Tagged Trump Administration

Trump Administration Seeks More Health Care Cost Details For Consumers

Anyone who has tried to “shop” for hospital services knows one thing: It’s hard to get prices.

President Donald Trump on Monday signed an executive order he said would make it easier.

The order directs agencies to draw up rules requiring hospitals and insurers to make public more information on the negotiated prices they hammer out in contract negotiations. Also, hospitals and insurers would have to give estimates to patients on out-of-pocket costs before they go in for nonemergency medical care.

The move, which officials said will help address skyrocketing health care costs, comes amid other efforts by the administration to elicit more price transparency for medical care and initiatives by Congress to limit so-called surprise bills. These are the often-expensive bills consumers get when they unwittingly receive care that is not covered by their insurers.

“This will put American patients in control and address fundamental drivers of health care costs in a way no president has done before,” said Health and Human Services Secretary Alex Azar during a press briefing on Monday.

The proposal is likely to run into opposition from some hospitals and insurers who say disclosing negotiated rates could instead drive up costs.

Just how useful the effort will prove for consumers is unclear.

Much depends on how the administration writes the rules governing what information must be provided, such as whether it will include hospital-specific prices, regional averages or other measures. While the administration calls for a “consumer-friendly” format, it’s not clear how such a massive amount of data — potentially negotiated price information from thousands of hospitals and insurers for tens of thousands of services — will be presented to consumers.

“It’s well intended, but may grossly overestimate the ability of the average patient to decipher this information overload,” said Dan Ward, a vice president at Waystar, a health care payments service.

So, does this new development advance efforts to better arm consumers with pricing information? Some key point to consider:

Q: What does the order do?

It may expand on price information consumers receive.

The order directs agencies to develop rules to require hospitals and insurers to provide information “based on negotiated rates” to the public.

Currently, such rates are hard to get, even for patients, until after medical care is provided. That’s when insured patients get an “explanation of benefits (EOBs),” which shows how much the hospital charged, how much of a discount their insurer received and the amount a patient may owe.

In addition to consumers being unable to get price information upfront in many cases, hospital list prices and negotiated discount rates vary widely by hospital and insurer, even in a region. Uninsured patients often are charged the full amounts.

“People are sick and tired of hospitals playing these games with prices,” said George Nation, a business professor at Lehigh University who studies hospital contract law. “That’s what’s driving all of this.”

Some insurers and hospitals do provide online tools or apps that can help individual patients estimate out-of-pocket costs for a service or procedure ahead of time, but research shows few patients use such tools. Also, many medical services are needed without much notice — think of a heart attack or a broken leg — so shopping simply isn’t possible.

Administration officials say they want patients to have access to more information, including “advance EOBs” outlining anticipated costs before patients get nonemergency medical care. In theory, that would allow consumers to shop around for lower cost care.

Q: Isn’t this information already available?

Not exactly. In January, new rules took effect under the Affordable Care Act that require hospitals to post online their “list prices,” which hospitals set themselves and have little relation to actual costs or what insurers actually pay.

What resulted are often confusing spreadsheets that contain thousands of a la carte charges — ranging from the price of medicines and sutures to room costs, among other things — that patients have to piece together if they can to estimate their total bill. Also, those list charges don’t reflect the discounted rates insurers have negotiated, so they are of little use to insured patients who might want to compare prices hospital to hospital.

The information that would result from Trump’s executive order would provide more detail based on negotiated, discounted rates.

A senior administration official at the press briefing said details about whether the rates would be aggregated or relate to individual hospitals would be spelled out only when the administration puts forward proposed rules to implement the order later this year. It also is unclear how the administration would enforce the rules.

Another limitation: The order applies only to hospitals and the medical staff they employ. Many hospitals, however, are staffed by doctors who are not directly employed, or laboratories that are also separate. That means negotiated prices for services provided by such laboratories or physicians would not have to be disclosed.

Q: How could consumers use this information?

In theory, consumers could get information allowing them to compare prices for, say, a hip replacement or knee surgery in advance.

But that could prove difficult if the rates were not fairly hospital-specific, or if they were not lumped in with all the care needed for a specific procedure or surgery.

“They could take the top 20 common procedures the hospital does, for example, and put negotiated prices on them,” said Nation at Lehigh. “It makes sense to do an average for that particular hospital, so I can see how much it’s going to cost to have my knee replaced at St. Joe’s versus St. Anne’s.”

Having advance notice of out-of-pocket costs could also help patients who have high-deductible plans.

“Patients are increasingly subject to insurance deductibles and other forms of substantial cost sharing. For a subset of so-called shoppable services, patients would benefit from price estimates in advance that allow them to compare options and plan financially for their care,” said John Rother, president and CEO  at the advocacy group National Coalition on Health Care.

Q: Will this push consumers to shop for health care?

The short answer is maybe. Right now, it’s difficult, even with some of the tools available, said Lovisa Gustafsson, assistant vice president at the Commonwealth Fund, which has looked at whether patients use existing tools or the list price information hospitals must post online.

“The evidence to date shows patients aren’t necessarily the best shoppers, but we haven’t given them the best tools to be shoppers,” she said.

Posting negotiated rates might be a step forward, she said, but only if it is easily understandable.

It’s possible that insurers, physician offices, consumer groups or online businesses may find ways to help direct patients to the most cost-effective locations for surgeries, tests or other procedures based on the information.

“Institutions like Consumer Reports or Consumer Checkbook could do some kind of high-level comparison between facilities or doctors, giving some general information that might be useful for consumers,” said Tim Jost, a professor emeritus at the Washington and Lee University School of Law.

But some hospitals and insurers maintain that disclosing specific rates could backfire.

Hospitals charging lower rates, for example, might raise them if they see competitors are getting higher reimbursement from insurers, they say. Insurers say they might be hampered in their ability to negotiate if rivals all know what they each pay.

“We also agree that patients should have accurate, real-time information about costs so they can make the best, most informed decisions about their care,” said a statement from lobbying group America’s Health Insurance Plans. “But publicly disclosing competitively negotiated, proprietary rates will reduce competition and push prices higher — not lower — for consumers, patients, and taxpayers.”

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


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


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

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

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

Among the takeaways from this week’s podcast:

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

To hear all our podcasts, click here.

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

Must-Reads Of The Week From Brianna Labuskes

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

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

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


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

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

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

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

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

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

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

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

The New York Times: 2020 Democrats on Health Care


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

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

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

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


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

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


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

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

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


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

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

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

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


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

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

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


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

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


In the miscellaneous file this week:

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

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

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

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

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

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

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

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


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

Curing Cancer: Easy Politics, Difficult Science

President Donald Trump made a new promise if voters grant him a second term: “We will come up with the cures to many, many problems, to many, many diseases, including cancer.”

Trump’s statement was part of his 2020 campaign kickoff in Orlando, Fla., on Tuesday. It echoed remarks by former vice president and Democratic candidate Joe Biden on the stump last week in Iowa: “I promise you, if I’m elected president, you’re going to see the single most important thing that changes America: We’re going to cure cancer.”

“Let’s cure cancer” is hardly a new political ambition. Go back to 1971, when then-President Richard Nixon launched “The War on Cancer” by signing the National Cancer Act, which directed $1.6 billion to research and established the National Cancer Institute.

Or take a famous fictional White House: On “The West Wing,” a TV drama that first aired from 1999 to 2006, President Jed Bartlet pushes to include in his State of the Union a pledge to “cure cancer in 10 years.”

In 2016, President Barack Obama tapped Biden to run the White House’s “cancer moonshot” soon after Biden’s son Beau died of brain cancer.

It’s a compelling promise. After all, who could be against curing the nation’s second-leading cause of death?

If only it were that simple. Here are three reasons “let’s cure cancer” is very easy for politicians to say but very hard to accomplish.

Neither the Trump campaign nor the Biden campaign responded to requests for comment.

With Cancer, The Biology Is Especially Tricky

Cancer is multifaceted and uniquely complex — it is not so much one disease as a class of related diseases.

“‘One cure’ is not a tenable concept,” said Edward Giovannucci, an associate professor at Harvard Medical School. “An analogy I think of is ‘curing infectious disease.’ No one would ever say this.”

For one thing, individual cancers mutate differently. And those different mutations don’t always respond to the same medicines. That means the best therapy for one person’s lymphoma might not work for someone else’s. And there is consistently potential for new cancer mutations to develop — meaning that, in some ways, there is also a consistent need for new treatments.

“One cannot rightfully say, ‘In the next five years, we’re going to cure cancer,’ because cancer is so many different diseases,” said Dr. Philip Kantoff, the chairman of medicine at Memorial Sloan Kettering Cancer Center in New York.

Some suggested literalism isn’t the point. And, to be fair, statements and pledges like these can yield advances in cancer treatment in research when accompanied by substantial increases in research funding or efforts to encourage interdisciplinary scientific endeavors.

“One of the things Biden has done is generate a much larger public awareness that cancer is a set of problems that, if we direct both science and policy in the right way to it, we can actually transform,” said Paula Hammond, a chemical engineering professor at the Massachusetts Institute of Technology, who has worked with the nonprofit Biden Cancer Initiative.

We Already Have Treatments. But There’s An Affordability Problem.

Many cancers — certain types of breast or colon cancer, for instance — are already curable. But they need to be promptly diagnosed and treated. Meanwhile, 27.4 million Americans don’t have health insurance.

Universal prevention, treatment and curing of cancer means anyone with a chance of developing the disease needs health insurance, experts said. And the coverage needs to be robust enough that patients will go for preventive screenings and follow-up care, without being deterred by the cost.

“If you’re going to find it early, treat it early and completely, which would be the ‘cure it’ option, that’s something where insurance is going to be required, whether it’s ‘Medicare for All,’ or some variant of that,” said Amy Davidoff, a health economist at Yale who studies how cancer costs affect people.

Focusing on treatments without expanding meaningful access to coverage, she said, is “problematic.”

Already, that link is clear. For instance, research Davidoff worked on found that when states expanded eligibility for Medicaid coverage — optional under the Affordable Care Act — gaps between white and black adults closed when it came to timely treatment of advanced cancer.

Health insurance — and universal health care, in particular — has already emerged as an election issue.

Trump, for his part, has not rolled out a health care agenda. But his administration’s work thus far has exacerbated insurance barriers. Some 700,000 more Americans were uninsured in 2018 under Trump. The White House’s stance on a pending Obamacare lawsuit would dismantle the law, leaving millions more Americans without coverage and upending its protections for people with preexisting conditions — including, crucially, cancer.

Biden has not formally released a health care platform, and he has favored policies to expand coverage. This week, he suggested making a “Medicare-like public option” generally available, and available at no premium for uninsured people who live in states that did not expand Medicaid.

That sort of proposal could go a long way toward addressing the issues of uninsured people. But it also could leave holes.

Currently, even if people have coverage, Davidoff said, the price tag for many newer cancer treatments and immunotherapies can put them well out of reach.

That means the generosity of any public option, and indeed of any existing health plans, matters a great deal, too.

The Importance Of Healthy Habits

And when it comes to advancing cancer treatment, experts stressed the importance of disease prevention.

In practice, that means developing strategies to bring down smoking rates and obesity, or improving access to nutritious food. Those require funding, political will and a robust public health infrastructure — none of which is easy to come by. But the potential payoff is far bigger.

“If we are to make very significant inroads on cancer mortality rates over the next several decades, we need to focus on prevention and early detection,” Giovannucci said. “We know the majority of cancers are, in principle, preventable.”

Study: Arkansas Medicaid Work Requirements Hit Those Already Employed

The Medicaid work requirement plan devised by Arkansas and approved by the Trump administration backfired because it caused thousands of poor adults to lose coverage without any evidence the target population gained jobs, a new study finds.

In fact, the requirement had only a limited chance for success as nearly 97% of Arkansas residents ages 30-49 who were eligible for Medicaid — those subject to the mandate — were already employed or should have been exempt from the new law, according to the study published Wednesday in the New England Journal of Medicine.

Yet the state’s mandate — the first of its kind in the nation — resulted in 18,000 of the 100,000 targeted people falling off the Medicaid rolls. And despite administration officials’ statements that many of them may have found jobs, the study by researchers at Harvard found no evidence they secured either jobs or other insurance coverage. In fact, it noted a dip in the employment rate among those eligible for Medicaid.

The researchers said the uninsured rate increased among 30- to 49-year-old Arkansans eligible for Medicaid from 10.5% in 2016 to 14.5% in 2018, while the employment rate fell from about 42% to just below 39%.

While the thousands of Arkansas residents losing Medicaid coverage has been documented since last year, the Harvard study is the first to provide evidence that the change left them uninsured and did not promote employment.

The results, based on a telephone survey of about 3,000 low-income adults in Arkansas, concluded that the law befuddled enrollees and that its mandatory reporting requirements led many to unnecessarily lose coverage.

“Lack of awareness and confusion about the reporting requirements were common, which may explain why thousands of individuals lost coverage,” the researchers wrote.

Asked whether the findings mean the administration should pull the plug on work requirements, co-author Benjamin Sommers, a professor of health policy and economics at Harvard, replied, “It’s time for them to pump the brakes at the very least.”

As millions of nondisabled adults gained Medicaid coverage following the 2010 passage of the Affordable Care Act, conservatives pushed for requiring people to work or do other kinds of “community engagement” to keep their Medicaid, much as food stamps and welfare cash benefit programs do. The Trump administration embraced that ideal and has made Medicaid work requirements a central feature of its plan to restructure the federal-state entitlement program, which has more than 70 million enrollees.

Arkansas put the plan into action in spring 2018.

But in March, a federal judge struck down Arkansas’ mandate and a plan to begin one in Kentucky. U.S. District Judge James Boasberg ruled the work requirement violated federal law because it failed to meet the core objective of Medicaid — getting medical coverage to the poor.

The Trump administration is appealing that ruling and, meanwhile, has approved similar plans in eight other states, including New Hampshire, which is scheduled to start cutting coverage in August for those not meeting the rules. New Hampshire’s law also is being challenged in court by Medicaid advocates.

Six more states have pending applications to add work mandates.

Seema Verma, administrator of the Centers for Medicare & Medicaid Services, defends the work requirements, saying they “are not some subversive attempt to just kick people off of Medicaid. Instead, their aim is to put beneficiaries in control with the right incentives to live healthier, independent lives.”

Arkansas officials disputed the thrust of the study, noting that the requirement was short-lived because the judge intervened before it was in effect even a year and researchers did not find out why people who were dismissed from Medicaid didn’t reapply.

“So you cannot describe this as the robust evaluation that we want and expect of a demonstration project that truly has national significance,” said Amy Webb, a spokeswoman for the state’s Medicaid program. “The best way to get answers to everyone’s questions about the impact of work and community engagement requirements would be to let Arkansas continue what was started and conduct a true evaluation that follows people over time.”

Under the Arkansas law, targeted enrollees were notified by the state via mail and informational flyers that they were required to work 80 hours a month, participate in another qualifying activity such as job training or community service, or meet criteria for an exemption such as pregnancy, a disability or parenting a child.

If they were out of compliance for three months during a calendar year or failed to report their status to the state through online reports, they could lose coverage.

For the first several months of its new mandate, Arkansas required enrollees to use an online portal for that reporting, a problem since 20% lacked internet access and another 20% lacked fast broadband. The state online portal also was unavailable after 9 p.m. each day.

The study found one-third of individuals subject to the policy had not heard anything about it, and 44% were unsure whether the requirements applied to them.

The findings back up arguments from advocates for the poor and nonpartisan experts that many Medicaid enrollees already have jobs. They also directly contradict claims by federal and Arkansas officials that many of those who lost coverage found a job.

In a hearing before the Senate Finance Committee earlier this year, Health and Human Services Secretary Alex Azar noted that only 1,452 of the 18,000 people who lost coverage because of the work requirement rules reapplied for Medicaid. He added that likely meant most no longer needed the government assistance.

“That seems a fairly strong indication that those people got a job and insurance elsewhere and didn’t need the coverage,” Azar said.

Sommers said the Arkansas experiment answers many questions about how work requirements could function nationally, although he acknowledged that other states might do a better job promoting the program and making it easier for enrollees to report their status.

“There are just not that many people [enrolled in Medicaid] who aren’t working but could,” Sommers said.

He noted Arkansas added the work requirement feature without adding new funding for job training or child support to help people who want to work.

Federal officials who approve the waivers allowing states to use work requirements should take note of the results, he said. “It does not make sense to keep approving the same waiver without doing anything differently,” Sommers said.

Must-Reads Of The Week From Brianna Labuskes

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

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

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

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

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

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

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

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

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

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

Modern Healthcare: Arbitration for Surprise Medical Bills Splits House Panel

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

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

The Hill: House Panel Launches Investigation Into Juul


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

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

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

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

And read Doherty’s thread here.


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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

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


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

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


In the miscellaneous file this week:

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

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

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

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

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

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

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

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


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

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


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


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

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

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

Among the takeaways from this week’s podcast:

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

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

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

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

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

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

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