Tagged U.S. Congress

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! As you all know, when I come across an outrageous medical mystery story I like to drag you all down with me because horrified misery loves company. This week’s offering: A man in Kentucky went into his doctor complaining of eye irritation. And what did his doctor pull out of his eyeball? That’s right! A tick. (You’re welcome.)

Quickly moving on! Here’s what you might have missed during this very hot week.

The tensions in the Democratic presidential field that have been brewing for a while erupted into verbal sparring between Sen. Bernie Sanders (I-Vt.) and former Vice President Joe Biden. The mini-war seems to be more than just your typical political posturing — both men have deep personal stakes in the issue (which, if you haven’t noticed, voters care a lot about right now). Sanders’ “Medicare for All” plan is nearly synonymous with the man himself, while Biden experienced firsthand the blood, sweat and tears it took to actually get the health law passed.

Earlier in the week, Biden dropped his own health plan, which could be summed up as the Affordable Care Act on steroids. And his promise that went along with the reveal — “If you like your plan … you can keep it” — was a blast-from-the-past that highlights all the advantages (the health law is quite popular at the moment) and pitfalls (that promise when President Barack Obama made it was ranked PolitiFact’s “Lie of the Year”) of taking this particular path.

It also nudged Biden and Sanders into a collision over their philosophical differences that played out in public at various events this week. Neither candidate pulled punches, but Sanders, in particular, had some tough words for his rival. “Unfortunately, he is sounding like Donald Trump,” he said. “He is sounding like the health care industry, in that regard.”

On that note, Sanders called on the Democratic candidates to join his pledge not to take donations from the health industry or pharma. Though he didn’t name names, it seemed to many like another jab at Biden.

Biden also took shots of his own, calling Medicare for All costly and complicated, and insinuating that those looking to get rid of the health law are no better than Republicans.

Whatever the outcome of this particular scuffle, it highlights that, in a crowded field, candidates are looking for things to set them apart. And in this particular election cycle, looks like it’s health care.

CNN: Biden Proposes Massive New Obamacare Subsidies, Public Option in Health Care Plan

The New York Times: Sanders and Biden Fight Over Health Care, and It’s Personal

Politico: Sanders Calls on Democratic Rivals to Reject Drug, Insurance Industry Donations

The New York Times: Anxious Democratic Governors Urge 2020 Field Not to Veer Too Far Left


Meanwhile, the health law faced off against an unlikely foe this week: Democrats. Lawmakers in the House delivered what is in all intents and purposes a death blow to the “Cadillac tax,” a cost-containing provision that at one point in time was looked at as crucial to the law’s success. (The Senate hasn’t voted on it yet, but Republicans are not exactly fans of the tax, so its fate seems decided.)

But as hell has not frozen over, it’s not as if the Democrats are suddenly jumping on the GOP bandwagon to dismantle the law. The tax was disliked by unions (a key constituency) and some liberal-leaning economists. Rep. Joe Courtney (D-Conn.), the author of the repeal bill, even (subtly) called it, the “Middle Class Health Benefits Tax Repeal Act.”

The New York Times: House Votes to Repeal Obamacare Tax Once Seen As Key to Health Law

As a side note, you should be following Noam Levey’s great series on the ways Americans are hurting in the wake of the high-deductible revolution.

Los Angeles Times: Rising Health Insurance Deductibles Fuel Middle-Class Anger and Resentment


The Democratic field’s fireworks over candidates’ philosophical differences weren’t the only ones on display this week. Dr. Leana Wen was ousted from her position as head of Planned Parenthood after only eight months in the role. Although there have been reports about managerial styles, Wen has hinted that the friction comes from her desire to view the organization through a public health prism. During a time when the abortion wars grow only more intense, Wen’s strategy to emphasize abortion as part of a larger part of improving women’s health felt out of step to some.

The New York Times: A Messy Exit Leaves Planned Parenthood at a Philosophical Crossroads

As if underscoring that very tension, the ousting came as the Trump administration announced that the changes to family planing funding, often called a “gag rule” by critics, would be enforced immediately, now that it has the court’s go-ahead.

The Associated Press: Trump Abortion Restrictions Effective Immediately


After a yearlong legal battle, The Washington Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, obtained information from a Drug Enforcement Administration database that shows how 76 billion oxycodone and hydrocodone pain pills saturated the country as the opioid epidemic was gaining steam. Just six companies distributed 75% of the pills from 2006 to 2012, sending millions of pills into tiny rural towns with only a few thousand residents. The numbers reveal a trail of bright, screaming red flags that were overlooked as the country barreled toward a crisis point.

The Washington Post: Largest U.S. Drug Companies Flooded Country With 76 Billion Opioid Pills, DEA Data Shows

PBS NewsHour: The Opioid Industry Fought Hard to Keep This Database Hidden. Here’s What It Shows

There was some rare good news on the opioid front this week: For the first time since 1990, fatal drug overdoses actually fell. There are (of course!) caveats, though: Experts still see worrying trends when it comes to synthetic drugs such as fentanyl.

The Washington Post: Drug Overdoses Fell Significantly in 2018 for First Time in Decades, Provisional CDC Data Show


Everyone in Congress and the administration is really, very, extremely angry about high drug prices … and yet pharma is still racking up the wins on Capitol Hill. Stat has a great read on exactly what’s going on with the industry’s influence, and looks at a new strategy from drugmakers, who seem to be targeting a pair of vulnerable Republicans to get their way.

Stat: How Pharma, Under Attack From All Sides, Keeps Winning in Washington


In a landscape where everyone is jonesing to cut costs, why is it so breathtakingly easy to scam insurers? Some investigators estimate that fraud eats up 10% of all health care spending. Consumers’ gut reaction is that insurers would, of course, be stepping in to police these bad actors. But they don’t seem to have any desire — or, at least, not enough — to actually act. Maybe that’s because consumers are the ones getting stuck with the losses.

ProPublica: Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You.

Speaking of, a former VA employee who was supposed to help veterans navigate insurance for their kids who had spina bifida used the position to collect millions in kickbacks, prosecutors allege.

The Daily Beast: Feds Say Former VA Employee Used Vets’ Ailing Kids to Scam Millions


A lot of very cool (or at least interesting) news came out of the Alzheimer’s Association International Conference this week. A look at highlights:

Los Angeles Times: Blood Test for Alzheimer’s Disease Moves Closer to Becoming a Reality

CNN: Lifestyle Can Still Lower Dementia Risk Even If You Have High Genetic Risk, Study Suggests

The Washington Post: Women Who Work for a Salary See Slower Memory Decline in Old Age, Reducing Their Risk of Dementia, a New Study Suggests


And in the miscellaneous file:

• What’s it like to be a Border Patrol agent? Because access to them can be tightly controlled, it’s rare to hear about their experiences. This story contains a chilling, yet fitting musing: “Somewhere down the line people just accepted what’s going on as normal.”

ProPublica: A Border Patrol Agent Reveals What It’s Really Like to Guard Migrant Children

• It’s one of health care’s biggest challenges: weaning people off the habit of going to the ER instead of a primary care doctor. Well, New York City is going to invest $100 million a year to try to do just that.

The Wall Street Journal: New York City Hopes to Ease Strain on Its Emergency Rooms

• More than 200,000 kids in Tennessee were either cut or slated to be cut from insurance because the state’s unwieldy system heavily relied on hard-copy forms.

The Tennessean: At Least 220,000 Tennessee Kids Faced Loss of Health Insurance Due to Lacking Paperwork

• Do service dogs actually help veterans with PTSD? Although there are plenty of heart-warming anecdotal stories about the benefits, doctors in the VA are hesitant to recommend them over treatment that has been shown to work because there’s little hard science on their benefits. The thing is, the VA is supposed to be doing research on it. Yet, for some reason, it’s been lagging, despite the burgeoning mental health crisis among veterans.

The New York Times: Do Service Dogs Help Treat PTSD? After Years of Research, the V.A. Still Doesn’t Know

• A look at law enforcement in Alaska, where violence against women is gaining national attention, shows that dozens of convicted criminals have been hired as cops for these communities. In one small village, every single policeman on the force, including the chief, has a criminal record of domestic violence.

ProPublica/Anchorage Daily News: The Village Where Every Cop Has Been Convicted of Domestic Violence


That’s it from me! Try to stay cool and make sure to hydrate this weekend!

KHN’s ‘What The Health?’: Biden Doubles Down On Obamacare


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


Former Vice President Joe Biden has said if he’s elected president he would build on the Affordable Care Act rather than move to a whole new health care system, such as the “Medicare for All” plan supported by some of his primary opponents for the Democratic nomination. But his campaign’s new health plan would include many things Congress tried and failed to pass as part of the health law, including a government-run “public option” plan that would be widely available.

Meanwhile, the U.S. House voted to repeal one of the ACA’s key financing mechanisms, voting overwhelmingly to cancel the so-called “Cadillac tax,” which was set to take effect in 2022. It is a 40% excise tax on the most generous employer-provided health plans.

And it was not a good week for Planned Parenthood. The women’s health provider parted ways with its president of less than a year, Leana Wen. And the Trump administration announced it would begin enforcement of new rules for the federal family planning program that Planned Parenthood said will force it to stop participating.

This week’s panelists are Julie Rovner from Kaiser Health News, Joanne Kenen of Politico, Kimberly Leonard of the Washington Examiner and Margo Sanger-Katz of The New York Times.

Among the takeaways from this week’s podcast:

  • Biden’s health proposal seeks to lower out-of-pocket costs for many people in several ways. For example, it would make federal premium help available to all who buy their own insurance, not just those with low and middle incomes. It would also change how federal premium subsidies are determined. It would base the assistance on the cost of a gold plan, rather than the current practice of using the second lowest priced silver plan. Since gold plans are more generous, using that standard could lower the amount of deductibles and copayments people getting subsidies have to pay.
  • The ACA’s Cadillac tax has been strongly endorsed by health economists, who view it as a way to cut the amount of unnecessary care some people with generous plans seek. But many employers, consumers and labor unions don’t want to tinker with the current tax system of job-based insurance.
  • The administration’s decision to go forward with its new rules for the Title X family planning program — while critics are challenging those regulations in the courts — will have a significant effect on Planned Parenthood’s finances. But the group gets even more government money through the Medicaid program.
  • Despite two setbacks last week in the administration’s efforts to reduce drug prices, President Donald Trump is continuing to hint that he wants to go forward with a plan to tie some Medicare drug prices to what people in other countries pay for the medications.
  • Federal officials have announced that opioid deaths have declined, but it is not clear that opioid overdoses or addiction has declined.

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

Julie Rovner: The New York Times’s “Where Roe v Wade Matters Most,” by Quoctrung Bui, Claire Cain Miller and Margot Sanger-Katz.

Joanne Kenen:  Scientific American’s “Why Doctors Are Drowning in Medical School Debt,” by Daniel Barron.

Margot Sanger-Katz: Bloomberg News’ “Deadly Disease Is Treatable, But Newborn Screening Patchwork Leaves Many Vulnerable,” by Michelle Cortez.

Kimberly Leonard: The Washingtonian’s “DC Types Have Been Flocking to Shrinks Ever Since Trump Won. And a Lot of the Therapists Are Miserable,” by Britt Peterson.

To hear all our podcasts, click here.

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

Surprise Medical Bill Legislation Takes A Step Forward, But Will It Lead To A Step Back?

The House Energy and Commerce Committee Wednesday approved its version of legislation to curb surprise medical bills.

Though this step was an important advance, there’s still a long way forward before Congress agrees on a legislative solution to this high-profile consumer concern.

These bills, the unexpected and often high charges patients face when they get care from a doctor or hospital that isn’t in their insurance network, have been the hot issue on Capitol Hill for months. Lawmakers on both sides of the aisle have been tripping over themselves to address the widely loathed problem.

One of the existential questions of the debate has been how to compensate health care providers if balance billing — which is what happens when patients are responsible for the costs not covered by their insurer — is prohibited.

The bill before Energy and Commerce originally included what’s known as “benchmarking” to set the payment amount for out-of-network doctors. So, instead of sending patients a bill for the amount that their health plans don’t pay, a doctor would be forced to accept an amount that is the average of what other doctors in the area are paid for the procedure.

This approach has been favored by groups representing employers and insurance plans but draws disdain from medical specialty provider groups. Those doctor organizations, which include specialists like emergency physicians and anesthesiologists, prefer arbitration, sometimes called “independent dispute resolution.” Under that system, both the insurer and provider would propose an amount to an independent third party, who would pick one of the two prices. The loser then pays the costs of the arbitration.

During the panel’s markup, Reps. Raul Ruiz (D-Calif.) and Larry Bucshon (R-Ind.) successfully added an amendment, which would create a “backstop” to the measure’s benchmarking approach.

Here’s how it works: The doctor’s payment would still be based on a benchmark, but if he or she thinks that isn’t high enough, the physician can appeal to an arbitrator. This backstop could be used only if the dollar amount in question is more than $1,250, and the arbitrator can consider only the complexity of the case and the quality of care.

“While I prefer the benchmark like we have in Oregon, I think it strikes a fair and necessary balance,” said the committee’s top Republican, Rep. Greg Walden of Oregon.

Though it’s a tidy compromise between the positions, it means the House bill no longer matches the primary legislation moving through the Senate, which earlier this summer gained the approval of that chamber’s Health, Education, Labor and Pensions (HELP) Committee  That bill exclusively favors benchmarking.

HELP Committee Chairman Lamar Alexander (R-Tenn.) has indicated he’s open to discussions. Other members of the panel, such as Sen. Bill Cassidy (R-La.), applauded the House action.

“The House is taking a step in the right direction,” Cassidy said in an email. “We need to end up in a place that gives patients security while having a level playing field for providers, hospitals and insurers.”

No everyone viewed the “backstop” idea as a positive step forward.

A range of stakeholders who oppose the arbitration approach because they think it will lead to higher costs over time have offered stinging criticism, some even withdrawing their support for the Energy and Commerce measure.

“We have asked Congress for one key assurance — protect us, and our employees, from being locked into government-mandated binding arbitration, which is being pushed by Wall Street-owned doctor groups,” Annette Guarisco Fildes, the CEO of ERIC, a group that represents large employers, said in a statement around five hours before the amendment was introduced in committee.

“Disappointingly, the House Energy and Commerce Committee is set to report out legislation that locks employers into exactly such a mandate,” she added.

Even groups that have been championing the independent dispute resolution approach, like the American College of Emergency Physicians, have qualms with the compromise, saying most emergency services cost less than $1,250 and won’t qualify for arbitration.

That isn’t the only hurdle ahead for the surprise bill legislation.

In the Senate, where the surprise bill provisions are part of a larger package aimed at lowering health care costs across the industry, senators have placed 10 “holds” on the legislation, meaning it can’t go to the Senate floor for a vote yet.

Still, staffers are optimistic that bill can still pass before the Senate leaves D.C. for its August recess.

A ‘No-Brainer’? Calls Grow For Medicare To Cover Anti-Rejection Drugs After Kidney Transplant

On Wednesday, Alexis Conell will mark seven years since she received the kidney transplant that saved her life, but the 53-year-old Chicago woman isn’t exactly celebrating.

Although the federal government paid most of the costs for her 2012 transplant, a long-standing Medicare policy halted coverage three years later for the drugs that keep her body from rejecting the organ.

So when Conell lost her job suddenly last September, she also lost her health insurance — and her ability to afford the 16 daily medications she needs to survive.

“I was terrified,” she said. “All you’re thinking is, ‘I don’t want to lose my kidney.’”

For nearly a half-century, Medicare has covered patients, regardless of age, who have end-stage renal disease, including paying the costs of kidney transplants and related care, which run about $100,000 per patient.

But coverage ends after 36 months for those younger than 65 who don’t otherwise qualify for the program — and that includes payment for the vital immunosuppressive drugs that cost thousands per patient each month.

Last week’s announcement of a Trump administration overhaul of kidney care in the U.S. has reanimated an effort by federal lawmakers and kidney care advocates to extend drug coverage.

“After a transplant, patients should not have to worry about whether they can afford the treatment needed to keep their transplanted kidney,” Rep. Ron Kind (D-Wis.) said in a statement.

For years, Kind has been among a bipartisan coalition in Congress championing legislation targeting kidney immunosuppressive drugs — to no avail.

The sticking point was price. A 2009 estimate by the Congressional Budget Office pegged the cost at $400 million over 10 years if the government were to extend lifetime drug coverage to those patients.

Two recent federal projections show that Medicare could actually save money — between $73.4 million and $120 million over a decade — by expanding payment for anti-rejection medications to help decrease the need for patients to get additional transplants or dialysis. Depending on financing, savings could reach $300 million in that period, suggested an estimate by the Centers for Medicare & Medicaid Services.

Armed with this data, a bipartisan coalition led by Kind and Rep. Michael Burgess (R-Texas), a physician, is expected to introduce legislation by August that would narrowly extend Medicare’s Part B program to provide drug coverage for kidney transplant patients who have no other option.

“We must ensure patients have access to immunosuppressant coverage to ensure the success of their transplant, which will keep costs down by decreasing the need for a re-transplant or further dialysis,” said Kind.

Sens. Richard Durbin (D-Ill.) and Bill Cassidy (R-La.) are poised to introduce their own legislation, sources told KHN on background.

Conell needs 16 daily medications to survive following her kidney transplant seven years ago. “If I had to pay full price for them, it would easily be $3,000 or more per month,” she says.(Taylor Glascock for KHN)

The efforts in Congress will hinge on whether the CBO agrees that paying for the medication would save the government money, advocates said. Even the new estimates by CMS suggest that changing the program would increase costs initially, with savings apparent only after a decade.

Dr. Emily Blumberg, president of the American Society of Transplantation, said there appears to be high-level support for change now. In championing the overhaul of U.S. kidney care policy, Health and Human Services Secretary Alex Azar has cited a personal tie, noting that his father suffered from kidney failure and received a transplant in 2014.

Nearly 100,000 patients are waiting for kidney transplants in the U.S. and about 10 people die each day because of an ongoing shortage of organs.

More than 56,000 Americans with functioning kidney transplants don’t have Medicare coverage, according to data from the U.S. Renal Data System. About two-thirds pay for their medications through private insurance, Medicaid or other government programs, experts said.

But about one-third of those patients may have no other source of drug coverage, which can lead to missed doses, jeopardizing their new kidneys. A 2010 study found that nearly 70% of U.S. kidney transplant programs reported deaths or organ losses directly related to the high cost of anti-rejection drugs.

If Medicare drug coverage had been extended in 2015, it would have averted at least 375 kidney transplant failures that year alone, the latest analysis showed.

When transplants fail, patients can die — or they must return to dialysis — paid for by Medicare at a cost of about $90,000 per year, with a poor prognosis.

“It’s a no-brainer that you should do this both from a moral and ethical and, now it sounds like, cost perspective,” said Dr. Robert Gaston, a nephrologist at the University of Alabama-Birmingham who co-authored a call for coverage in an Institute of Medicine report two decades ago.

When Alexis Conell lost her job and health insurance last fall, she drained her savings and nearly ran out of medication before she found a pharmaceutical firm program that provides the drugs she needs at a deep discount.(Taylor Glascock for KHN)

Conell battled end-stage renal disease for years before receiving her kidney transplant. When she lost her job abruptly last fall, she had to cancel scheduled medical appointments and lab tests.

She drained her savings, then nearly ran out of medication before she found a pharmaceutical firm program that provides the drugs she needs at a deep discount.

“If I had to pay full price for them, it would easily be $3,000 or more per month,” Conell said.

When her unemployment benefits ended in April, Conell qualified for Medicaid, which covers her drugs for now. The stress has been unrelenting, said Conell, who spent a day last week in the emergency room with dangerously high blood pressure.

“I was trying to look for a job, worried about paying my bills. Ultimately, I’m worried about losing my kidney,” she said, adding that the long-delayed legislation could solve the problem. “I think they should pass it, like, yesterday.”

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! If you want a smile after this long week, be sure to check out today’s Google Doodle. I feel like this is the right crowd to appreciate it.

Now on to what you may have missed!

The courtroom was where much of the action took place this week, from Title X funding to drug prices to opioids. But the biggest spotlight of all was on the fate of the Affordable Care Act.

The latest challenge to the health law was a long-shot case, with legal experts writing off its chances of prevailing at the start. The suit can be perfectly summed up by a question from Judge Jennifer Walker Elrod, one of the three judges who heard oral arguments on the case in New Orleans: “If you no longer have the tax, why isn’t it unconstitutional?”

Judge Kurt Engelhardt also asked why the Senate hadn’t sent a lawyer along with the House counsel to convey that the congressional intent had been to keep most of the law. “They’re sort of the 800-pound gorilla that’s not in the room,” he said.

Despite some blunt questioning, though, it’s not clear where the judges will land on the final decision. The case could end up in front of the Supreme Court right in the heart of the 2020 election cycle. Considering that the “we’re the side protecting all those popular health law provisions” argument was at least partly credited for Democrats’ blue wave in the midterms, the timing of the case could have deep political ramifications for Republicans.

The Washington Post: Appeals Judges Question Whether the ACA Can Stand Without Insurance Penalty

Politico: Long-Shot Legal Challenge Could End Obamacare During the 2020 Campaign

If the law is overturned, the far-reaching ripple effects would go far beyond politics. It’s not just that 21 million people could lose health insurance, or that the protections for people with preexisting conditions would go away or that insurers would no longer have to cover young adults on their parents’ plans. So many of the Affordable Care Act’s directives have become ingrained in daily life that it’s as if many people forget they’re tied to that hot-button “Obamacare” topic.

On that list? Calorie counts on menus, lactation rooms at work, transparency for gifts from pharma companies to doctors, YMCA courses that teach diabetes maintenance, etc., etc.

The New York Times: So You Want to Overturn Obamacare. Here Are Some Things That Would Be Headaches.

Also on that list? A wonky provision that grants HHS “innovation” authority. The reason it’s important? President Donald Trump is using that very authority (that’s part of the law he’s trying to get overturned) to make big promises on revolutionizing the kidney care marketplace.

The New York Times: Trump’s Assault on Obamacare Could Undermine His Own Health Initiatives

(Pardon my detour from the courts for a minute, but that’s an impossible-not-to-utilize segue for the other big news of the week, and I’m going to jump on it.)

Trump announced an extremely ambitious plan this week to upend the kidney care world. Currently, the marketplace relies heavily on patients getting care at large dialysis clinics, even though at-home options are both safe and cost-effective. But those big chains can pull in $24 billion a year in revenue, so I somehow doubt that they’re going to go gently into that good night. Another part of the plan would incentivize kidney donations with reimbursements for lost wages and child care to try to address the country’s shortages. (And a special shoutout to Politico for the scoop on the plan.)

The New York Times: Trump Proposes Ways to Improve Care for Kidney Disease and Increase Transplants

Politico: Trump Aims to Shake Up Kidney Care Market

And now back to our court news: Trump’s strategy to curb drug prices sustained the first of two significant blows this week when a federal judge ruled that the administration can’t force companies to put prices in their TV ads. Judge Amit Mehta dodged the tricky First Amendment debate and instead focused on HHS’ authority (or lack thereof, really) to enforce such a rule. His ruling was, essentially: Hey, high drug prices are the pits and this might be an effective tool. But HHS can’t do more than Congress has authorized.

The New York Times: Judge Blocks Trump Rule Requiring Drug Companies to List Prices in TV Ads

The second punch came Friday when the administration pulled the plug on a signature proposal to eliminate drug rebates for pharmacy benefit managers (the target du jour for ire over high prices). Policy experts had worried the rule would lead to higher premiums for Medicare beneficiaries. Insurers and PBMs were popping the champagne over the announcement, while the general consensus is that pharma companies should now be braced for (an even bigger) storm headed their way.

Stat: After Trump Pulled the Plug on Rebates, His Options to Reduce Drug Prices Narrow. And He May Need Congress


The 2020 Democratic candidates were busy bees this week:

— Sen. Elizabeth Warren (D-Mass.) announced an immigration plan that would include the creation of a DOJ task force to investigate complaints of abuse and neglect from detainees.

Politico: Elizabeth Warren Takes on Trump With Immigration Overhaul

— Sen. Kamala Harris (D-Calif.) wants to take on the epidemic of outrageous rape kit backlogs. The kits can sometimes sit in police departments, which are strained for resources, for years. Harris has some bona fide experience to back up her plan. When she was California’s attorney general, her Rapid DNA Service team said it cleared all 1,300 untested rape kits in the state’s backlog in one year and earned national recognition and grants for its efforts.

USA Today: Kamala Harris: Rape Kit Backlog Can Be Cleared at Cost of Trump Golf Trips

— Sen. Amy Klobuchar (D-Minn.) released a proposal to tackle a wide range of problems that affect Americans’ seniors, from high drug costs to Alzheimer’s research to long-term care issues.

Politico: How Amy Klobuchar Would Improve Care for Seniors

— And Sen. Bernie Sanders (I-Vt.) is hopping on a bus to Canada with a group of Americans in search of cheaper insulin. This isn’t his first time embarking on such a trip. Twenty years ago, he went north with a group of breast cancer patients with a similar goal. (That two-decade gap between the trips speaks volumes, doesn’t it?)

CNN: Bernie Sanders to Join People With Type 1 Diabetes on Canada Trip for Cheaper Insulin

As we’ve seen in recent weeks, nearly all the Democratic candidates support the idea of providing health care to people who are in the country illegally. But what exactly would that entail? For one, it would place the U.S. even further left of progressive countries who already have universal health care. Most of them have at least some restrictions in place. But experts say that not only in the long run could providing care for them save money — immigrants in the country without legal permission tend to be young and relatively healthy and underuse available care.

The New York Times: What Would Giving Health Care to Undocumented Immigrants Mean?

Meanwhile, California is charging forward to become the first state in the country to offer Medicaid coverage to residents below the age of 26, regardless of their immigration status.

The Associated Press: California OKs Benefits to Immigrants In Country Illegally


Speaking of Medicaid, New Hampshire pumped the brakes on its new work requirements following reports that more than 17,000 people (yes, you read that right) would be found to be noncompliant with the rules after its first month. The state has been making the rounds with mailings, phone calls and even a door-knocking campaign, but officials still suggest the problem is that most people aren’t aware they need to report their hours. The experience mirrors Arkansas’ (almost down to the exact number of people who would be booted) and highlights the inherent obstacles states face when putting such rules in place.

Modern Healthcare: New Hampshire Delays Its Medicaid Work Requirement


A mother whose 19-month-old daughter died after being detained by ICE spoke at a House hearing this week about reports of the inhumane conditions at the facilities. “The world should know what happened,” Yazmin Juárez said during deeply emotional testimony. The name of the hearing — “Kids in Cages: Inhumane Treatment at the Border” — set the tone and reflected the state of affairs on Capitol Hill over the issue.

The Washington Post: ‘Kids in Cages’: House Hearing Examines Immigration Detention As Democrats Push for More Information


About 20% of the nation’s hospice facilities have safety lapses that are serious enough to endanger patients. What does that look like, beyond the dry terminology of an inspector general’s report? Gangrene so bad that a patient’s leg needed to be amputated; maggots burrowing near wound openings; and unnoticed sexual assault. But the report highlights another issue: There’s not much CMS can do about all of it. It would take an act of Congress to give CMS the power to fine the industry’s bad actors.

NPR: Roughly 20% of U.S. Hospice Programs Cited for Serious Deficiencies, Inspectors Say


In the miscellaneous file for the week:

• There are lots of voices in the abortion wars these days. Many of them, though, are from white leaders — on both sides of the issue — while the unique nuances and challenges that black communities face are missing from the debate. For women of color, race is tied to abortion in a way that white advocates rarely have to contend with.

The New York Times: When ‘Black Lives Matter’ Is Invoked in the Abortion Debate

•  An alleged mix-up at a fertility clinic that resulted in a woman having two babies who were not related to either her or each other highlights the real pitfalls of human error and advanced medicine.

USA Today: IVF Couple Sues California Clinic, Alleges Babies Weren’t DNA Match

• On paper, as medical aid-in-dying laws continue to pass across the country, more Americans are gaining control over how they end their lives. The reality looks a lot different, though.

The New York Times: Aid in Dying Soon Will Be Available to More Americans. Few Will Choose It.

• A Disney Channel star’s death this week highlighted the dangers of epilepsy-linked sleep deaths. Although it is rare, SUDEP is responsible for more deaths than SIDS (sudden infant death syndrome) and yet few people have heard of it.

CNN: Cameron Boyce’s Death: How Seizures Can Kill People With Epilepsy

• A new Secret Service report on mass violence incidents reveals that two-thirds of perpetrators had made threats before the attacks.

CNN: A New Report on Mass Attacks in the US Shows Common Traits Among Assailants

• A hospital in Ohio fired 23 employees in the wake of murder charges against one of its doctors in a case related to patients’ painkiller-linked deaths. There are a lot of issues here, but of particular note is how systemic such problems can become. One medical professional might be the root problem, but, at some point, that infection can spread to many interlocking parts within a health system.

The New York Times: Hospital C.E.O. Resigns and 23 Employees Are Fired After Ohio Doctor Is Charged in Murders


And, as election season kicks up, I really don’t blame any of the candidates for grabbing the Purell. Have a great weekend!

How To Get A Cheaper Prescription Before Leaving The Doctor’s Office

When Mary Kay Gilbert saw her doctor in May for a skin infection on her leg, she wasn’t surprised to receive a prescription for an antibiotic cream.

But Gilbert, 54, a nurse and health consultant, was shocked when her physician clicked on the desktop computer and told Gilbert the medicine would cost $30 on her Blue Cross and Blue Shield plan.

“I was like, ‘Wow — that’s pretty cool that you know that information,’” she recalled telling the doctor in Edina, Minn.

Allina Health, a large Minnesota hospital network to which Gilbert’s doctor belongs, is one of a growing number of health systems and insurers providing real-time drug pricing information to physicians so they can help patients avoid “sticker shock” at the pharmacy.

Mary Kay Gilbert, a nurse, was surprised when her doctor was able to tell her during an office visit how much an antibiotic prescription would cost her out-of-pocket.(Courtesy of Mary Kay Gilbert)

The pricing tool, which is embedded in physicians’ electronic health record and prescribing system, shows how much patients will pay out-of-pocket based on their insurance and the pharmacy. It allows the doctor to find a cheaper alternative when possible and start the process of getting authorization for a drug, if the insurer requires that.

The soaring cost of drugs has been front and center in the growing national debate about revamping U.S. health care.

Consumers abandon hundreds of thousands of prescriptions each year at the pharmacy, often because of high prices, jeopardizing their health and often leading to higher costs down the road, studies show.

Experts say the tool can help consumers — who are facing increasing copayments and higher deductibles — learn about cheaper options in the doctor’s office.

Still, doctors have been slow to adopt the technology, sometimes because of concerns about getting bogged down in long discussions about drug costs. Humana, for example, introduced its drug pricing tool to its network doctors in 2015. Today, fewer than 10% are using it, company officials said.

But the tool has serious limitations too. Because price negotiations among insurers, drugmakers and middlemen are often highly competitive and secretive, the tools often don’t have data for everyone. For example, Allina’s works for only about half its patients. That’s because not all pharmacy benefit managers share their data on health plan enrollee costs, and those that do often provide only a fraction of their information.

“It’s a chicken-and-egg thing where doctors don’t use it because they don’t have the data for all their patients, and health plans don’t promote it to physicians because doctors don’t have the technology in place,” said Anthony Schueth, a health information technology consultant in Jacksonville, Fla. “It can be a powerful tool when it works, but at the moment the drivers are not there across the board for widespread adoption.”

At a hearing last month, Sen. Martha McSally (R-Ariz.) pressed a top Trump administration health official about why many patients lack access to information on prescription drug prices at their doctor’s office.

“This is America. Why can’t we have this tool available tool now?” she asked. “The data is out there; the information is out there. What is it going to take to make this happen?”

The technology got a boost last month when the Centers for Medicare & Medicaid Services mandated that all Medicare drug plans embed such a tool in their doctors’ electronic prescribing system starting in 2021.

The details of what consumers spend out-of-pocket for drugs is provided by pharmacy benefit managers, or PBMs. They are the middlemen that negotiate with drugmakers on the prices insurers will pay for the medications and which ones the insurers will cover. So a tool’s usefulness is undermined when key PBMs are not included in the listings.

For example, a drug pricing tool sold by Arlington, Va.-based Surescripts, which is owned partly by the PBMs CVS Caremark and Express Scripts, includes data from those companies, but not OptumRx, a PBM owned by insurance titan UnitedHealth. And the OptumRX drug pricing tool includes Optum data but not that of Express Scripts and CVS.

Demetrios Kouzoukas, who heads the Medicare program for CMS, said he hopes the program’s new drug mandate will spark the industry to provide doctors and patients access to a pricing tool, regardless of their insurance.

“What we are hoping and expecting is that there will be a standard that’s developed by the industry … so that the tool is available in all the electronic health records, for all the doctors and all patients, and spreads even beyond Medicare,” he told McSally at the hearing.

Given the competitive nature of the industry, cooperation does not seem to be on the horizon, some industry officials say.

“I don’t see any chance that there will be a centralized system that will connect all of the plans/PBMs with all of the EHR systems currently in use anytime soon,” said Thomas Borzilleri, CEO of InteliSys Health, a health technology company based in San Diego.

However, the National Council for Prescription Drug Programs, a nonprofit group that helps set guidelines for the pharmacy industry, has been working on standards for a drug pricing tool. John Klimek, a senior vice president, predicts that by next year doctors across the country will be able to use the same drug pricing tool to look up all their patients’ drug costs, regardless of the insurer.

Even without such a standard in place, doctors and hospitals have an incentive to use the tool beyond offering a cost-saving service to their patients: It can save providers money, too.

Dr. Norman Rosen, a family physician in Orange, Calif., who is employed by Providence St. Joseph Health System, has been testing the California Blue Shield drug pricing tool this year.(Courtesy of Providence St. Joseph Health System)

For example, Allina, which owns or operates about a dozen hospitals and dozens of clinics in Minnesota and Wisconsin, gets a set fee from some insurers to care for all of a patient’s health needs. So the doctors and health system benefit when they can reduce costs and improve patients’ adherence to taking their medication, said Dr. David Ingham, a family doctor also from Edina, one of 600 primary care doctors at Allina using the tool.

“When we prescribe a more expensive medication, we share less revenue from the insurance contract,” he said.

For example, he noted that the tool helped him prescribe inhalers to asthma patients.

“I pulled up one medication I normally use, and it said it would be $240 out-of-pocket, but it suggested an alternative for $20 that was pharmacologically equivalent. I sheepishly asked the patient which we should choose,” he said.

Dr. Norman Rosen, a family physician in Orange, Calif., who is employed by Providence St. Joseph Health System, is one of 800 doctors at the hospital testing the Blue Shield of California drug pricing tool this year. Based on the first few months of use, the tool is expected to save patients a total of more than $100,000 in out-of-pocket costs this year, according to the companies.

Without the tool, Rosen said, it would be impossible for him to quickly know what drugs are covered by which insurers and what the copays are. He said he already has saved some patients several thousand dollars a year by changing their blood pressure and diabetes medications.

“It doesn’t take a lot of time, and this can be an important intervention because one of the fears we have is a patient not taking their medication because it’s too expensive,” Rosen said.

Federal Appeals Court Takes Up Case That Could Upend U.S. Health System

The fate of the Affordable Care Act is again on the line Tuesday, as a federal appeals court in New Orleans takes up a case in which a lower court judge has already ruled the massive health law unconstitutional.

If the lower court ruling is ultimately upheld, the case, Texas v. United States, has the potential to shake the nation’s entire health care system to its core. Not only would such a decision immediately affect the estimated 20 million people who get their health coverage through programs created under the law, ending the ACA would also create chaos in other parts of the health care system that were directly or indirectly changed under the law’s multitude of provisions, such as calorie counts on menus, a pathway for approval of generic copies of expensive biologic drugs and, perhaps most important politically, protections for people with preexisting conditions.

“Billions of dollars of private and public investment — impacting every corner of the American health system — have been made based on the existence of the ACA,” said a friend-of-the-court brief filed by a bipartisan group of economists and other health policy experts to the 5th Circuit Court of Appeals. Upholding the lower court’s ruling, the scholars added, “would upend all of those settled expectations and throw healthcare markets, and 1/5 of the economy, into chaos.”

Here are five important things to know about the case:

It was prompted by the tax bill Republicans passed in 2017.

The big tax cut bill passed by the GOP Congress in December 2017 eliminated the penalty included in the ACA for failure to maintain health insurance coverage. The lawsuit was filed in February 2018 by a group of Republican attorneys general and two governors. They argued that since the Supreme Court had upheld the ACA in 2012 specifically because it was a valid exercise of Congress’ taxing power, taking the tax away makes the entire rest of the law unconstitutional.

Last December, Judge Reed C. O’Connor agreed with the Republicans. “In some ways the question before the court involves the intent of both the 2010 and 2017 Congresses,” O’Connor wrote in his decision. “The former enacted the ACA. The latter sawed off the last leg it stood on.”

State and federal Democrats are defending the law.

Arguing that the rest of the law remains valid is a group of Democratic attorneys general, led by California’s Xavier Becerra.

“Our argument is simple,” said Becerra in a statement last Friday. “The health and wellbeing of nearly every American is at risk. Healthcare can mean the difference between life and death, financial stability and bankruptcy. Our families’ wellbeing should not be treated as a political football.”

The Democratic-led House of Representatives has also been granted “intervenor” status in the case.

The Trump administration has taken several positions on the lawsuit.

The defendant in the case is technically the Trump administration. Traditionally, an administration, even one that did not work to pass the law in question, defends existing law in court.

Not this time. And it is still unclear exactly what the administration’s position is on the lawsuit. “They have changed their position several times,” Sen. Chris Murphy (D-Conn.) told reporters on a conference call Monday.

When the administration first weighed in on the case, in June 2018, it said it believed that without the tax penalty only the provisions most closely connected to that penalty — including requiring insurers to sell policies to people with preexisting conditions — should be struck down. The rest of the law should stay, the Justice Department argued.

After O’Connor’s ruling, however, the administration changed its mind. In March, a spokeswoman for the Justice Department said it had “determined that the district court’s comprehensive opinion came to the correct conclusion and will support it on appeal.”

Now it appears the administration is shifting its opinion again. In a filing with the court late last week, Justice Department attorneys argued that perhaps the health law should be invalidated only in the GOP states that are suing, rather than all states. It is unclear how that would work.

Legal scholars — including those who oppose the ACA — consider the case dubious.

In a brief filed with the appeals court, legal scholars from both sides of the fight over the ACA agreed that the lawsuit’s underlying claim makes no sense.

In passing the tax bill that eliminated the ACA’s tax penalty but nothing else, Congress “made the judgment that it wanted the insurance reforms and the rest of the ACA to remain even in the absence of an enforceable insurance mandate,” wrote law professors Jonathan Adler, Nicholas Bagley, Abbe Gluck and Ilya Somin. Bagley and Gluck are supporters of the ACA; Adler and Somin have argued against it in earlier suits. “Congress itself — not a court — eliminated enforcement of the provision in question and left the rest of the statute standing. So congressional intent is clear.”

It could end up in front of the Supreme Court right in the middle of the 2020 election.

Depending on what happens at the appeals court level, the health law could be back in front of the Supreme Court — which has upheld the health law on other grounds in 2012 and 2015 — and land there in the middle of next year’s presidential campaign.

Democrats are already sharpening their rhetoric for that possibility.

“President Trump and Republicans are playing a very dangerous game with people’s lives,” Senate Minority Leader Chuck Schumer told reporters on a conference call Monday.

Murphy said he is most concerned that if the lower court ruling is upheld and the health law struck down, Republicans “won’t be able to come up with a plan” to put the health care system back together.

“Republicans tried to come up with a replacement plan for 10 years, and they couldn’t do it,” he said.