff

The Washington Post’s “How Democrats Could Lose on Health Care in 2020,” by Ronald A. Klain

The American Prospect’s “The Pleasant Illusions of the Medicare-for-All Debate,” by Paul Starr

The Week’s “Why Do Democrats Think Expanding ObamaCare Would Be Easier Than Passing Medicare-for-All?” by Jeff Spross

Vox’s “How to Build a Medicare-for-All Plan, Explained By Somebody Who’s Thought About It for 20 Years,” by Dylan Scott

The New York Times’ “The Best Health Care System in the World: Which One Would You Pick?” By Aaron E. Carroll and Austin Frakt

The Nation’s “Medicare-for-All Isn’t the Solution for Universal Health Care,” by Joshua Holland

The New York Times’ “’Don’t Get Too Excited’ About Medicare for All,” by Elisabeth Rosenthal and Shefali Luthra

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

Julie Rovner: Yahoo News’ “What Trump Got Wrong About ‘Right to Try,’” by Kadia Tubman

Joanne Kenen: STAT News’ “The Modern Tragedy of Fake Cancer Cures,” by Matthew Herper

Rebecca Adams: The Texas Tribune’s “Thousands of Texans Were Shocked By Surprise Medical Bills. Their Requests for Help Overwhelmed the State,” by Jay Root and Shannon Najmabadi

Paige Winfield Cunningham: STAT News’ “The ‘Big Pharma’ Candidate? As He Runs for President, Cory Booker Looks to Shake His Reputation for Drug Industry Coziness,” by Lev Facher

To hear all our podcasts, click here.

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

Utah’s Novel Plan For Medicaid Expansion Opens Door To Spending Caps Sought By GOP

Utah this week became the 35th state to approve expanding Medicaid under the Affordable Care Act, but advocates for the poor worry its unusual financing could set a dangerous precedent and lead to millions of people losing coverage across the country.

That’s because the plan includes unprecedented annual limits on federal and state spending.

Those restrictions would be a radical change for Medicaid. Since it began in 1966, the state-federal health program for low-income residents has been an open-ended entitlement for anyone who meets eligibility criteria. State and federal spending must keep pace with enrollment.

Joan Alker, executive director of the Georgetown University Center for Children and Families, is concerned that the state and federal Medicaid funding caps can limit how many people are enrolled and what services they receive. She said no state has before tried to cap its own funding.

“This is a way for the state to look like it’s doing expansion when they are really doing very little,” she said.

If Utah’s plan is approved, Alker added, other states that have already expanded Medicaid and some that are considering it will likely seek to strike a similar deal.

Limiting spending on Medicaid has been a longtime goal of fiscal conservatives, but opposition to the idea helped blow up  Republican efforts to repeal and replace the ACA in 2017.

Also fueling criticism: The law signed by Utah Gov. Gary Herbert on Monday expands Medicaid only to people earning up to 100 percent of the federal poverty level instead of the 138 percent mark set by the ACA and approved by Utah voters in a referendum supporting expansion in November. Both the Obama and Trump administrations have refused in the past to accept that condition.

The proposal also includes a work requirement for adults who gain coverage through the expansion.

Utah’s proposal needs federal approval, and state officials said they hope to have that in time to expand Medicaid to 90,000 adults on April 1.

The state expects to adopt annual spending caps after negotiations with the Trump administration.

Congressional Republicans and President Donald Trump tried to cap federal Medicaid payments as part of their health law repeal efforts in 2017. But that move met stiff opposition from Democrats, hospital and patient advocates and some Republican lawmakers. They warned it would lead to cuts in benefits and enrollment.

Utah’s proposal to limit federal spending was necessary to get the Trump administration to approve its application to only partially expand Medicaid, the state’s top Medicaid official said.

“We were looking for a way to make our waiver more attractive to the federal government,” said Nathan Checketts, Utah’s Medicaid director.

He said the Trump administration last year was skeptical of the state’s proposal to expand Medicaid to adults with incomes below 100 percent of the federal poverty level — about $12,500 annual income for an individual — instead of 138 percent of the poverty level, about $17,000 in annual income. That’s because it would mean higher federal spending, since people earning between 100 percent and 138 percent of poverty would be eligible for federal subsidies to help pay for premiums for insurance they buy on the ACA exchange.

By capping funding at a negotiated per capita rate, the federal government could better control its spending, Checketts said.

Under Trump, the federal Centers for Medicare & Medicaid Services has not approved requests by Arkansas and Massachusetts to get the higher federal match rate for partial expansion.

CMS, Checkett added, has been open to a deal since after Election Day. “They’ve become more receptive to our request than they were last year, but there are no guarantees,” he said.

Under the proposed deal, the federal government would pay 90 percent of the costs for anyone coming into Medicaid through expansion — the rate set by the ACA. In traditional Medicaid, the state receives a 70 percent federal match.

The federal spending cap would vary based on how many people are enrolled under expansion. If the costs for covering the expansion population exceeded the federal spending cap, the state could limit how many people it enrolled, Checketts said.

The law also includes a state funding cap so Utah officials can limit enrollment if spending were to exceed the budget, Checketts said. The federal government would also have to approve a state spending cap.

“The state has to balance its budget every year, and this allows the state to align its budget and a certain amount of money to put toward this population and not any more,” he said.

If CMS does not grant the waiver for a partial expansion, the bill requires the state to establish a full expansion in 2020.

Jessie Mandle, senior health policy analyst for Voices for Utah Children, an advocacy group, said the plan is tough to swallow for advocates who have been fighting for expansion for more than six years.

“This will create more barriers and restraints to care,” she said. “This was not the way voters chose to expand.”

Utah’s plan to seek a per capita spending cap comes even though the state’s per capita Medicaid spending is among the lowest, according to a report last year by the Utah Foundation, a nonpartisan research group.

The average cost for each Medicaid enrollee in Utah was $5,326 in 2014, the most recent year for which that figure is available, the report found. That number was the 10th lowest in the United States.

Nationwide, Utah also had the lowest percentage of its population enrolled in Medicaid as of 2016, the report said.

Advocates Hope Emerging Evidence About Economic Benefits Of Medicaid Expansion Will Nudge Kansas, Missouri Into Action

The states have long-balked at the price tag associated with expansion, but economists are saying other red states are reaping the benefits of injecting the economy with millions in federal dollars. Beginning next year, however, the federal government’s contribution will phase down to 90 percent from the current 93 percent of expansion costs, which will make it a harder sell. Medicaid news comes out of Utah and North Carolina.

‘Medicare For All’ May Be A Litmus Test For Progressives, But Not All Possible 2020 Hopefuls Are Rushing To Back It

Moderate Sens. Sherrod Brown (D-Ohio) and Amy Klobuchar (D-Minn.) are bucking the trend of Democratic hopefuls voicing strong support for “Medicare for All.” “I want to see universal health care, and there are many ways to get there,” Klobuchar said when asked if she backed Medicare for All, whereas Brown has said he supports incremental changes to Medicare.

In Era Of Public Rage Over Drug Prices, Cory Booker Is Haunted By His Past Relationship With ‘Big Pharma’

As Sen. Cory Booker (D-N.J.) eyes the 2020 White House race, he’s scrambling to mitigate any damage that may have been done by his decision to accept campaign donations from pharmaceutical companies. As public outrage boils over about high drug prices, most presidential contenders, such as Sen. Amy Klobuchar (D-Minn.), are trying to get in front of the issue by offering plans they believe will demonstrate a hard stance against Big Pharma.

CMS Has Granted Red States Ever-Increasing Flexibility With Medicaid. Will That Hold True When Blue States Come Knocking?

Following the elections that flipped seven governorships, this could be a pivotal year for CMS Administrator Seema Verma. “Does flexibility go to everyone or is it just for cheaper, less regulated insurance?” said Chris Sloan, a director at Avalere, a health-care consulting firm. “That has yet to be decided.” Meanwhile, Democrats want the administration to crack down on state that aren’t fully complying with Medicaid abortion rules.

Fast-Moving Bill To Curtail Voter-Approved Medicaid Expansion Secures Key Approval In Utah Legislature

Lawmakers who have been worrying about the long-term costs of expanding Medicaid have been quickly working to roll back some of the changes that Utah voters approved through a ballot initiative in November’s elections. Other Medicaid news focuses on waivers, delays in payment and mental health services.

Direct And Unfiltered: John Dingell’s Popular Health Care Tweets

Former Rep. John Dingell, who died Thursday, was known for his strong opinions during his nearly 60 years in Congress. And even after leaving Congress, he continued to express his views through a lively, partisan — and sometimes earthy — Twitter account that attracted a keen following of more than 265,000 supporters and critics.

Although his posts dealt with a wide variety of issues, Dingell’s longtime devotion to improving health care was a frequent topic.

Here is a small sampling of his musings on health care. Click on the examples to see the full post and retweets.

From his many years championing health reform in Congress, Dingell could offer a unique historical perspective of the efforts to expand coverage, a quest he said would make “my pop” proud.

Dingell took great pride in the passage of the Affordable Care Act. He acknowledged it wasn’t perfect. “The only perfect law was handed to Moses on stone tablets by God himself.”

He had no patience with Republican lawmakers’ efforts to repeal and replace the ACA.

And he didn’t take kindly to efforts by “knaves and know-nothings” in recent years to add work requirements to Medicaid programs.

He clearly enjoyed jousting with friends and foes on Twitter.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Also known as the day President Donald Trump is getting his second annual physical. Last year, Dr. Ronny L. Jackson attributed the president’s “excellent health” to good genes and God. Will this year be different with a new physician?

The headliner from this week was obviously the State of the Union address, so let’s get right to it.

Trump’s pledge to end the HIV epidemic was greeted with cautious optimism — laced with a heavy dose of skepticism. The administration’s plan involves targeting HIV hot spots and increasing access to medications that treat and prevent the disease. However, the lack of specific details in Trump’s address have HIV advocates nervous. “To date, this administration’s actions speak louder than words and have moved us in the wrong direction,” said AIDS United.

The Associated Press: Trump Launching Campaign to End HIV Epidemic in US by 2030

Kaiser Health News: Trump Pledges To End HIV Transmission By 2030. Doable, But Daunting.

When it comes to high drug prices, Trump had very simple instructions for Congress: “Do more.” The response, as you can imagine, was mixed. Some Democrats saw it as an invitation to work on an issue that could be one of the few bipartisan successes emerging from the current Congress. Others don’t have any interest in getting on board with the president’s policies — which include capping U.S. drug payments based on prices paid abroad.

Stat: Democrats Can’t Decide How to React to Trump’s Call for ‘More’ on Drug Pricing

Meanwhile, in his address, Trump used a pretty wonky (as in, in the weeds) metric to praise his administration’s efforts on bringing down drug prices. The consumer price index, at best, doesn’t tell the full story of costs, and experts say that, given how complicated the system has become (i.e. with rebates), it has outlived its usefulness.

Stat: Trump Claims Drug Prices Have Fallen. But He’s Cherry-Picking That Data

Recent controversies over abortions provided Trump the perfect opportunity, as he starts to gear up for 2020, to give a little love to a highly valued segment of his base. Virginia’s governor had made comments last week that led to accusations that he supported infanticide; and New York just passed a bill that protects against efforts to roll back Roe v. Wade. Trump used those incidents as a springboard to call on Congress to ban “late-term abortions.” And the language he used in the speech — “All children — born and unborn — are made in the holy image of God” — is being seen as a play for evangelical voters.

The Associated Press: With Anti-Abortion Push, Trump Woos Evangelicals Again

Doctors weighed in on the debate with this reality check: Clinically, there is no such thing as a “late-term abortion.” See what else they say the president got wrong.

The New York Times: What Is Late-Term Abortion? Trump Got It Wrong

Childhood cancer also got a shout-out in the SOTU. Although it has an 80 percent cure rate, scientists say that number is skewed by the tremendous progress that’s been made against childhood leukemia. Other pediatric cancers have a long way to go. (And so they are welcoming the $500 million with open arms and a distinct list of ideas.)

Stat: Scientists Have Ideas to Spend Trump’s Money for Childhood Cancer


Former Rep. John Dingell died on Thursday at age 92. Lawmakers and politicians praised the country’s longest-serving congressman, calling him a “beloved pillar of the Congress” who is leaving behind “a towering legacy.” One common thread in the heartfelt messages was the impact he had on America’s health care. “He had a long tradition of introducing legislation on the first day of each new Congress to guarantee health care for every single American,” former President Barack Obama wrote. “Because of him, we’ve come closer to that vision than ever before. And when we finally achieve it — and we will — we’ll all owe him our gratitude.”

The Washington Post: Colleagues, friends remember John Dingell, an ‘American legend’ and ‘beloved pillar of Congress’


Fresh off their midterm victories, Democrats are wasting no time setting up hearings to secure protections for people with preexisting conditions. Any legislation would be mostly symbolic because it would face an all-but-certain death in the Republican-controlled Senate, but it solidifies talking points that have been successful for Democrats recently.

The New York Times: Democrats Unite to Begin Push to Protect Pre-Existing Condition Coverage


If you’re confused about Trump’s rebate proposal join the (very crowded) club. But here’s the bottom line: Most patients will pay a little more since their premiums will go up (because insurers would no longer be able to apply rebate money from the drugs to lower premiums). However, people who take outrageously expensive medication will get relief. Experts say the trade-off is worth it.

The New York Times: How Trump’s Latest Plan to Cut Drug Prices Will Affect You

How does a drug that, until December, was free to patients now have a $375,000 price tag? Paint Sen. Bernie Sanders (I-Vt.) … curious … to say the least.

Stat: Sanders Calls Price of a Rare Disease Drug ‘Immoral Exploitation’


Court watchers were eagerly awaiting the Supreme Court’s decision on a Louisiana admitting-privileges law — the first real gauge of how the new dynamics of the court will play out with abortion decisions. The Louisiana restrictions are quite similar to ones knocked down in a 2016 ruling, but the court is also more conservative than it was at that time. For now, Chief Justice John Roberts disappointed his conservative colleagues by joining with the liberal justices in issuing a stay on the law. The decision likely means the court will take up the issue in its next term, which starts in October.

The New York Times: Supreme Court Blocks Louisiana Abortion Law


Medicaid expansion advocates were ecstatic last year when ballot initiatives proved a successful way to circumnavigate red-state legislatures that had been blocking changes to the program. This week, a bucket of cold water has doused that enthusiasm as lawmakers in both Utah and Idaho scramble to counter the expansion as much as possible. While the proposals — like adding work requirements — gain popularity in red states across the country, the fact it’s happening at all after voters OK’d the expansion highlights the reality that ballot initiatives can do only so much.

The New York Times: In Utah and Idaho, G.O.P. Looks to Curb Medicaid Expansions That Voters Approved


In a startling, horrifying trend, veterans have been killing themselves in VA parking lots in what experts see as a protest against a system that failed them. The latest was a Marine colonel who, dressed in his uniform blues and medals, sat on top of his military and VA records and shot himself with a rifle outside the Bay Pines Department of Veterans Affairs. “It’s very important for the VA to recognize that the place of a suicide can have great meaning. There is a real moral imperative and invitation here to take a close inspection of the quality of services at the facility level,” said Dr. Eric Caine, director of the Injury Control Research Center for Suicide Prevention at the University of Rochester.

The Washington Post: Parking Lot Suicides at Veterans Hospitals Prompt Calls for Better Staff Training, Prevention Efforts

Meanwhile, USA Today released a comprehensive analysis on the quality of VA hospitals versus civilian ones. Some of the scores came back positive (death rates, on the whole, were lower at VA facilities); others that look at preventable infection rates and bedsores hinted at neglect. USAT offers a very cool look-up tool if you want to see how your clinic fared.

USA Today: Death Rates, ER Waits: Where Every VA Hospital Lags, Leads Other Care


An HHS official is arguing that pulling separated migrant children from their sponsor homes to reunite them with their families would do more harm than good psychologically at this point. Jonathan White, an official leading HHS’ reunification efforts, said in a court filing that it would make more sense for the government to focus on children who were still in custody. The ACLU called the position a “shocking concession that it can’t easily find thousands of children it ripped from parents, and doesn’t even think it’s worth the time to locate each of them.”

The Associated Press: US Sees Limitations on Reuniting Migrant Families


In the miscellaneous file for the week:

• There’s a long history of mistrust between the African-American community and medical professionals, and Virginia Gov. Ralph Northam’s photo involving black face pressed sharply against that never-healed wound. (At the time, Northam was graduating from medical school on his way to becoming a pediatrician.)

The Associated Press: Blackface Photo Reopens Long History of Bigotry in Medicine

• Anecdotal evidence was thick on the ground that women were seeking emergency contraception in the wake of Trump’s election victory. Now there are numbers to back it up.

The Hill: Demand for Certain Forms of Contraception Increased After Trump’s Election: Study

• Could an infamous party drug really help quiet suicidal ideation in the midst of an ever-worsening crisis? This fascinating history on the use of ketamine is well-worth the read.

Bloomberg: Ketamine Could Soon Be Used to Treat Suicidal Ideation

• “It’s like throwing a match into a can of gasoline,” experts say of the measles outbreak in the Pacific Northwest. Are they just the norm now? And why were there so many kids who weren’t vaccinated?

The New York Times: ‘A Match Into a Can of Gasoline’: Measles Outbreak Now an Emergency in Washington State

CNN: Measles Rarely Kills in the US — But When It Does, Here’s How 


I was delighted this morning over the fact that scientists had a major breakthrough in creating a way to take insulin in pill form because of … turtles! Last week hedgehogs, this week turtles. I swear the Breeze isn’t turning into an animal news newsletter (or is it?). Have a great weekend!

Shrinking Medicaid Rolls In Missouri And Tennessee Raise Flag On Vetting Process

Tangunikia Ward, a single mom of two who has been unemployed for the past couple of years, was shocked when her St. Louis family was kicked off Missouri’s Medicaid program without warning last fall.

She found out only when taking her son, Mario, 10, to a doctor to be treated for ringworm.

When Ward, 29, tried to contact the state to get reinstated, she said it took several weeks just to have her calls returned. Then she waited again for the state to mail her a long form to fill out attesting to her income and family size, showing that she was still eligible for the state-federal health insurance program for the poor.

Mario, who is in third grade, missed much of school in December because Ward could not afford a doctor visit without Medicaid. His school would not let him return without a doctor’s note saying he was no longer infected.

In January, with the help of lawyers from Legal Services of Eastern Missouri, she was able to get back on Medicaid, take her son to a doctor and return him to school. “It was a real struggle as it seemed like everyone was giving me the runaround,” Ward said. “I am upset because my son was out of school, and that pushed him behind.”

Ward and her children are among tens of thousands of Medicaid enrollees who were dropped by Missouri and Tennessee last year as both states stepped up efforts to verify members’ eligibility.

Last year, Medicaid enrollment there declined far faster than in other states, and most of those losing coverage are children, according to state data.

State health officials say several factors, including the improved economy, are behind last year’s drop of 7 percent in Missouri and 9 percent in Tennessee.

But advocates for the poor think the states’ efforts to weed out residents who are improperly enrolled, or the difficulty of re-enrolling, has led to people being forced off the rolls. For example, Tennessee sent packets to enrollees that could be as long as 47 pages to verify their re-enrollment. In Missouri, people faced hours-long waits on the state’s phone lines to get help in enrolling.

Medicaid enrollment nationally was down about 1.5 percent from January to October last year, the latest enrollment data available from the federal government’s Centers for Medicare & Medicaid Services (CMS).

Herb Kuhn, president and chief executive of the Missouri Hospital Association, said the state’s efforts to verify Medicaid eligibility could be tied to an increase in the number of people without coverage that hospitals are seeing.

“When we see over 50,000 children come off the Medicaid rolls, it raises some questions about whether the state is doing its verifications appropriately,” he said. “Those who are truly entitled to the service should get to keep it.”

In 2018, Missouri Medicaid began automating its verification system for the state-federal insurance program for the poor. People who were identified as ineligible, for income or other reasons, were sent a letter asking them to provide updated documentation. Those who did not respond or could not prove their eligibility were dropped.

The state does not know how many letters it sent or how many people responded, said Rebecca Woelfel, spokeswoman for the Missouri Department of Social Services, which oversees Medicaid. She said Missouri Medicaid enrollees were given 10 days to respond.

Woelfel cited the new eligibility system, the improved economy and Congress rescinding the federal tax penalty for people who lack insurance as factors behind the decline in enrollment.

Missouri’s unemployment rate dropped from 3.7 percent in January 2018 to 3.1 percent in December as the number of unemployed people fell by about 17,000.

Missouri Medicaid had almost 906,000 people enrolled as of December, down from more than 977,000 in January 2018, according to state data. About two-thirds of those enrolled are children or pregnant women.

Timothy McBride, a health economist at Washington University in St. Louis who heads a Missouri Medicaid advisory board, said the state’s eligibility system has made it too difficult for people to stay enrolled. Since low-income people move or may be homeless, their mailing addresses may be inaccurate. Plus, many don’t read their mail or may not understand what was required to stay enrolled, he added.

“I worry some people are still eligible but just did not respond, and the next time they need health care they will show up with their Medicaid card and find out they are not covered,” McBride said.

Tennessee’s Medicaid enrollment fell from 1.48 million in January 2018 to 1.35 million in December, according to state data. Tennessee Medicaid spokeswoman Kelly Gunderson credits a healthy job market. The state’s unemployment rate was relatively stable last year at under 4 percent.

“Tennessee is experiencing a state economy that continues to increase at what appears to be near-historic rates, which is positively impacting Tennesseans’ lives and, in some cases, decreasing their need to access health insurance through the state’s Medicaid” program and the Children’s Health Insurance Program (CHIP), she said.

She added that the state has a “robust appeals process” for anyone who was found ineligible by the state’s reverification system.

The Tennessee Justice Center, an advocacy group, has worked with hundreds of families in the past year trying to restore their Medicaid coverage. The verification process will make “Medicaid rolls smaller and saves money, and that’s a poor way for the state to measure success,” said Michele Johnson, executive director of the nonprofit group. “But it’s penny-wise and pound-foolish” because it leads to people showing up at emergency rooms without coverage — and hospitals have to pass on those costs to everyone else.

After rapid growth since 2014, when the Affordable Care Act expanded health insurance coverage to millions of Americans, Medicaid enrollment nationally started to fall, declining from 74 million in January 2018 to about 73 million in October, according to the latest enrollment data released by CMS.

Missouri and Tennessee are among 17 states that have not expanded Medicaid under the ACA. But many of those non-expansion states nevertheless saw enrollment grow, because as people tried to sign up for insurance on the ACA exchanges, those meeting state criteria were routed to Medicaid.

McBride, the health economist, said the steep drop is especially disconcerting because most of those affected are children. Because children are eligible for Medicaid or CHIP with family incomes as high as 300 percent of the federal poverty level, or $77,250 for a family of four, he said, it’s unlikely a parent’s change in job would be enough for a child to lose eligibility.

Missouri’s 70,000-person drop in enrollment, he noted, marks the biggest single-year reduction since 2006, when the state instituted tighter eligibility levels for certain groups.

Legal Services of Eastern Missouri, which advocates for low-income residents, estimates that nearly 57,000 of those dropped from the Medicaid rolls were children, a decline that is nine times the national average.

Joe Pierle, chief executive officer of the Missouri Primary Care Association, a trade group representing community health centers, said he doesn’t think the state is doing anything “underhanded or nefarious.” Nevertheless, he’s not sure Medicaid officials did enough to reach out to people before dropping them.

“I suspect some people are falling through the cracks,” he said.

Former Rep. John Dingell Dies; Longest-Serving Congressman Was A Force In Health Policy

Former Rep. John Dingell, the Michigan Democrat who holds the record as the longest-serving member of the U.S. House, died Thursday night in Michigan. He was 92.

And while his name was not familiar to many, his impact on the nation, and on health care in particular, was immense.

For more than 16 years Dingell led the powerful House Energy and Commerce Committee, which is responsible for overseeing the Medicare and Medicaid programs, the U.S. Public Health Service, the Food and Drug Administration and the National Institutes of Health.

As a young legislator, he presided over the House during the vote to approve Medicare in 1965. As a tribute to his father, who served before him and who introduced the first congressional legislation to establish national health insurance during the New Deal, Dingell introduced his own national health insurance bill at the start of every Congress.

And when the House passed what would become the Affordable Care Act in 2009, leaders named the legislation after him. Dingell sat by the side of President Barack Obama when he signed the bill into law in 2010.

Dingell was “a beloved pillar of the Congress and one of the greatest legislators in American history,” said a statement from House Speaker Nancy Pelosi. “Yet, among the vast array of historic legislative achievements, few hold greater meaning than his tireless commitment to the health of the American people.”

He was not always nice. He had a quick temper and a ferocious demeanor when he was displeased, which was often. Witnesses who testified before him could feel his wrath, as could Republican opponents and even other committee Democrats. And he was fiercely protective of his committee’s territory.

In 1993, during the effort by President Bill Clinton to pass major health reform, as the heads of the three main committees that oversee health issues argued over which would lead the effort, Dingell famously proclaimed of his panel, “We have health.”

Dingell and his health subcommittee chairman, California Democrat Henry Waxman, fought endlessly over energy and environmental issues. The Los Angeles-based Waxman was one of the House’s most active environmentalists. Dingell represented the powerful auto industry in southeastern Michigan and opposed many efforts to require safety equipment and fuel and emission standards.

In 2008, Waxman ousted Dingell from the chairmanship of the full committee.

But the two were of the same mind on most health issues, and together during the 1980s and early 1990s they expanded the Medicaid program, reshaped Medicare and modernized the FDA, NIH and the Centers for Disease Control and Prevention.

“It was always a relief for me to know that when he and I met with the Senate in conference, we were talking from the same page, believed in the same things, and we were going to fight together,” Waxman said in 2009.

Dingell was succeeded in his seat by his wife, Rep. Debbie Dingell, herself a former auto industry lobbyist.

Energized By Success In Other Conservative States, Advocates Work To Get Medicaid Expansion On Florida’s 2020 Ballot

But Florida activists face additional obstacles to get the measure in front of voters. While in Idaho, Maine, Nebraska and Utah, advocates only needed a simple majority for approval, Florida ballot measures must get at least 60 percent support. However, supporters have been cleared by the Florida Division of Elections to begin collecting signatures. Medicaid news comes out of North Carolina, as well.

Trump Pledges To End HIV Transmission By 2030. Doable, But Daunting.

Noting that science has “brought a once-distant dream within reach,” President Donald Trump on Tuesday night pledged to eliminate HIV transmission within 10 years.

“We have made incredible strides, incredible,” Trump said in the annual State of the Union address. “Together, we will defeat AIDS in America and beyond.”

It’s a goal long sought by public health advocates. But even given the vital gains made in drug therapies and understanding of the disease over nearly 40 years, it is not an easy undertaking.

“The reason we have an AIDS epidemic is not just for a lack of the medication,” said Dr. Kenneth Mayer, medical research director at the Boston LGBT health center Fenway Institute. “There are a lot of social, structural, individual behavioral factors that may impact why people become infected, may impact if people who are infected engage in care and may impact or affect people who are at high risk of HIV.”

Health and Human Services Secretary Alex Azar, who provided details of the initiative after Trump’s announcement, said the administration will target viral hot spots by providing local groups more resources, using data to track the spread of the disease and creating local task forces to bolster prevention and treatment.

Neither Azar nor other federal officials who briefed reporters offered cost estimates for the program.

Azar said the plan seeks to reduce new infections by 75 percent in the next five years and 90 percent in the next decade.

That goal is predicated on growing use of current medications that suppress the virus to such low levels that it is not transmitted during sexual intercourse. PrEP, a drug combination available to individuals with a negative HIV status but may become infected, can reduce their risk of getting the virus by 97 percent, Azar said.”

“This is not the HIV epidemic of the 1990s,” said Terrance Moore, acting executive director of NASTAD, a nonprofit organization that represents officials who administer HIV and hepatitis programs. “We have the tools to end this epidemic.”

Gay and bisexual men made up two-thirds of the nearly 40,000 new HIV cases in 2017, but one clear signal of that difference in the epidemic today is the geography. The nation’s HIV hotbeds are no longer located just in coastal metropolitan areas. In 2017, more than half of the new cases were diagnosed in Southern states.

HHS said it will focus its efforts on the heart of the epidemic: 48 counties across 19 states; the District of Columbia; San Juan, Puerto Rico; and rural areas in seven states, many of which are in the South.

The new federal initiative would expand PrEP access in community health clinics for low-income patients and quickly refer any new clinic patients with HIV to specialized care.

Medications alone are not the answer. Lawmakers must have the political will to move forward with policies based in science, said Moore. Existing programs do not provide enough infrastructure to achieve this goal, he added.

“You can’t be simultaneously attacking and undermining the needs of these communities, while claiming that you want to support them and end the AIDS epidemic,” said Scott Schoettes, HIV project director for the LGBT advocacy group Lambda Legal.

The Trump administration has pursued policies that may hinder the president’s goal. And efforts in the South face additional challenges, like higher levels of poverty, difficulty providing health care in rural areas and historical racial tension.

“I don’t think that these things are things that we cannot overcome,” said Greg Millett, vice president and director of public policy at the HIV research foundation amfAR. “But I also think that we need to be very clear about what the obstacles are and to start thinking now innovatively about how we’re going to be able to obviate them.”

Here are some of the challenges that experts said the president’s plan could face.

Health Insurance

Insurance coverage plays a crucial role in keeping HIV patients healthy.

Comprehensive insurance helps patients access the expensive medications needed to keep the virus under control and vital tests to check on virus levels and white blood cell counts — key health indicators. HIV patients are also often susceptible to infections because the virus compromises the immune system. And they tend to have higher rates of mental health conditions, which could affect their ability to adhere to HIV medication if left untreated.

The Affordable Care Act opened up coverage for thousands of HIV patients with its guarantee of insurance for people with preexisting conditions, but many Republican officials are still calling for the law’s repeal.

In addition, the ACA’s Medicaid expansion led to a substantial jump in the number of people with AIDS who got that coverage, according to the Kaiser Family Foundation. But many states, especially in the South, have not expanded Medicaid. (Kaiser Health News is an editorially independent program of the foundation.)

A federal judge in Texas in December ruled the ACA unconstitutional in a lawsuit waged by a faction of conservative states and supported by the president.

“If you’re not going to provide it through the Affordable Care Act,” Schoettes said, “then there needs to be something that’s as comprehensive in terms of getting people care.

Housing

Although the federal government provides some housing assistance for people with HIV, it does not fill the need.

Those who are homeless or have unstable housing have lower access to HIV medications and poorer treatment outcomes.

A study from the Centers for Disease Control and Prevention found that among individuals living with HIV in certain impoverished urban areas across the country, the lower the household income, the higher the rate of HIV in the area. 

The federal government provides assistance through a program called Housing Opportunities for Persons With AIDS, known as HOPWA. In 2016, HOPWA changed its  funding formula to better allocate its resources to Southern areas hardest hit by HIV.

However, some of these HOPWA programs have waiting lists that can extend years. The nation is also experiencing an affordable housing shortage, which further limits options for low-income individuals living with HIV and their families.

Stigma And Mistrust

Experts continue to cite stigma as a key obstacle for treatment. Twenty-six states have laws that penalize an HIV patient for exposing someone to the virus, including 19 that require people who are aware they are infected to notify sexual partners and 12 that mandate disclosure to needle-sharing partners, according to the CDC.

The problems extend to doctors and medical staff. One study, published in 2016, found widespread stigma against HIV patients among health care staff in Alabama and Mississippi, especially among whites and men.

Gina Brown, a community engagement manager for the Southern AIDS Coalition, in part blames the culture of the South, where religious beliefs often clash with gay culture, for perpetuating these problems. “We are still in Bible Belt country, where religion plays a huge part in how we talk about sex or not talk about sex,” she said.

But federal policies, such as the Trump administration’s ban on transgender men and women serving in the military, also play a role.

Federal officials acknowledged these difficulties and affirmed the program would not discriminate against transgender patients.

In addition, minority communities hard hit by the HIV epidemic harbor lingering distrust toward the medical system due to historical abuses such as the Tuskegee syphilis trials, said Mayer.

Injection Drug Use

The scourge of addiction has killed tens of thousands across the nation, spread hepatitis C and is now leading to spikes in HIV transmission, as drug users share needles. In 2015, Scott County, Ind., sought to combat an HIV outbreak fueled by injected opioid use that infected 215 people. Drug use has also been connected to multiple HIV clusters in Massachusetts and Kentucky.

HHS reported that injection drug users accounted for 1 in 10 new HIV cases in 2016.

Expanding syringe exchange programs across the country could minimize this problem, experts said.

“Unfortunately, in the United States we haven’t done as good a job as other Western countries in making sure that those programs are widely available for those Americans who need them,” said Millett.

The CDC and HHS consider syringe exchange programs effective interventions, but some cities, such as Charleston, W.Va., that implemented the programs have now shut them down because of neighborhood complaints, funding concerns and opposition from citizens who object to providing injection equipment.

Federal funds can be used to support this intervention, but these dollars cannot go directly toward purchasing needles.