Must-Reads Of The Week From Brianna Labuskes

Happy Friday, aka Day 28 of the government shutdown. We all might be getting a little shutdown-news fatigue, but this piece about the spouses of furloughed workers who have had it up to here with their husbands or wives being around all the time was a bright spot in a heap of gloom.

Speaking of gloom, let’s get to it.

The shutdown has hit Native American tribes harder than others because they rely heavily on federal funding for basic services — like running their health clinics. As the standoff drags on, there’s a real fear that members will not be able to get lifesaving medication, such as insulin or blood pressure drugs. “This is a crisis like we’ve never seen,” said Aaron Payment, a board member of the National Congress of American Indians, in Montana Public Radio’s coverage of the story.

The Washington Post: Tribes Face Food and Medicine Crisis As Shutdown Continues, Lawmakers Are Told

One furloughed worker who is rationing her insulin because she can’t afford to buy more told CNN that she was doing it because “the thought of having more debt was scarier than the thought of dying.” One night she went to bed with sky-high sugar levels and just “hoped to wake up.”

CNN: This Diabetic Federal Worker Rationed Her Insulin During the Shutdown Because Debt Was Scarier Than Dying

Food insecurity is a topic area that can sometimes fly under the radar in this country, but the shutdown is thrusting it into the spotlight. Worries about SNAP (the Supplemental Nutrition Assistance Program, commonly known as food stamps), school lunches and food banks highlight how many families are fundamentally struggling with hunger on a daily basis.

Politico: Next Shutdown Victim: School Lunches


A damning government watchdog report found that there may be thousands more young migrant children who were separated from their parents than the administration previously reported. That’s because there was a wave of separations back in 2017. They acted as somewhat of a test balloon for the “zero-tolerance policy” that eventually caused a deafening public outcry.

One of the scariest parts of the report? No one actually knows the total number of kids who were separated from their parents.

The New York Times: Family Separation May Have Hit Thousands More Migrant Children Than Reported


President Donald Trump’s attempts to relax rules on employers’ responsibilities for contraception coverage got a one-two punch in the courts this week. First, a federal judge blocked the rules for the 13 states (and D.C.) that were a part of the case in front of him. The very next day, that narrow decision was followed by a broader nationwide injunction. I’m going to go ahead and wager that this isn’t the last we’ve heard of the issue.

Reuters: Second U.S. Judge Blocks Trump Administration Birth Control Rules

Heading into a general-election season may seem like an odd time to rock the boat on health law premiums, but a new proposal from the Trump administration may do just that. The change, which officials say is necessary to adjust for inflated subsidies, could mean millions of Americans will be paying more for coverage next year. And we all saw how health care factored into the midterms.

The Associated Press: Trump Administration Proposes Higher ‘Obamacare’ Premiums


Drug pricing was absolutely center stage again this week on Capitol Hill as newly empowered Democrats fired their opening salvo against Big Pharma. Oversight and Reform Committee Chairman Elijah Cummings announced that he’s launching a wide-scale and in-depth probe on drugmakers, seeking information specifically about why prices have increased so dramatically on old drugs (among other things).

The Associated Press: House Dems Announce Sweeping Investigation Of Drug Pricing


Talking about block-granting Medicaid used to be all the rage, but as the Trump administration has given states more flexibility with waivers the topic has quieted down. Now, though, there are reports that the Centers for Medicare & Medicaid Services is quietly devising a plan to achieve the long-held conservative dream.

Any block grant proposal, though, faces both legal obstacles and pretty staunch opponents in Democrats, who have already vowed to fight any changes by “literally every means that a U.S. senator has.”

Politico: Trump Wants to Bypass Congress on Medicaid Plan

(Need a refresher on what Medicaid block grants are? KHN’s Shefali Luthra has your back: Everything You Need To Know About Block Grants — The Heart Of GOP’s Medicaid Plans.)


New court documents have revealed, in stunning detail, just how closely the prominent family that started Purdue Pharma was involved with its aggressive marketing strategies for OxyContin. Richard Sackler, one family member, said the debut of the painkiller should be followed by “a blizzard of prescriptions” to effectively bury the competition. And when the heat started turning up on the drug’s addictive qualities, Sackler directed workers to “hammer on abusers in every way possible” to shift blame for the epidemic to them.

Stat: ‘A Blizzard of Prescriptions’: Documents Reveal New Details About Purdue’s Marketing of OxyContin


Republican Sen. Rand Paul had to fend off some jabs this week when it was announced that he (an outspoken critic about socialized health care) was going to Canada for a surgical procedure. The issue was more about optics than anything else, though — Paul’s office confirmed that he will be paying out-of-pocket for his care.

Politico: Rand Paul Headed to Canada for Surgery, But Will Pay Out Of Pocket


In this fascinating story, The New York Times pulls back the curtain on the thriving gray market that exists for diabetes strips. People with insurance don’t pay that much for the strips, but they can be really expensive for anyone without it. There’s no law against reselling them, and so you get this wild marketplace that cropped up, as they tend to do, to meet the demand.

The New York Times: The Strange Marketplace for Diabetes Test Strips


If you haven’t gotten your flu shot yet, officials are reminding you that it’s not too late! Have a great weekend!

Kaiser Health News

BEST DEAL UPDATE:

Must-Reads Of The Week From Brianna Labuskes

Happy Friday, where we’re 20 days and so-and-so hours (depending on when you read this) into the partial federal shutdown. As of today, it’s tied as the second-longest one in U.S. history, matching the funding gap that stretched from December ’95-January ’96 under President Bill Clinton. (Side note: The history of U.S. shutdowns is a good read for us policy nerds.)

Although health care has been somewhat insulated from the standoff (because funding for the Department of Health and Human Services had already been approved), the battle is really a lesson in the power of a ripple effect. Among the health-related things that have been touched by the impasse in some way: the CVS-Aetna merger, domestic violence victims, food stampswildfire and storm disaster funding, pollution inspections, drug approvals and the Affordable Care Act lawsuit.

But a lot of focus this week was on how the shutdown is curtailing food safety inspections by the Food and Drug Administration, especially following a year that was marked by several high-profile foodborne illness outbreaks.

Politico: FDA Looks to Restart Safety Inspections for Risky Foods Amid Shutdown


This week, my pharma files in Morning Briefing were bursting at the seams, and to be honest, I don’t see that changing anytime soon. This is definitely going to be a year of drug-pricing news, especially because it’s one of the few bipartisan topics that Capitol Hill watchers say might gain traction in a divided Congress.

In recent days, that — along with the fact that drug prices are most certainly a winning election issue — was on stark display. Democratic hopefuls for 2020 are jostling at the starting line to be the one to get THE big, flashy pharma bill out, with Vermont Sen. Bernie Sanders (joined by fellow hopeful New Jersey Sen. Cory Booker and others) as the latest to announce a proposal.

Sanders’ bundle of bills includes allowing the importation of cheaper drugs from Canada, letting Medicare negotiate prices and stripping monopolies from drug companies if their prices exceed the average price in other wealthy countries.

One interesting thing to note (from Stat’s coverage) is that even potential candidates from states that have a heavy biopharma presence (like Massachusetts Sen. Elizabeth Warren and New Jersey’s Booker) are coming out swinging against the industry — a sure sign that being firmly against Big Pharma is seen as crucial to securing the Democratic nomination.

Stat: Democrats Eyeing 2020 Put an Early Spotlight on Drug Prices

The Hill: Sanders, Dems Unveil Sweeping Bills to Lower Drug Prices

The pharma action this week wasn’t limited to the Hill, because the movers and shakers in the industry were all thinking big thoughts at the annual J.P. Morgan Healthcare Conference. There, Johnson & Johnson CEO Alex Gorsky argued that drugmakers were going to have to step up their own self-policing when it comes to pricing or face “onerous” alternatives. Looking at the stories above, I’m thinking he’s not wrong.

The Wall Street Journal: Health-Care CEOs Outline Strategies at J.P. Morgan Conference

Meanwhile, health systems tired of shortages and high prices are flocking by the dozens to the fledgling nonprofit that was created by a group of hospitals to manufacture its own generic drugs.

Stat: Generic Drug Maker Formed by Hospitals Attracts a Dozen More Members

It was hard to pick just a few pharma stories this week, considering the abundance of choices, but one that you should absolutely make time to read is this insulin-rationing piece. Insulin has become the new face of public outrage against outrageous price increases, and this piece presents a good overview of how that came to be, as well as the human toll the hikes have taken. The gut-punch sentence: “Within a month of going off [his mother’s] policy, [Alec Raeshawn Smith] would be dead.”

The Washington Post: Insulin Is a Lifesaving Drug, But It Has Become Intolerably Expensive. and the Consequences Can Be Tragic.


In a largely symbolic move, House Democrats voted to intervene in the health care lawsuit — a strategy geared more toward putting Republicans on record voting against the law (and thus against popular provisions they promised in the midterms to protect) than anything else.

The Hill: Dems Hit GOP on Health Care With Additional ObamaCare Lawsuit Vote

The vote highlighted a problem the GOP faces as it eyes 2020: For the longest time, Republicans have fallen back on “repeal and replace” as their main health care message. Now, the party is going to have to come up with a “positive vision” if they want to regain ground with voters, experts say.

The Hill: GOP Seeks Health Care Reboot After 2018 Losses


States, states, states! Everyone says that’s where the health care movement will be in the next two years, which certainly held true this week.

In California, new Gov. Gavin Newsom revealed his big health care dreams that include reshaping how prescription drugs are paid for, taking steps toward a single-payer system, reinstating the individual mandate, expanding Medi-Cal coverage for immigrants in the country illegally, and creating a surgeon general position for the state.

Reuters: New California Governor Tackles Drug Prices in First Act

Sacramento Bee: Gavin Newsom CA Health Plan Includes Individual Mandate

Meanwhile, up in Washington state, Gov. Jay Inslee proposed a “public option” health care plan for residents, a move that would set the stage for a universal coverage system. (It should be noted that Inslee is a 2020 contender.)

Seattle Times: Inslee Proposes ‘Public Option’ Health-Insurance Plan for Washington

In New York, several big health care developments emerged this week. NYC Mayor Bill de Blasio plans on investing $ 100 million into making sure that everyone in the city — including residents in the United States illegally — is guaranteed health coverage.

The New York Times: De Blasio Unveils Health Care Plan for Undocumented and Low-Income New Yorkers

And in Albany, Gov. Andrew Cuomo, citing the looming threat to Roe v. Wade, promised to cement a woman’s right to abortion in the state’s constitution.

The Wall Street Journal: Cuomo Vows to Codify Roe V. Wade Decision Into New York Constitution


It seems these days, you can’t swing a cat without hitting someone talking about “Medicare-for-all,” but what about a Medicaid “buy-in”? Some states are considering the option as a politically palatable alternative to help people who are struggling to buy coverage on the exchanges. The plans might not offer the full range of benefits available to traditional beneficiaries, but it could be something.

Stateline: Medicaid ‘Buy-In’ Could Be a New Health Care Option for the Uninsured

Speaking of MFA: A new Politico/Harvard poll shows that 4 in 5 Democrats favor Congress enacting a taxpayer-funded national health plan. Also to note, a fair amount of Republicans (60 percent) supported the idea of letting Americans under 65 buy into Medicare.

Politico: POLITICO/Harvard Poll: Many Democrats Back a Taxpayer-Funded Health Care Plan Like Medicare For All


As of Jan. 1, hospitals have had to post their prices online — which has resulted in much grumbling from industry and experts alike who say the numbers are meaningless to consumers. Centers for Medicare & Medicaid Administrator Seema Verma acknowledged the flaws with the rules this week, but still called them an important first step toward transparency.

Modern Healthcare: Verma: Chargemaster Rule Is ‘First Step’ to Price Transparency


In the miscellaneous file for the week:

• The Chinese scientist who used CRISPR to edit the genes of human embryos had scientists up in arms over the ethical dilemma late last year. But the path of medical breakthroughs is often littered with lapses such as his. Do the ends ever justify the means in these cases? And if so, where should the line be drawn?

CNN: Unethical Experiments’ Painful Contributions to Today’s Medicine

• Juul: Public health crusader? That’s the image the e-cigarette company (under ever-increasing government scrutiny for its marketing practices directed toward youths) is going with these days. But experts are calling its new ad campaign — which touts Juul products as a way to tackle adults’ smoking habits — revisionist history.

The New York Times: Juul’s Convenient Smoke Screen

• A woman who was in a vegetative state for more than 10 years reportedly gave birth last month. The workers at the nursing facility she was in didn’t realize she was even pregnant until she went into labor, raising all kinds of questions about quality of care, abuse and the medical complications of the process.

CNN: How Does Someone in a Vegetative State Have a Baby?

• HIV prevention medication has been shown to be highly effective and, quite literally, a lifesaver to vulnerable populations. But taking it was costing some people their chance at qualifying for life insurance. Now, though, one insurer has settled a lawsuit over the denials, possibly leading the way to changes in the industry.

The New York Times: Facing Legal Action, Insurer Now Will Cover People Taking Truvada, an H.I.V.-Prevention Drug


And good news! The E. coli outbreak is officially over, so you can go back to your romaine (yay?). Have a great weekend!

Kaiser Health News

BEST DEAL UPDATE:

Must-Reads Of The Week From Brianna Labuskes

Happy New Year! Welcome to 2019 and the 116th Congress! I hope everyone had a wonderful and restful break, because now the fun (or something in that neighborhood) starts again.

Democrats are raring to go now that the new class has been sworn in and Nancy Pelosi has retaken the House gavel. They’re setting the stage to put Republicans in the political hot seat with a vote to formally intervene in the Affordable Care Act lawsuit currently moving through the courts.

I’m pretty sure everyone at this point realizes that vowing to protect preexisting conditions was (and will be) a winning issue on the campaign trail. The Democrats’ move will (and, let’s be honest, is designed to) put the GOP in the awkward position of voting against those popular provisions.

The Washington Post: The New Congress: Pelosi Retakes House Gavel As Shutdown Continues

The Washington Post: House Democrats Vote to Defend ACA in Court — and Jam Republicans

Then on the states’ side of things, the attorneys general leading the defense of the health law have filed an appeal against the federal judge’s ruling (from December, I know it feels ages ago) that the ACA can’t stand without the individual mandate penalty. The filing was, obviously, completely expected, but it does continue to move the case down a long legal path likely to end at the Supreme Court.

The Wall Street Journal: Democratic-Led States Appeal Ruling Invalidating Affordable Care Act


Stories about excessive human waste piling up in national parks are grabbing headlines, but when it comes to the shutdown the issues go much deeper than that for Native Americans. Because of treaties, tribes receive a significant amount of the funding they need to provide basic services (like running health clinics) from the federal government. So, the shutdown cuts deeper for them than in other places in the country.

“The federal government owes us this: We prepaid with millions of acres of land. We don’t have the right to take back that land, so we expect the federal government to fulfill its treaty and trust responsibility,” said Aaron Payment, the chairman of the Sault Ste. Marie Tribe, in The New York Times’ coverage.

The New York Times: Shutdown Leaves Food, Medicine and Pay in Doubt in Indian Country

P.S. If you’re confused about the shutdown and what health programs are affected, 1) you’re not alone, and 2) read KHN’s roundup, which, without bias, is the most comprehensive health-related breakdown I’ve seen. Cliff notes, though: Most big-ticket items (like Medicaid and Medicare) were already funded by Congress earlier in the year and are insulated from the standoff’s dramatics.

Kaiser Health News: How The Government Shutdown Affects Health Programs


Bristol-Myers Squibb kicked off the year with a huge $ 74 billion deal with Celgene. The experts at Stat break down exactly what the acquisition means for the industry. A big takeaway is that one of the sector’s largest companies will essentially cease to exist. The deal could also spark more megamergers and further consolidation of the biotech landscape — which, as you can imagine, will not be good for drug prices.

Stat: 9 Big Takeaways From the $ 74 Billion Bristol-Celgene Deal

Next week, movers and shakers in the biotech industry will be flocking to San Francisco for the annual J.P. Morgan Healthcare Conference. It’s the place to see and be seen, but some attendees want to be anywhere but there. Why? The location.

Stat: Will San Francisco’s Issues Push People Away From J.P. Morgan?


Adding work requirements to Medicaid has proven to be the honey it takes to make expanding coverage more palatable to Republican states. But, in Arkansas — the testing ground for what exactly those rules look like in practice — thousands of residents are getting kicked off the Medicaid rolls. A picture of confusion, flawed technology and basic human error is emerging as advocates try to figure out what is going wrong.

Politico: Conservative Health Care Experiment Leads to Thousands Losing Coverage


If you managed to tune out a bit from the news over the holidays, here are some developments you should know about:

A second migrant child died in U.S. custody, prompting President Donald Trump to attempt to shift blame to the Democrats. The administration has been under ever-increasing scrutiny for the quality of care the young migrant children are receiving.

The New York Times: Trump Blames Democrats Over Deaths of Migrant Children in U.S. Custody

Hospitals were handed a major victory when a judge blocked cuts to the 340B drug program, which requires pharmaceutical manufacturers to sell drugs at discounts to hospitals serving large proportions of low-income and vulnerable people, such as children or cancer patients. The judge said the administration overstepped its authority in its push to try to lower drug prices.

Stat: Judge Blocks Trump Administration Cuts to 340B Hospital Payments

A damning investigation into the nation’s major hospital watchdog found that more than 100 psychiatric hospitals have remained fully accredited by the commission despite serious safety lapses, some of which were connected to the death, abuse or sexual assault of patients.

The Wall Street Journal: Psychiatric Hospitals With Safety Violations Still Get Accreditation


And in my miscellaneous file: 

• The old and powerful veteran advocacy groups — aka the “Big Six” — have been major players on Capitol Hill for years. But their power is diminishing as leaner, more efficient and more tailored groups chip away at the establishment and reflect the priorities of a new generation of veterans.

The New York Times: Their Influence Diminishing, Veterans Groups Compete With Each Other and Struggle With the V.A.

• The prominent Memorial Sloan Kettering Cancer Center has not been having a good fall. That’s in part due to the fabulous reporting done by The New York Times and ProPublica, which revealed conflicts of interest among the organization’s leaders. If you haven’t kept up with the story, this offers a great overview on how this ethical morass is playing out not only there but across the country as well.

The New York Times: Memorial Sloan Kettering’s Season of Turmoil

• Does medication-assisted treatment for opioid addiction simply replace one drug with another? Or is it necessary to stop a relentless and sweeping epidemic that has claimed far too many victims? That’s the raging debate as experts try to get their arms around the crisis.

The New York Times: In Rehab, ‘Two Warring Factions’: Abstinence Vs. Medication

• An outbreak of cancer in children is pitting families deep in Trump Country against the president’s agenda to roll back health and environmental restrictions.

The New York Times: A Trump County Confronts the Administration Amid a Rash of Child Cancers

• Between salmonella in turkeys and E. coli in romaine lettuce, the country was beset with foodborne illness outbreaks last year. But one of the biggest recalls is one you probably haven’t even heard about.

New Food Economy: The Listeria Scare That Hit Whole Foods, Trader Joe’s, and Walmart Led to 100 Million Pounds of Recalled Product — And No One Noticed


Apparently, New Year’s resolutions won’t bring you joy (whether you achieve them or not), but if one of yours is to switch up your diet, check out the newly released rankings from U.S. News & World Report.

Kaiser Health News

BEST DEAL UPDATE:

Must-Reads Of The Week From Brianna Labuskes

Happy shortest day of the year! But this certainly won’t be the shortest Breeze of the year, because everyone seemed to want to cram about a month’s worth of news into the past five days.

First, a quick programming note before we get started: KHN is closing up shop for a winter break, but the Breeze will be back in your inboxes Jan. 4.

Now buckle up, this week was a wild ride.

“The proverbial dog that caught the car” is the phrase that keeps cropping up about the Texas ruling that deemed that the health law could not stand apart from the individual mandate tax. Republicans have been pounding the “unconstitutional” drum for years, but after the decision (which legal experts on both sides panned) came out, the celebration was … fairly nonexistent.

The thing is, a lot of the health law’s provisions that have survived Republicans’ attempts to chip away at the legislation are wildly popular (so much so that they became a successful battle cry for Democrats in the midterms). Also, millions of Americans (including a wide swath of the GOP’s base) are benefiting from protections that many people don’t even realize are part of the legislation.

On top of that, Republicans are still smarting from the intraparty bruises they left the last time they tried to replace the ACA.

In short, this ruling could be a big ol’ headache that lasts straight up until the 2020 elections.

The Washington Post: Why Republicans (Secretly) Want the ACA to Survive

The Washington Post: Legal Experts Rip Judge’s Rationale for Declaring Obamacare Law Invalid

Politico: Obamacare’s Secret Base: America’s Middle Class

The Texas case also highlights how carefully selecting the particular judge who hears your case has become a strategy that’s being employed by both sides of the aisle.

The New York Times: In Weaponized Courts, Judge Who Halted Affordable Care Act Is a Conservative Favorite

Few other things in the health law inspire such vitriol in its opponents as the individual mandate. But new enrollment numbers hint that the penalty, despite the angst surrounding it, may have become somewhat superfluous. While the new sign-ups for 2019 coverage did dip slightly (about 4 percent from last year), they were much better than the dire predictions in the weeks leading up to the deadline.

Maybe the mandate was a necessary “stick” in a “carrot-and-stick strategy” that helped steer the health law through its infancy, but those days may be gone, experts say. Now, the “carrots” (subsidies, essential benefits, preexisting conditions protections) seem to be enough to keep consumers around.

The New York Times: Despite Challenges, Health Exchange Enrollment Falls Only Slightly

The Associated Press: Health Law’s Fines Are Not the Big Stick Everybody Thought


An AP investigation paints a grim picture of the conditions at youth detention centers— one that looks a lot like the crowded institutions and orphanages of decades past. The lasting trauma from being held at such places cannot be overstated, experts say. “This is not a perplexing scientific puzzle. This is a moral disaster,” said Dr. Jack Shonkoff in AP’s coverage.

The Associated Press: ‘A Moral Disaster’: AP Reveals Scope of Migrant Kids Program

Several high-profile cases of sexual abuse at the detention facilities have drawn attention to the widespread problem in the system. But it turns out that even when the young people do report the abuse, police are closing the cases often within days, or even hours, sometimes with very little investigation at all.

ProPublica: In Immigrant Children’s Shelters, Sexual Assault Cases Are Open and Shut


Johnson & Johnson has been facing thousands of lawsuits that allege its talc powder causes cancer. The science has always been a little blurry here, and J&J has been adamant that its iconic product is safe. But new memos reveal that the company has known since the ’70s that its powders sometimes tested positive for asbestos.

Reuters: J&J Knew for Decades That Asbestos Lurked in Its Baby Powder


Is the government ready to get into the generic-drug-making business? Well, under a new plan from Sen. Elizabeth Warren (D-Mass.) it would be thrust into that role. Warren wants to create an office that would step in during drug shortages or when only one or two companies produce a certain medication. It’s unclear how much of an impact this legislation would have (ignoring the fact that it would have to get passed at all), because overall generics prices have been going down.

Stat: Sen. Warren’s New Plan to Lower Prices: Have the Government Make Drugs


Letting veterans seek private care is a much-ballyhooed idea by conservatives (and has been championed enthusiastically by President Donald Trump), but the VA Choice Program led to not only longer wait times for veterans but also a higher cost to taxpayers. So, who exactly are the winners in this scenario? Two private companies that secured a cushy government contract to run the program.

ProPublica: The VA’s Private Care Program Gave Companies Billions and Vets Longer Waits

The Veterans Affairs Department’s alarming failures in terms of suicide prevention efforts were detailed this week in a damning report from the Government Accountability Office. Millions that had been budgeted to address the growing crisis have gone unspent, and social media outreach and public service announcement efforts had gone all but dormant in a time when 20 veterans a day still die by suicide.

The New York Times: Suicide Among Veterans Is Rising. But Millions for Outreach Went Unspent by V.A.


Despite all the warning signs, the Drug Enforcement Administration, along with drug distributors, did little to stem the flood of opioids into rural West Virginia during the early days of the epidemic. The 300-plus-page congressional report that blasted the agency for its inaction was the result of an 18-month intensive investigation to figure out why 21 million pain pills were funneled to a small town with the population of 3,200.

The Washington Post: Congressional Report: Drug Companies, DEA, Failed to Stop Flow of Millions of Opioid Pills

Harm-reduction advocates in Maine have come up with a strategy to circumnavigate laws that would impede them from helping people addicted to opioids use the drugs more safely: setting the organization up as a church.

Stat: Recovery Experts Set Up New ‘Religion’ in Maine That May Skirt Drug Laws

And you have to check out this New York Times visual story on how and why people get addicted to opioids, which also contains one of the best quotes to sum up the crisis: “One is too many, and a thousand is never enough.”

The New York Times: Heroin Addiction Explained: How Opioids Hijack the Brain


“Follow the money” is a journalism adage that will rarely let you down. Like with this AP investigation that pulls back the curtain on an organization that represents itself as a champion for Medicare beneficiaries.

The Associated Press: Insurance Giants Bankroll Group That Pushes Private Medicare

Imagine treating health insurance like renting a movie on demand instead of paying for a cable package you almost never use. That radical approach is drawing attention in a landscape that’s hungry for new ideas on reining in health care costs.

The Associated Press: Health Insurance on Demand? Some Are Betting on It


And I’m going to send you into the winter break with a jampacked miscellaneous file, just in case all of that wasn’t enough news:

• A deep dive considers the political paradox of why Republicans, who are the main beneficiaries of government aid (such as Medicaid) are so ardent in their opposition to … government aid.

The New York Times: Where Government Is a Dirty Word, But Its Checks Pay the Bills

• Advocates rejoiced when ballot initiatives to expand Medicaid in three red states found success. But what about that fourth one? What went wrong there? (Hint: They got Big Tobacco involved.)

Stateline: Lone Medicaid Expansion Defeat Offers Lessons for Other States

• A heart-wrenching report finds that when report cards are released on Fridays, child abuse increases nearly fourfold.

The Associated Press: Child Abuse Climbs After Friday Report Cards, Study Says

• When it comes to public health crises, look to West Virginia as the canary in the coalmine. Oftentimes, epidemics, such as obesity and opioids, start here before spreading throughout the country.

The Associated Press: As US Life Expectancy Falls, West Virginia Offers Lessons

• A University of Southern California gynecologist is at the center of the LAPD’s largest-ever single-suspect investigation. If you haven’t been following the case, the Los Angeles Times offers a great overview of where it stands and how it got so bad.

Los Angeles Times: How George Tyndall Went From USC Gynecologist to the Center of LAPD’s Largest-Ever Sex Abuse Investigation

• What we have learned in 2018: Flu shots are great, when hospitals merge patients pay more, teen vaping rates have reached epidemic proportions, and tons more. Check out The New York Times’ look back at lessons from this past year.

The New York Times: What We Learned In 2018: Health And Medicine

And for all you policy wonks out there, check out this Twitter thread on health-related academic papers.


Please have a wonderful and restful last few days of 2018, and I’ll see you guys in the new year!

Kaiser Health News

BEST DEAL UPDATE:

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Apologies for unexpectedly going MIA last week, but your girl here decided she needed some firsthand experience with the health care system via a trip to the emergency room. (Hot tip: Stay hydrated during stomach bug season, folks!) Many thanks to the wonderful Damon Darlin (also known as KHN’s executive editor) for filling in last week. Make sure to check it out if you missed it.

Onward to this week, though, where we’re finally starting to slow down as we drift toward the holidays.

“I hate to panic, but …” was a quote from NPR’s coverage of the health law enrollment numbers that pretty much summed up the atmosphere the day before the sign-up deadline. The big number to focus on here is that there are nearly 20 percent fewer new enrollees than at about this same time last year. The lag has advocates pointing nervous fingers at the Trump administration’s efforts to chip away at the health law.

But some experts eschew Chicken Little predictions (at least quite yet), saying that fewer sign-ups don’t necessarily mean more people will be uninsured. For one, the unemployment level is the lowest in decades (although that has nuances that are too complex to get into right here) so people who used to get health law plans might be covered by their employers. Secondly, the sign-up numbers don’t reflect anyone who is sticking with the plan they currently have.

Either way, we won’t have long to wait to see how it shakes out.

NPR: Enrollment in HealthCare.Gov Plans May Be Down for 2019

The Associated Press: Health Law Sign-Ups Lagging As Saturday Deadline Is Looming

Amid all that talk of sabotage and low numbers came a study that found 4.2 million Americans are actually eligible to get what amounts to free health care through the exchanges, as an unintended consequence of President Donald Trump nixing key health law payments last year.

The Hill: Study: 4.2 Million Uninsured People Eligible for Free ObamaCare Coverage


A quietly simmering debate over fetal tissue research brewing the past few months has started to come to a boil this week. (Although, if you’ve been reading your Morning Briefing regularly, this won’t come as a surprise.) Back in September, the administration launched an audit of all federally funded research that uses fetal tissue. The far-reaching ramifications were felt recently when a lab that has played an integral role in testing for HIV cures was put on notice that its funding could be canceled.

The sides are firmly drawn here and have deep roots in abortion politics (as witnessed in this quote from CQ’s coverage of Thursday’s heated House hearing on the topic: “Obviously the 800-pound gorilla in the room is that we know aborted tissue is being used,” said Georgia Republican Rep. Jody Hice).

With the National Institutes of Health signaling interest in pumping $ 20 million into finding an alternative to fetal tissue for research purposes, I don’t think this topic is going away anytime soon.

The New York Times: Fetal Tissue Research Is Curtailed by Trump Administration

The Hill: NIH to Fund Research Into Fetal Tissue Alternatives


The death of a 7-year-old Guatemalan girl who had been taken into Border Patrol custody is likely to intensify scrutiny of the care immigrants detained by the U.S. government are receiving. U.S. Customs and Border Protection said the girl had not eaten or consumed water in several days, and it’s unclear whether the agents had tried to rectify that situation. Advocates are saying the death is reflective of a “culture of cruelty” within the agency.

Meanwhile, there are nearly 15,000 migrant children in detention facilities in the country, where issues with background checks, abuse and neglect continue to make headlines.

The Washington Post: 7-Year-Old Migrant Girl Taken Into Border Patrol Custody Dies of Dehydration, Exhaustion

NPR: Almost 15,000 Migrant Children Now Held at Nearly Full Shelters

More voices are starting join the growing chorus of advocates, doctors and city leaders who oppose the administration’s proposed policy to penalize immigrants who are accepting government aid (such as Medicaid). It’s not just about public health, they say. The policy would also take a heavy financial toll.

Dallas Morning News: Dallas Mayor Says Trump Administration’s Proposed ‘Public Charge’ Rules Would Harm City’s Immigrants, Economy


There was some shade being thrown at the Supreme Court this week, when the justices declined to take up a case on state Medicaid funding and Planned Parenthood. Justice Clarence Thomas called out his conservative colleagues Chief Justice John Roberts and Justice Brett Kavanaugh for dodging the case. “So what explains the court’s refusal to do its job here? I suspect it has something to do with the fact that some respondents in these cases are named ‘Planned Parenthood,’” he wrote. The case itself was somewhat complex, but essentially the decision leaves in place Medicaid patients’ right to sue over provider issues.

The Associated Press: Justices Won’t Hear States’ Appeal Over Planned Parenthood


The maker of a device that reverses overdoses recently drew fire for jacking up the list price of its injector from $ 575 to $ 4,100 during a span of time that opioid-related deaths were also accelerating rapidly. As you can imagine, this did not go over well with either lawmakers or the public when it came to light. Now Kaleo, in damage-control mode, is releasing a generic version that comes with a $ 178 price tag. The whole journey is quite the snapshot of what’s going wrong with high health care costs.

Stat: Kaleo, Maker of $ 4,100 Overdose Antidote, to Offer Generic For $ 178

Speaking of, you have to check out the salacious details emerging in this case that started as an antitrust lawsuit against just two drugs and has ballooned into this sweeping investigation into price-fixing allegations in the generics marketplace.

The Washington Post: Generic Drug Price-Fixing Investigation Expands to 300 Drugs and 16 Companies

Pharma, meanwhile, is sweating over the Democrats taking power in the House. Once a political powerhouse of nearly mythological proportions, the industry has lost clout in recent years, and companies don’t think the new power structure will work in their favor.

Stat: Will Democrats in Congress Keep the Door Open for Pharma — or Slam It?


Whew! That was not as short as expected. Just in case you want some more great reads for your weekend, check out the miscellaneous file:

• What happens to your life when millions of people have witnessed you hit rock bottom? As the opioid epidemic dug deep roots into the country, there was this trend where videos and photos of people overdosing would go absolutely viral. Public health officials and cops at the time justified putting them up because the videos could act as a deterrent for drug use. For the people used as the face of the crisis, however, it was deeply life-altering.

The New York Times: How Do You Recover After Millions Have Watched You Overdose?

• Baby boomers are now aging alone more than any other generation in U.S. history. That isn’t just a sad statistic — it’s also a looming public health crisis. Loneliness has been as closely linked to early mortality as smoking up to 15 cigarettes or consuming more than six alcoholic drinks a day.

The Wall Street Journal: The Loneliest Generation: Americans, More Than Ever, Are Aging Alone

• A rash of recent headlines explores whether trauma is passed down through genes. It’s a very buzzy idea, but the evidence that trauma can leave a signature that lasts generations is circumstantial at best.

The New York Times: Can We Really Inherit Trauma?

 

I’ll leave you with some bah-humbug! warnings about not eating that raw cookie dough this holiday season (even though it’s clearly the best part of making cookies). Have a great weekend!

Kaiser Health News

BEST DEAL UPDATE:

Must-Reads Of The Week From Brianna Labuskes

Welcome back to the Friday Breeze! Brace yourself, because with the midterms in the rear-view mirror (psshh, the 2018 elections are so five minutes ago), lawmakers, hopefuls and sideline experts are all barreling toward 2020. (I have only just this moment realized the vast opportunity for puns we’ll see when it’s over. Hindsight being … you get it.) First, though, everyone has to make it through two years of likely gridlock with a split Congress.

So what’s on the agenda for the newly empowered Democrats?

“Health care was on the ballot and health care won.” That’s House Minority Leader Nancy Pelosi’s assessment, at least. How it shakes out is trickier.

Some of the Dems’ top priorities are related to bandaging up the health law. Their efforts will likely include forcing a vote on a bill to protect preexisting conditions; shoring up the marketplaces, possibly by helping states pay for large medical claims; and pushing to get the House to intervene in the Texas lawsuit that challenges the law’s constitutionality.

At the same time, many of the party’s 2020 contenders are going to be on the trail going hard for “Medicare-for-all,” aka the litmus test for candidates who want to woo the more progressive wing of voters. The dissonance in the party that has been brewing since MFA gained popularity is at the very least going to require some complicated political maneuvering on all sides.

One Democratic agenda item many people (including President Donald Trump) seem to agree on, though? Reining in drug prices.

The New York Times: Democrats Won a Mandate on Health Care. How Will They Use It?

Politico: California’s New Governor Embodies Democrats’ Dilemma on Single Payer


New numbers out of Arkansas that detail just how many people have been dropped from the state’s Medicaid program since work requirements were enacted have experts increasingly alarmed. An additional 3,815 lost coverage in October for not reporting their hours, pushing the total number of people who have been affected by the state’s new requirements to over 12,000. And about 6,000 more residents are on their second strike and poised to lose coverage next month.

An outcry among health care experts prescribes the rules be suspended until officials figure out why the numbers are so startlingly high.

Modern Healthcare: Arkansas Drops 3,815 More Medicaid Enrollees Over Work Requirement


The Food and Drug Administration is cracking down on certain tobacco products and e-cigarettes that contribute to the emerging teen-vaping epidemic. But the ban on selling flavored e-cigarettes at brick-and-mortar stores (a ban that won praise when an early version of the rules was leaked) was conspicuously tempered. Stores will be allowed to sell the products if they can be kept in an age-restricted area.

The agency did come out swinging hard with a proposed ban on menthol. It could take years to enact, and the tobacco industry has hinted at a court battle, but if the ban does go through, it could have a profound effect on African-American males and young people who smoke menthol cigarettes at higher rates than other groups.

The Washington Post: FDA Unveils Sweeping Anti-Tobacco Effort to Reduce Underage Vaping and Smoking


The National Rifle Association has long been a Goliath among Davids when it comes to election spending. New numbers suggest, though, that the gun control movement may actually become a formidable foe for the political powerhouse.

The New York Times: Gun Control Groups Eclipse N.R.A. in Election Spending

It was not a friendly news week for the NRA in general. One of the organization’s tweet’s (a suggestion that doctors should “stay in their lane” on the gun debate) sparked viral outrage from providers. With the floodgates opened, stories of physicians’ firsthand experience with gun violence blanketed social media. “I see no one from the @nra next to me in the trauma bay as I have cared for victims of gun violence for the past 25 years,” tweeted one doctor (from the New York Times’ coverage). “THAT must be MY lane. COME INTO MY LANE. Tell one mother her child is dead with me, then we can talk.”

NPR: After NRA Mocks Doctors, Physicians Reply: ‘This Is Our Lane’


The wildfires continued to devastate California, with the death toll climbing to at least 63 and the number of missing people soaring to more than 600. Heartbreaking tales about elderly and young evacuees living in the harsh conditions of parking-lot tent cities serve as a reminder of just how long recovery will take after the fires are contained.

The (San Jose) Mercury News: Camp Fire: 63 Dead, 631 Missing; Second Origin Spot Probed

Los Angeles Times: Made Homeless by Flames, Camp Fire Evacuees Face Hardship, Disease And Desperation


Drug prices didn’t always used to be this bad. For a while, America was spending about what other wealthy countries did. Then something happened in the 1990s. To be fair, many factors are in play with our current pricing system, but the record number of new drugs that emerged in that decade likely set the stage for our current morass.

The New York Times: Something Happened to U.S. Drug Costs in the 1990s


Enrollment in Affordable Care Act plans was a bit slower at the start of this year’s sign-up season compared with last year’s. The reason this item appears so low in this newsletter, though, is that those numbers lack context (we, as a nation, were kind of preoccupied with a little thing called the midterms) and experts say it’s too early to call this a trend. Something to keep an eye on.

The Hill: ObamaCare Enrollment Down Compared to Last Year


Sick of medical bills? Yeah, doctors aren’t really fans of having to be debt collectors either. Especially when it comes to a patient. As premium costs shift more and more to employees, providers are no longer able to just deal with impersonal insurers and are instead having to go after the very people they’re trying to help.

Bloomberg: Doctors Are Fed Up With Being Turned Into Debt Collectors

Who in the family doesn’t get health care this year? Americans are having to make such tough decisions in an era where insurance plans can be price-tagged at more than $ 1,000 a month. Bloomberg offers a series that puts names and faces to the problem that has been a punch in the gut for many across the country.

Bloomberg: Soaring Health-Care Costs Forced This Family to Choose Who Can Stay Insured


As you can tell, this week was popping in terms of health news, so the miscellaneous file is going to be a bit more robust today:

Native American and Alaska Native women have been vanishing in high numbers, but the reporting on the depth and breadth of the problem is woefully lacking.

• The Associated Press: Report Cites Weak Reporting on Missing, Murdered Native Women

Who decides the parole of people who have been found not guilty by reason of insanity? In Oregon, where it’s a board that reviews the state’s cases, the balance between civil rights and safety has been praised. However, an analysis of 220 defendants found that about a quarter of them were charged with attacking others within three years of being released. And the board hasn’t changed its policies.

• ProPublica: Oregon Board Says Those Found Criminally Insane Rarely Commit New Crimes. The Numbers Say Otherwise.

So, it turns out a 150-pound pig is uncannily humanlike in organ size and function. This could go a long way in addressing our perpetual donated organ shortage.

The New York Times: 20 Americans Die Each Day Waiting for Organs. Can Pigs Save Them?

A sweeping study put a damper on all the “magical thinking” surrounding the benefits of fish oil and vitamin D.

The New York Times: Vitamin D And Fish Oils Are Ineffective For Preventing Cancer And Heart Disease

If it seems as if at least one kid in every classroom these days has a food allergy, that’s because they probably do. Could hypoallergenic food be the answer?

The Boston Globe: Allergies Change How We All Eat

A revealing series of jail conversations between Aaron Hernandez, who died by suicide in April 2017, and other football players details a grim culture of opioid abuse in the NFL.

The Boston Globe: In Jail Calls, Hernandez Discussed NFL’s Reliance on Painkillers With Former Teammates

In an era of medical malpractice suits, it feels rare to get an apology out of anyone health-related these days. But the widower of a woman who died of an asthma attack outside of a locked emergency department got one from the hospital. (It’s a tragic, yet recommended read overall.)

First lady Michelle Obama spoke candidly about her miscarriage and about how women often feel alone and isolated when it comes to fertility and pregnancy.

The Associated Press: Michelle Obama Had Miscarriage, Used IVF to Conceive Girls


Whew! Everyone was definitely busy before heading into the holidays. Speaking of, we’ll be off eating turkey next week, but will hit your inbox again on Nov. 30.

Happy holidays!

Kaiser Health News

BEST DEAL UPDATE:

Must-Reads Of The Week From Brianna Labuskes

It’s late October, so you know what that means: It’s time to get your flu shot! (You thought I was going to say elections, didn’t you? Don’t worry, we’ll be getting to that.) Before your roll up your sleeve, check out this story about pharmacies and grocery stores competing for flu shot customers now that the vaccination is covered by the health law. Would money off gas or gift cards for food be more likely to draw you in? (Also, if you do get the flu, good news: There’s now a single-dose medication for it.)

A quick editor’s note before we get into it: “The Friday Breeze” will be on break for the next two weeks as I take a poorly timed (or well-timed! depending on your mentality) vacation. I’ll be back in your inboxes Nov. 16.

Now, on to what shaped up to be a fairly busy week in the health care realm.

President Donald Trump is proposing tying the amount the government pays for certain drugs to their costs in other countries. The president has long railed against the “global freeloading” that he says forces American consumers to subsidize lower drug prices in foreign countries. To be clear, the plan would not apply to medicines people buy at the pharmacy, just ones administered in a doctor’s office.

The New York Times: Trump Proposes to Lower Drug Prices by Basing Them on Other Countries’ Costs

Pharma came out swinging against the plan in an opening salvo of what is likely to be an uphill, exhausting fight over the issue. But, overall, the reaction seems to be muted from both candidates on the trail and the general public, overshadowed perhaps by more easily digestible talking points.

Bloomberg: Drug Lobby Compares Trump Drug Price Plan to ‘Socialized’ System

Politico: Trump’s Drug Plan Falls Flat in Health Care Messaging War

There’s a feeling of foreboding setting in over the pharmaceutical industry as a blue wave gathers force to possibly sweep into the House. Put together a populist president and a party that’s made high drug costs a central, winning issue and what do you get? Pharma’s worst fears realized.

The New York Times: What Big Pharma Fears Most: A Trump Alliance With Democrats to Cut Drug Prices


Protections for preexisting conditions have become something of an Achilles’ heel for Republicans on the trail. Some have chosen to duck the topic, while others vow to keep that popular provision without providing details on how. But Trump took it a step further by trying to claim that ensuring coverage for preexisting conditions is a Republican priority and not a Democratic one. Critics were quick to point out that in addition to the GOP’s years-long battle to eradicate “every word” of the health law, there’s currently an administration-backed lawsuit in the courts aiming to overturn the whole thing.

The Washington Post: Trump’s False Claim on Health Care Ignores Years-Long GOP Effort to Repeal Obamacare

On that note, the administration this week announced that it is going to give states more flexibility over coverage requirements, which could allow them to circumvent some of the health law’s protections for patients. States could, for example, use federal funds to subsidize short-term insurance plans.

The Washington Post: Trump Administration Allows ACA Subsidies for Leaner Health Plans

Experts worry this is a step back toward the pre-ACA landscape, when the state a patient lived in determined what kind of health care they received.

Modern Healthcare: Waiver Flexibility Could Widen Gap Between States


How do you make Medicaid expansion a winning issue if you’re running as a Democrat in a deep-red state? Make it about smart business decisions. At least, Georgia gubernatorial candidate Stacey Abrams hopes that tactic works.

The New York Times: Stacey Abrams Hopes Medicaid Expansion Can Be a Winning Issue in Rural Georgia


A report in The New York Times revealed that the Trump administration is considering redefining gender in a way that would strip transgender individuals of certain protections. Backlash from the LGBTQ community was fierce, with some people questioning the timing of the news. “It’s a reminder that pain is a political tool,” said Gabrielle Bychowski in NYT’s coverage. A #WeWillNotBeErased movement was quickly ignited.

The New York Times: ‘Transgender’ Could Be Defined Out of Existence Under Trump Administration

The New York Times: Two Weeks Before Midterms, Transgender People Feel Like ‘Pawns’

Biologists spoke out, as well, saying that defining a person’s gender at birth and making it unchangeable is an “insult to science.”

The Associated Press: Science Says: Sex and Gender Aren’t The Same


America is turning the tide against the opioid epidemic, HHS Secretary Alex Azar said this week, citing a dip in overdoses. While acknowledging there’s still a long way to go, Azar was optimistic government efforts have been starting to make a dent in the crisis. Experts were more cautious, however, warning that six months of data is not enough to determine that, and the trend could just be a blip.

Politico: U.S. ‘Turning the Tide’ on the Opioid Crisis, Health Secretary Says

Stat: Is a Recent Fall in Overdose Deaths Temporary or a Sign of a Corner Turned?

Meanwhile, as everyone’s eyes (and money! and resources!) are on the opioid crisis, methamphetamines, cocaine and benzodiazepines are quietly flooding into the gaps left behind.

Politico: Meth and Cocaine Complicate Trump’s War on Drugs


In the miscellaneous must-read file:

• First female Supreme Court Justice Sandra Day O’Connor wrote a touching email to “friends and fellow Americans” announcing that she’ll be stepping out of public life following a dementia diagnosis. “While the final chapter of my life with dementia may be trying, nothing has diminished my gratitude and deep appreciation for the countless blessings in my life,” she wrote.

The New York Times: Sandra Day O’Connor, First Female Supreme Court Justice, Says She Has Dementia

• That can’t be legal, right? That was my first thought upon reading this heartbreaking story about women who work in strenuous jobs and are denied lighter duties when pregnant (even when they have a doctor’s note). Some of them go on to have miscarriages while working.

The New York Times: Miscarrying at Work: The Physical Toll of Pregnancy Discrimination

• We’ve all heard about how crowdfunding sites can be like a miracle to desperate patients who can’t afford care. But there’s a dark side to the recent boom in medical crowdfunding: The campaigns have raked in millions of dollars for scientifically unproven, and potentially dangerous, treatments in the past three years alone.

Stat: Crowdfunding Raises Millions for Unproven and Potentially Harmful Treatments

• The rural mountain West is dubbed the “suicide belt” of America, containing eight of the top 10 states with the highest suicide rates in the country. Stigma, guns and a “pull yourself up by your bootstraps” culture may be contributing to the problem.

NPR: Why Are Suicide Rates Higher in the Mountain West?


That’s it from me until after the elections. See you on the flip side!

Kaiser Health News

BEST DEAL UPDATE:

Must-Reads Of The Week From Brianna Labuskes

We’re barreling toward November, folks. (How is it mid-October already?) As you might expect, election stories made up the bulk of the health care news this week. Other great gems and intriguing developments surfaced, though, so let’s get right to it.

Republicans on the campaign trail have been hammered by attack ads over their stance on the health law, with “preexisting conditions protections” — insurance safeguards for patients diagnosed with chronic illness — becoming a catch-all phrase for the most popular parts of the Affordable Care Act. Even the law’s most vocal opponents have been reading tea leaves and softening their stances. That’s why statements from GOP leadership this week that Congress could revisit their “repeal” fight post-midterms may have landed with a thunk.

The New York Times: Republican Candidates Soften Tone on Health Care As Their Leaders Dig In

The Washington Post: Trump Says ‘All Republicans’ Back Protections for Preexisting Conditions, Despite Repeated Attempts to Repeal Obamacare

Democrats are pulling out a tried-and-true talking point that seemed perfectly timed for them as news of the federal deficit reignited Republican talk about cutting entitlement programs. Dems (who have been playing defense over Medicare) seized the opportunity to accuse Republicans of putting the beloved program on the chopping block.

The Associated Press: Dems Shift Line of Attack, Warning of GOP Threat to Medicare

As the parties duke it out on the trail, voters seem to agree on one thing: Our health care system is broken and someone needs to fix it. “It’s crippling people. It’s crippling me,” one voter says in Politico’s deep read that takes us to a Pennsylvania county where the “margins of electoral victories traditionally are as slim as the spectrum of political opinion is vast.”

Politico Magazine: The Great American Health Care Panic

On the state level, a Missouri Democrat opposed to abortion struggles to find her place in the party. And Georgia becomes a preview of the growing political clout of home health aides.

The New York Times: Is It Possible to Be an Anti-Abortion Democrat? One Woman Tried to Find Out

Politico: Home Health Aides Test Political Clout in Georgia Governor’s Race


The Trump administration this week proposed a requirement that pharma add drug prices to TV ads — triggering skepticism. One problem is that ad prices wouldn’t reflect what most people end up paying for a drug at the pharmacy counter.

Politico: Trump Set to Force Drugmakers to Post Prices in Ads

What I found surprising, considering how common those ads are, is that just a few dozen drugmakers run any at all — nearly half are put out by five companies. Those manufacturers would bear the brunt of the new rules.

Stat: Five Drug Makers Will Be Hit Hardest By Trump’s New Proposal on Drug Ads

Trying to think outside the box to rein in high drug prices, several states are considering treating pharma as they would a public utility — with rate-setting bodies to review, approve or adjust medication prices.

Stat: A Growing Number of States Consider Legislation to Treat Pharma As a Utility

And keep an eye on this battle: Minnesota became the first state to sue drugmakers over the price of insulin, but I don’t think it will be the last. The “life-or-death” drug has gotten a lot of attention recently, synthesizing the human toll of high costs into a digestible talking point.

Stat: Minnesota Becomes First State to Sue Major Insulin Makers Over Price-Gouging


Another 4,100 Arkansas beneficiaries were dropped from the state’s Medicaid rolls, and 4,800 more are at risk next month (on top of the original 4,353 people dropped last month) — all because of the state’s new work requirements. For critics of the restrictions, their worst fears are realized, while state and national officials focus on what they call positive outcomes. It’s unclear why so many workers are failing to report their hours, but experts suggest limited internet access and lack of knowledge about the requirements as possibilities.

Modern Healthcare: 4,100 More Arkansans Lose Medicaid Over Work Requirements


Anthem was slammed this week with a $ 16 million settlement over its massive data breach. (Remember the biggest known health care hack in U.S. history?) That penalty is nearly three times the previous record paid over such a case.

The Associated Press: Insurer Anthem Will Pay Record $ 16M for Massive Data Breach


I’m not sure whether it’s because I saturate myself in health care stories, but I detect a serious reckoning in the field of medical research. The latest call for retractions involves a prominent cardiologist.

The New York Times: Harvard Calls for Retraction of Dozens of Studies by Noted Cardiologist


In the miscellaneous must-read file:

• A mysterious polio-like illness that causes sudden paralysis is hitting children in states across the country. The wave of cases is similar to one officials saw in 2014 and 2016, but experts are baffled.

Los Angeles Times: What Is AFM? Everything You Need to Know About the Polio-Like Virus Suddenly Affecting Children Across the U.S.

• I have to admit, this is the headline that most piqued my interest this week. Gene editing is such a hot field, but in the racially charged landscape of the country, scientists are worried their research into genes and genetic diversity will be twisted by hate groups to support their views.

The New York Times: Why White Supremacists Are Chugging Milk (And Why Geneticists Are Alarmed)

• Why hasn’t #WhyIStayed caught on fire like #MeToo? Stigma, for one. But also the #MeToo movement has shown how powerful multiple accusations can be, amplified to the point they can’t be ignored. In a domestic violence situation, it’s often only one survivor speaking out.

The New York Times: Domestic Violence Awareness Hasn’t Caught Up With #MeToo. Here’s Why.

• Viruses don’t always have to be a scary thing. This therapy uses bacteriophages — literally, eaters of bacteria — that inject themselves into germs and cause them to explode. (As this delightful image from the Stat article describes: The viruses can “pop bacteria the way middle schoolers pop zits.”)

Stat: How The Navy Brought a Once-Derided Scientist Out of Retirement — and Into the Virus-Selling Business

• “Pregnant? Don’t want to be? Call Jane.” That’s how a clandestine underground abortion network advertised during the years leading up to Roe v. Wade, according to this retro report from the NYT.

The New York Times: Code Name Jane: The Women Behind a Covert Abortion Network


It turns out, it is now scientifically supported that daylight helps kill germs indoors. So make sure to let the sun in this weekend! And have a good one.

Kaiser Health News

BEST DEAL UPDATE:

Must Reads Of The Week From Brianna Labuskes

Just in case our ever-decreasing anonymity in this tech-driven world hasn’t scared you enough, new studies find that within a few years 90 percent — 90 percent! — of Americans of European descent will be identifiable from their DNA. If you fall into that group, it doesn’t even matter whether you’ve given a DNA sample to one of the popular gene-testing sites (like 23andMe). Enough of your distant relatives have, so there’s a good chance you’re in the system.

Take your mind off that by checking out what you may have missed in health care this week.

The biggie, of course, was President Donald Trump’s opinion piece in USA Today about “Medicare-for-all.” (And the rebuttal from Vermont Sen. Bernie Sanders.)

Fact checkers came out in droves to comb through Trump’s arguments and found that nearly every paragraph contained a misleading statement or falsehood.

The Washington Post: Fact-Checking President Trump’s USA Today Op-Ed on ‘Medicare-for-All’

More than shedding any kind of light on the complicated topic, the back-and-forth highlights how much of a role health care is playing in the upcoming midterm elections. Each side has doubled down on its respective talking points (read: preexisting conditions and Medicare-for-all — I warned you you’d get tired of me saying that). In fact, health care is featured so heavily in ads that it trumps the topics of jobs or taxes.

The Wall Street Journal: Health Care Crowds Out Jobs, Taxes in Midterm Ads

(Side note: If you do want some light shed on Medicare-for-all and single-payer systems, check out these great pieces from KHN’s own Shefali Luthra.)

Speaking of midterms, the Democrats’ attempt to block the administration’s expansion of short-term plans (very predictably) failed, with only Maine Republican Sen. Susan Collins joining the Democrats. It was never about winning, though. What it did was force Republicans to go on record with a vote that is potentially politically dangerous in the current landscape.

Politico: Senate Democrats Fail to Block Trump’s Short-Term Health Plans

In stark contrast to the sharply partisan discourse, Trump signed two bipartisan health care measures into law this week. The bills banned “gag clauses” on pharmacists, which had prohibited them from offering consumers cheaper options. The legislation won’t directly affect drug prices, but it might mean people will pay less at the register.

The New York Times: Trump Signs New Laws Aimed at Drug Costs and Battles Democrats on Medicare


For the first time, premiums for the most popular level of insurance sold in the health law marketplaces have gone down. The numbers are the latest sign that the marketplace is stabilizing. (Centene’s expansion into new states is another from this week.) CMS Administrator Seema Verma touted the success, saying the news counters any accusations of sabotage. Health experts, however, said those price tags would have been even lower if not for the administration’s actions over the past year.

The Washington Post: Premiums for Popular ACA Health Insurance Dip for the First Time


The Justice Department approved CVS’ $ 69 billion merger with Aetna, and although the deal still needs approval from state regulators, the green light is a major hurdle cleared. The merger would reshape the health landscape and mark the end of an era for free-standing pharmacy benefit managers. The potential consolidation is just one of many in recent years in a fast-evolving industry — a trend critics worry will lessen competition and drive up prices for consumers.

The New York Times: CVS Health and Aetna $ 69 Billion Merger Is Approved With Conditions


Hospitals scrambled to ensure patient safety as Hurricane Michael battered Florida and Georgia this week. “It was like hell,” said one doctor who rode out the storm at Bay Medical Center in Panama City, Fla. The hurricane brought with it memories of last year’s power outages that came with Hurricane Irma and were linked to the deaths of several nursing home residents.

The New York Times: Hospitals Pummeled by Hurricane Michael Scramble to Evacuate Patients


Now that the Brett Kavanaugh battle is over and he’s taken a seat on the Supreme Court, Planned Parenthood has gone into planning mode in case anything happens to Roe v. Wade. A key component of the organization’s plan is to shore up networks in states where abortion would likely remain legal (with longer hours for clinics, for example). On the other side, abortion-rights opponents are getting primed for a new high court that’s likely friendlier to them by strategizing what cases would be best to move forward with.

NPR: With Kavanaugh Confirmed, Both Sides of Abortion Debate Gear Up for Battle

How do you fight measures to expand abortion rights in progressive states? Make it about money. A battle in Oregon illustrates a strategy that — although unlikely to be successful — gives opponents of the bills at least a hope of winning.

Politico: Oregon’s Unlikely Abortion Fight Hinges on Taxes


Holes in the court system have allowed state judges to grant full custody of migrant children to American families — without notifying their parents. Federal officials say it should never happen, but oversight of the problem is scattershot and challenging because states handle adoption proceedings differently.

The Associated Press: Deported Parents May Lose Kids to Adoption

Democrats have been vocal about what they don’t like when it comes to immigration policy. But they have a problem: a lack of cohesion within the party about the correct way forward.

The New York Times: The Democrats Have an Immigration Problem


In the miscellaneous, must-read file:

• A gripping piece takes you into the bowels of a Philadelphia neighborhood dubbed the “Walmart of heroin.” “Drug tourists” come from all over to buy the cheap, pure heroin flowing through the veins of the streets, and some never make it out. (Warning: Make sure you have some time before you start, it will suck you in completely.)

The New York Times: Trapped by the ‘Walmart of Heroin’

• Why were nursing home residents getting extremely pricey therapy in the last weeks of their lives? Bloomberg takes a closer look at these cash-strapped facilities and the questionable decisions made about patients’ rehab.

Bloomberg: Nursing Homes Are Pushing the Dying Into Pricey Rehab

• In good news from the segment of people who were too old to take advantage of the HPV vaccine, the Food and Drug Administration just approved its use for those up to age 45.

The Associated Press: FDA Expands Use of Cervical Cancer Vaccine up to Age 45


As an office of ardent dog lovers, we were distressed to hear the news that therapy dogs in hospitals are little germ machines, leaving behind happiness but also superbugs.

Have a great (hopefully superbug-free) weekend!

Kaiser Health News

BEST DEAL UPDATE:

Must-Reads Of The Week From Brianna Labuskes

Tucked away in an obit on a physicist’s death this week was the latest reality check-slash-gut punch on the state of spending in our health system. Leon Lederman, aka the man who coined the phrase “God particle,” died Wednesday at 96. A few years back, he auctioned off his Nobel Prize medal for $ 765,000 to help pay for his health care costs. What happens when you don’t have one of those lying around?

Do you need a mental break from following the play-by-play of the Supreme Court battle? Well here’s what you may have missed in health care.

If you think you can escape the phrases “Medicare-for-All” or “preexisting conditions” over the next few weeks, I’m sorry to break the bad news. Both sides have homed in on those key talking points, and we’ll be hearing a lot on both topics for the foreseeable future.

On the Republican side: Candidates are urging voters to believe they’ll preserve the popular insurance protections on preexisting conditions, but it’s difficult to convey that message while there’s a GOP lawsuit underway that would strip them away. To try to get ahead of the issue, some Republican lawmakers released a (non-binding) resolution vowing to keep the guarantees. But with no details on how they’ll accomplish it (turns out it’s hard to get insurers to just offer desserts without eating your veggies, too), the topic remains a thorn in their side.

The Washington Post: GOP Candidates Pay the Price for Attempts to Kill Obamacare and Its Guarantee of Coverage For Preexisting Conditions

The Hill: Vulnerable House Republican Unveils Resolution on Pre-Existing Conditions

(Side note: President Donald Trump did offer a way to cover costs for guaranteed preexisting conditions coverage: getting “a little more money from China.” From The Washington Post.)

Over to the Dems, who have their own vulnerabilities: “Medicare-for-All” has become something of a litmus test for Democrats, especially for progressive candidates, but that doesn’t mean the plan hasn’t left them open to attack from the right. At the same time, moderates in the party would prefer to focus on shoring up the health law.

The Wall Street Journal: Some Democrats Want Medicare for All. Others Aren’t So Sure

The Washington Post Fact Checker: GOP Ads Falsely Depict Democrats As Supporters of Sanders’s Health Plan

And, if you’d like a blast from the past (or a peek into the future?), check out the preexisting conditions checklist for Iowa Farm Bureau plans (the ones the state can sell that don’t fall under health law restrictions).

The Hill: Iowa to Sell Health Plans That Can Disqualify People Based on Pre-Existing Conditions


A lot of news coverage these days focuses on the individual marketplace, but a look at shifting costs for people who receive insurance through their employers paints a grim picture about why health care matters to many voters. Not only has the number of workers who face an annual deductible grown, but the average deductible has crept higher and higher for more than a decade.

The Associated Press: Survey: Companies Continue to Pass Health Costs to Workers

So, I’m not a negotiator. But apparently, if you can haggle, there are all sorts of lucrative clauses, side deals and kickbacks baked into the system that you can use to your advantage to get lower costs for care. Good luck! I’ll be over here wondering why we can’t all get that price.

NPR/ProPublica: Health Insurance Industry Insider to Employers: Learn to Negotiate


Hundreds of detained migrant children are being roused in the middle of the night for under-the-cover-of-darkness journeys to a tent city in West Texas. Advocates are alarmed that they’re being moved from shelters with formal schools and visits from legal representation to a pop-up tent city that has few such regulations in place.

The New York Times: Migrant Children Moved Under Cover of Darkness to a Texas Tent City

Meanwhile, a disturbing inspector general report found numerous safety violations at an immigration detention center in California, including nooses made from bedsheets in 15 of 20 cells (which were “not a high priority” to remove, guards said, per LAT’s coverage); detainees’ rotting teeth from delays to see dentists (and suggestions that they use string from their socks to floss); and more.

Los Angeles Times: Nooses in Cells, Rotting Teeth — Report Details Harsh Conditions at Adelanto Immigration Facility


Pharma failed to attach to the fast-moving opioid legislation its much-desired “doughnut hole” change, which would have let companies off the hook for paying to cover more drug costs for Medicare beneficiaries. But the industry is not giving up — and Congress might be more willing to play ball in the lame-duck session post-midterms.

Politico: Why Congress Is Poised to Give the Drug Industry a $ 4B Windfall


One street over. That’s all it took in a Washington state neighborhood for children to have a better chance of being lifted out of poverty. One street. A new, detailed (and very interesting) map looks at how location plays a part in the economic outcomes of children in low-income families. It’s also leaving advocates and city planners wondering if offering incentives to move into the neighborhoods with better statistics would be enough to change these families’ futures.

The New York Times: Detailed New National Maps Show How Neighborhoods Shape Children for Life


In the miscellaneous must-read file:

• Missouri is now down to one abortion clinic, and some of its laws are poised to land in the Supreme Court. Understanding the high-stakes legal developments that got the state to where it is a roller-coaster ride.

KCUR: Timeline: Abortion Restrictions in Missouri on a Possible Path to the U.S. Supreme Court

• Is a little radiation good for you? Like sunlight? That’s at least what Trump administration officials are betting on.

The Associated Press: Proposed Rule Change Worries Some About Radiation Regulation

• The lawsuits against Purdue Pharma have been likened to Big Tobacco’s reckoning in the 1990s. But experts see a big difference: The painkiller-maker will likely not have to pay nearly as much in the expected settlement.

Stat: Opioid Settlement Will Take Time, But May Cost Less Than the Big Tobacco Deal

• Time and again, following the money proves pretty interesting. Here’s a look at the industry behind “hardening” schools for mass shootings, and how it had stalled before the massacre in Parkland, Fla.

The Associated Press: Lawmakers Buy Industry Fix to Stop Mass School Shootings

• Australia is on track to all but eliminate cervical cancer in the coming decades. How did they do it? (Hint: It has to do with aggressive vaccination policies.)

The New York Times: In Australia, Cervical Cancer Could Soon Be Eliminated


Speaking of vaccinations, here’s your reminder to get your flu shot! Winter is coming.

Have a great weekend!

Kaiser Health News

BEST DEAL UPDATE: