Must-Reads Of The Week From Brianna Labuskes

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

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

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

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

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

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

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

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

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

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


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

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


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

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


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

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

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

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


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

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


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

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

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

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


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

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


In the miscellaneous file this week:

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

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

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

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

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

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

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

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

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

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

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

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


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

Kaiser Health News

BEST DEAL UPDATE:

Must-Reads Of The Week From Brianna Labuskes

Happy Friday and happy spring! A huge thanks to KHN Executive Editor Damon Darlin for stepping in last week as yours truly did a bit of sightseeing in the Windy City. (I now have some very shallow but gruesome trivia about Chicago’s gangster history to pull out at parties.)

Now on to what has been a rather busy health care week.

President Donald Trump handed (very delighted) Democrats a gift-wrapped talking point this week when he had the Justice Department tell the courts that the whole health law — and not just parts of it — should be nullified. It’s widely accepted that the Democrats rode a blue wave in the midterms in part because they capitalized on the popular aspects of the health law, so some (not so delighted) Republican lawmakers were caught off guard by the president’s pivot.

The announcement also set off a passive-aggressive game of “nose goes” between Senate Republicans and the president. Trump assured everyone that the lawmakers would come up with a “spectacular” replacement for the health law. Smash cut to Senate Majority Leader Mitch McConnell, who said he “looks forward to seeing what the president is proposing and what [Trump] can work out with the speaker.”

The New York Times: Trump Sided With Mulvaney in Push to Nullify Health Law

Politico: McConnell to Trump: Health Care’s All Yours

With timing that could not have been better if they’d planned it, House Democrats happened to unveil the next day their new proposal to shore up the health law. There’s not much new or different in the plan itself, but the optics of it made for some happy Dems.

The New York Times: Democrats Pivot Hard to Health Care After Trump Moves to Strike Down Affordable Care Act


And on top of all that, the Trump administration’s efforts to chip away at the Affordable Care Act took a battering in the courts this week.

First, in twin decisions, a judge rejected both Kentucky and Arkansas’ Medicaid work requirements. Kentucky’s had been, in theory, reworked from a previous rejection, but U.S. District Judge James Boasberg said he didn’t see anything new of substance that would justify giving them the green light.

The Arkansas decision wasn’t as emphatic in tone, but it might have more of an immediate impact. To comply with the judge’s order, the state immediately closed the online portal for people to report their work hours. Officials also said that even though they were about to announce a new round of cutoffs in a few weeks’ time for people who hadn’t logged their hours, no one going forward would be dropped from the rolls. The first-in-the-nation requirements, put in place last year, have resulted in more than 18,000 people in Arkansas losing coverage.

The Washington Post: Federal Judge Blocks Medicaid Work Requirements in Kentucky And Arkansas

The future may be uncertain for the rules, but this on-the-ground story about how they’re playing out in Arkansas, which is desperately hurting for jobs, is still worth a read. “I am just putting it in God’s hands,” said one woman  who had lost her Medicaid coverage. “He is going to let me stay on this Earth to see my grandbaby be raised.”

The Washington Post: A Job-Scarce Town Struggles With Arkansas’s First-in-Nation Medicaid Work Rules

The second court blow to the administration came as a judge ruled that association health plans — which offer less coverage than required under the health law — are illegal. The rule is “clearly an end-run around the ACA,” said Judge John D. Bates

The New York Times: Dealing Another Blow to Trump, Federal Judge Strikes Down Rule Skirting Requirements of Health Act


CMS Administrator Seema Verma might be the latest administration official to find herself in some ethical hot water over spending. Politico has the scoop about how Verma directed millions in taxpayer dollars to Republican communications consultants, whose job, in part, was to write her speeches and polish her own brand. The decision came, at times, over the objections of CMS staffers. Everything is aboveboard legally, but experts say the ethics involved are more murky.

Politico: Exclusive: Key Trump Health Official Spends Millions on GOP-Connected Consultants


“Medicare-for-all” might seem like the buzzword you can’t escape these days (and I don’t think it’s going anywhere soon), but what exactly would our very complicated, complex, unwieldy mess of a health system look like if we shifted to that model? The thing is, whatever ours would look like, it would still be so different from those of other countries with universal health coverage that it’s hard to know.

The New York Times: Medicare for All Would Abolish Private Insurance. ‘There’s No Precedent in American History.’


Once the Sackler family (who founded opioid maker Purdue Pharma) saw the writing on the wall with the opioid crisis — not to mention the financial reckoning that was barreling their way — they started shifting money into offshore accounts, according to the latest lawsuit against the family. New York Attorney General Letitia James is using that as a new legal angle to go after the Sacklers and Purdue, both of which are already facing a barrage of suits.

The New York Times: New York Sues Sackler Family Members and Drug Distributors

Speaking of: The company settled the Oklahoma case, which was a bellwether for how the rest of the lawsuits may play out. Purdue will pay $ 270 million — a number that many have called “woefully inadequate” — which let the opioid maker avoid the spectacle of a televised trial.

Reuters: Purdue Pharma Agrees to $ 270 Million Settlement in Oklahoma Opioid Case


The $ 50 million research behind PrEP, which helps prevent at-risk people from contracting HIV, was almost fully funded by the U.S. taxpayers. Yet it’s Gilead, the company that makes the drug, and not the federal government that raked in $ 3 billion in sales from it last year. So what happened? (Spoiler: It involves patents and the government’s failure to reach a royalty deal with the drugmaker.)

The Washington Post: Gilead Profits From Truvada HIV Treatment Funded by Taxpayers and Patented by the U.S. Government

Also make sure to check out this great read about what San Francisco has done to make such great strides at eliminating the HIV epidemic.

Los Angeles Times: Trump Pledged to End the HIV Epidemic. San Francisco Could Get There First


In news designed to enrage you: An Indian Health Service doctor who will be serving a prison term stemming from allegations that he sexually abused Native American boys in his care will still be collecting his pension while incarcerated. The total amount he’ll receive during that time: $ 1.8 million. And it would take an act of Congress to change that.

The Wall Street Journal: Pedophile Doctor Could Get U.S. Pension of More Than $ 1.8 Million While in Prison


Three apparent suicides tied to both the Parkland and Sandy Hook mass shootings stunned already devastated communities this week and highlighted just how long-lasting and complicated traumatic grief can be. The deaths sparked an outcry for more mental health help for anyone who has been touched by such an event.

Los Angeles Times: Suicides Highlight the Toll of School Shootings and the Role of ‘Complicated Grief’


In the miscellaneous file this week:

• A new report paints a grim picture of the quality of care at VA hospitals despite the amount of attention that has been given to the issue.

Boston Globe and USA Today: Bed Sores, Smeared Faces, Helplessness: New Reports Paint Dismal Picture of Care at VA Nursing Homes

• In a heartbreaking story I couldn’t look away from (even on deadline!), Stat explores what the parents of babies who die of SIDS have to go through during one of the most traumatic moments in their lives. That includes things like hospital bills and paperwork, but also questions from detectives and judgment from friends and strangers alike.

Stat: After Their Baby Died, Medical Bureaucrats Deepened Their Anguish

• In the midst of one of the worst outbreaks in the country, Rockland County, N.Y., took the unprecedented step of banning unvaccinated children from public spaces. Within the Orthodox Jewish community that this affects most, it puts a strain on an already tense relationship with the local governments.

Stat: In N.Y., a Drastic Response to a Measles Outbreak Tests Trust in Government

• The anti-abortion movement has been invigorated not only under President Trump, but also by what it sees as a friendly Supreme Court. But will the cases play out as abortion opponents expect? Recent decisions throw cold water on the enthusiasm.

The Wall Street Journal: New Anti-Abortion Measures Could Struggle for Traction in Courts

• Following yet another disappointment with potential Alzheimer’s drugs, experts are left wondering where to go next. But some say the thinking that there’s one magic cure is the problem.

The Wall Street Journal: Where Alzheimer’s Research Is Pushing Ahead


That’s it from me! Have a great weekend!

Kaiser Health News

BEST DEAL UPDATE:

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Has everyone recovered from their daylight saving time jet lag? Every year we get a whole host of articles about why changing the clocks is outdated, terrible and really quite bad for our health, and yet! Here were are, still grumpy and tired. But it’s almost the weekend, so let’s soldier on.

Here’s what you may have missed in your spring-forward daze.

President Donald Trump released his $ 4.75 trillion budget plan this week, which included a big increase in military funding and deep cuts to other domestic spending. Although the proposal will be dead on arrival in Congress, it still serves as a good road map for the administration’s priorities and Trump’s re-election campaign.

There were some health care wins, but there were also some blows, as well. At the heart of it all, critics say, are contradictions that undercut Trump’s talk about supporting certain public health causes. Take the $ 291 million budgeted for HIV, for example. Trump’s proposal allocates hundreds of millions toward the cause domestically, but then cuts global aid and chips away at programs like Medicaid, which HIV patients rely on.

Some of the health care highlights in the budget:

• Shaving $ 818 billion from projected spending on Medicare over 10 years and calling for belt-tightening within the popular program to combat “waste, fraud and abuse”;

• Cutting nearly $ 1.5 trillion from projected spending on Medicaid and transforming the program into a block grant system (a controversial idea that has received a lot of criticism in the past, even from Republican governors);

• Slashing spending on the National Institutes of Health, a longtime favorite of lawmakers of both parties, by $ 4.5 billion, with the National Cancer Institute absorbing the largest chunk of that cut;

• Increasing funding for pediatric cancer research by $ 50 million;

• Cutting HHS funding to $ 87.1 billion, which would be 12 percent less than in the spending plan Congress adopted for this fiscal year;

• Charging the e-cigarette industry $ 100 million a year in user fees that would go toward the FDA and its oversight efforts;

• And raising funding for VA medical care by nearly 10 percent.

Another interesting tidbit comes out of Politico’s reporting: HHS would be directed to steer $ 20 million toward a small children’s health program sought by one of Trump’s golfing buddies, Jack Nicklaus.

The New York Times: Trump Proposes a Record $ 4.75 Trillion Budget

The Washington Post: Springing Forward to Daylight Saving Time Is Obsolete, Confusing and Unhealthy, Critics Say

The Washington Post: Trump Pledges Support for Health Programs but His Budget Takes ‘Legs Out From Underneath the System’

Politico: Trump’s Budget Would Steer $ 20M to Jack Nicklaus-Backed Hospital Project

Democrats were less than pleased with the suggested budget. Lawmakers warned HHS Secretary Alex Azar — who bore the brunt of their ire at a hearing on Tuesday — that if Medicaid were transformed into a block grant system the change would face “a firestorm” of opposition.

The New York Times: Congress Warns Against Medicaid Cuts: ‘You Just Wait for the Firestorm’

Meanwhile, the “Mediscare” game went another round with Democrats saying that the “unbelievable” cuts fulfill long-standing Republican ambitions “to make Medicare wither on the vine.” If the accusations sound familiar to ones you’ve heard in the past, you’re not mistaken. They just might have been coming from Republicans. The Washington Post Fact Checker untangles it all to show that everyone is guilty of playing this particular scare game.

The Washington Post Fact Checker: Democrats Engage in ‘Mediscare’ Spin on the Trump Budget


Following FDA Commissioner Scott Gottlieb’s surprise resignation announcement, Dr. Ned Sharpless has been named as the acting chief of the agency. Sharpless’ current work as the director of the National Cancer Institute has focused on the relationship between aging and cancer, and the development of new treatments for melanoma, lung cancer and breast cancer.

The appointment was a bit of a curveball for some agency watchers. Some Republicans had been chafing at the way Gottlieb embraced his pro-regulation side as commissioner and were hoping for a sea change. But Sharpless is a Democrat who has spoken out before about how his worries over the e-cigarette industry keep him up at night, so the direction of the agency may not be changing soon. (HHS Secretary Alex Azar has said this is a temporary appointment and the search for a permanent commissioner is underway, but there are also hints that Sharpless could step into the role.)

Colleagues were quick to praise the cancer doctor and research veteran for his breadth of experience and his “approachable, objective” demeanor.

Stat: How Ned Sharpless, Biotech Veteran, Vaulted to the Top of the FDA

No one can accuse Gottlieb of getting whatever the professional version of “senioritis” is, despite the fact that he’ll be departing in a few weeks. The FDA has issued a proposal that would sequester flavored e-cigarettes to areas off-limits to anyone under age 18. The stores can still sell tobacco, mint and menthol e-cigarettes, which the FDA says are more popular among adults than minors.

The New York Times: F.D.A. Moves to Restrict Flavored E-Cigarette Sales to Teenagers


Beto O’Rourke is the latest Democrat to throw his hat in the ring for 2020, but can the moderate Texan overcome his baggage when it comes to his past opposition to the Affordable Care Act? In terms of his current stance, he has said that he supports universal health care, but has, like other moderates in the race, taken pains not to name “Medicare-for-all” in particular.

The Wall Street Journal: Beto O’Rourke’s Past GOP Ties Could Complicate Primary Run


The Connecticut Supreme Court has now cleared the way for Sandy Hook families to sue gunmakers over wrongful marketing. In the lawsuit, the families pointed out ads with slogans like “Consider your man card reissued,” which they say is specifically targeted for troubled young men like Adam Lanza. The ruling is fairly narrow and limited to marketing — the justices dismissed other aspects of the lawsuits — but could have far-reaching ramifications because it strips away some of the blanket immunity offered to gun manufacturers by Congress.

The New York Times: Sandy Hook Massacre: Remington and Other Gun Companies Lose Major Ruling Over Liability


Lawyers are starting to warn their clients who have filed disability claims with the government to clean up their social media because Uncle Sam might start snooping for fraud. “You don’t want anything on there that shows you out playing Frisbee,” one said. Advocates for people with disabilities say using social media sites in such a way would be irresponsible, as it’s impossible to gauge just from the pictures people post if they need disability aid.

The New York Times: On Disability and on Facebook? Uncle Sam Wants to Watch What You Post


In the miscellaneous file for the week:

• Calls for a worldwide moratorium on gene-editing human embryos expose the ethical divide over the research, which has been thrust into the spotlight following a Chinese scientist’s shocking and unexpected revelation that he successfully accomplished the feat.

Reuters: Experts Call for Halt to Gene Editing That Results in ‘Designer Babies’

• An entrenched culture of sexism at VA facilities has led female veterans to forgo needed care in order to avoid harassment. “It’s like a construction site,” said Rep. John Carter (R-Texas).

The New York Times: Treated Like a ‘Piece Of Meat’: Female Veterans Endure Harassment at the V.A.

• Court filings detail Johnson & Johnson’s role in the opioid epidemic, including accusations that the company operated like a drug “kingpin … profiting at every stage.’’

Bloomberg: US Opioid Drug Epidemic: J&J Called ‘Kingpin’ by Oklahoma

• The cost of this Oregon child not getting vaccinations? $ 800,000 in medical bills and 57 days in the hospital. The terrifying ordeal shows how quickly a small cut can spiral into a devastating emergency.

The New York Times: An Unvaccinated Boy Got Tetanus. His Oregon Hospital Stay: 57 Days and $ 800,000.

• Medical ethicists were given a lot to think about this week: In this case, it’s examining the tough decisions that come from deciding to extract sperm from a deceased loved one. While some support the choice if it’s a spouse, what happens if it’s the parents who are making the call?

Stat: Efforts to Save the Sperm of the Dead Bring Heartache and Tough Questions

• Is there a chilling effect on disease research when social media activists engage in thought-policing? Scientists say yes, and that, ultimately, the patients are the ones getting hurt.

Reuters: Special Report: Online Activists Are Silencing Us, Scientists Say


Doctors say our oversanitized culture does no favors to our immune system. (I have been pounding this drum for years, so I had to include this story.) The next time you drop some food on the floor, apparently the right move is to embrace the three-second rule and eat it. Have a great weekend!

Kaiser Health News

BEST DEAL UPDATE:

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Headline writers across the world (read: yours truly) breathed a sigh of relief this week when the venture formally known as “the health initiative founded by Amazon, Berkshire Hathaway and JPMorgan Chase” finally picked a name. After more than a year of tight-lipped secrecy, they settled on “Haven.” What do you guys think? I’m just thankful it’s short.

On to what you may have missed this week!

FDA Commissioner Scott Gottlieb sent shock waves through Washington and the industry when he announced he’ll be retiring at the end of the month. Gottlieb was a standout in the anti-regulatory, pro-business Trump administration as one of the most activist commissioners in recent years. Over the past two years, he has launched what could be termed a crusade against teen vaping — his most recent action coming just the day before the announcement, when he called out Walgreens and gas stations for selling tobacco products to minors — and cracked down on “miracle cures” and unregulated stem cell clinics and supplements, among other initiatives. Public health advocates are fretting that with him gone, some of the progress they’ve seen will be chipped away.

The departure is also a blow to the administration in that Gottlieb is a highly liked health official who worked well with Congress, winning over even Democratic lawmakers on Capitol Hill. Behind the scenes, he was known as someone who was “accessible,” would field lawmakers’ questions and was actively working on things that would make Congress happy. “I’ve never seen an administration official, Republican or Democrat, that has worked with the Hill so well on a bipartisan basis,” a senior congressional aide told Stat.

That’s not to say he didn’t have his critics. A decision on approving a powerful opioid late last year, in particular, drew fire from many advocates.

Gottlieb said his decision to leave was based on the fact that he missed spending time with his family, and White House officials confirmed that President Donald Trump did not seek the resignation.

Now the big question is: Who is going to replace him?

Stat: With Gottlieb’s Resignation, the Trump Administration Loses Its Backroom Whisperer on Capitol Hill

Politico: ‘Something Very Rare’: FDA’s Gottlieb Aggressively Tackled Difficult Issues

Stat: The Likely, Possible, and Longshot Contenders to Replace Gottlieb at FDA


As expected, legal challenges to the administration’s changes to the family planning rules came not in a trickle but a flood. California Attorney General Xavier Becerra, in his 47th lawsuit against the administration, said the rules restricting abortion referrals were like something out of 1920 and not 2019. Apart from California’s case, 20 states and D.C. announced they will be filing suits. Then came the announcement that Planned Parenthood Federation of America and the American Medical Association will also challenge the restrictions, deeming the changes a “domestic gag rule” and an overreach from the administration.

The New York Times: California Sues Trump Administration to Block Restrictions to Family Planning Program

The Washington Post: Planned Parenthood, American Medical Association Sue Trump Administration Over Abortion ‘Gag Rule’


Facing increasingly intense outrage over insulin prices, Eli Lilly has decided to offer an authorized generic version of its drug for half the cost. Stories of people dying after they rationed newly pricey insulin have been circulating with ever-increasing frequency, and lawmakers have made it their priority to specifically rout out answers about insulin price hikes. In that context, Eli Lilly’s move here seems more damage control than charitable, but it also puts them in good company with drugmakers who have been hotfooting it to avoid whatever worse would come out of Congress if they don’t make some changes.

Stat: Lilly Will Sell a Half-Price Version of Its Insulin. Will It Appease Critics?


Former Colorado Gov. John Hickenlooper officially threw his hat into the narrowing 2020 field this week. Hickenlooper seems to gravitate more toward the moderate wing of the Democratic Party, saying he supports universal health care in principle but refusing to get behind a “Medicare-for-all” plan. His evolution on gun control (as a governor who oversaw a mass shooting in the state where Columbine occurred) is also worth checking out.

The New York Times: John Hickenlooper on the Issues


There has always been a gap swallowing people who make too much for health law subsidies or Medicaid but not enough to comfortably afford insurance through the exchanges. A new county-by-county analysis looks at just how tough it is for the people who fall into the holes created by the ACA. A particularly striking figure? In almost all of Nebraska, a 60-year-old with a $ 50,000 income would pay from 30 to 50 percent of that income in premiums for the least expensive ACA health plan.

The Washington Post: ACA Premiums Rising Beyond Reach of Older, Middle-Class Consumers

Meanwhile, the Trump administration is interested in bolstering interstate insurance sales despite there being little appetite for it in the past and experts saying it wouldn’t lower premiums. In fact, the practice is already allowed under the health law, and no one does it because insurers think it’s just not worth it.

The Wall Street Journal: Trump Administration Looks to Jump Start Interstate Health-Insurance Sales


A teenager who got vaccinated against his mother’s wishes was the star witness at a hearing this week sparked in part by the measles outbreak. Ethan Lindenberger, a high school senior, hoisted the blame for his mother’s deeply rooted beliefs squarely on Facebook’s shoulders.

The anti-vaccination movement has long flourished on Facebook, partly because of the site’s search results and “suggested groups” feature. On Thursday, the company announced it has developed a policy to try to curb that culture of misinformation on vaccines, saying it will rank pages and groups that spread that kind of information lower and will keep them out of recommendations or predictions in search.

The Washington Post: Ethan Lindenberger: Facebook’s Anti-Vax Problem Intensified in Congressional Testimony

The New York Times: Facebook Announces Plan to Curb Vaccine Misinformation


After 12 long years, scientists finally announced that a second patient appears to have been cured of HIV. While the news was well-welcomed around the world — “This will inspire people that cure is not a dream,” said Dr. Annemarie Wensing, a virologist — there are some practical obstacles to consider. For example, bone marrow transplants (which is how both patients were cured) are extremely risky, especially since there are drugs that exist that can control HIV fairly well.

The New York Times: H.I.V. Is Reported Cured in a Second Patient, a Milestone in the Global AIDS Epidemic


In a scathing ruling that could have wide-reaching ramifications for the insurance industry, a judge blasted UnitedHealth Group for policies that he says were aimed at effectively discriminating against patients with mental health and substance abuse disorders to save money. The decision is part of a larger debate over parity in relation to coverage for mental health services versus other illnesses like diabetes. Insurance companies have been getting around parity requirements with internal rules, but advocates are viewing the judge’s ruling as a warning shot that those loopholes will no longer be tolerated.

The New York Times: Mental Health Treatment Denied to Customers by Giant Insurer’s Policies, Judge Rules

The FDA this week approved a cousin of party drug “Special K” to help people with severe cases of depression, marking a shift away from traditional antidepressant medications. While many said the news would give hope to desperate patients, others are worried about the potential for abuse.

The New York Times: Fast-Acting Depression Drug, Newly Approved, Could Help Millions


Honorable mention for International Women’s Day: A veritable “tsunami wave of women veterans” over the past several years is forcing the VA to step up in terms of meeting female-specific health care needs. Among basic issues are seeing to it that doctors are trained to deal with gynecological matters and ensuring that VA facilities have child care services available when female veterans come in for appointments.

The Wall Street Journal: As More Military Women Seek Health Care, VA Pursues Improvements


In the miscellaneous file for the week:

• Nearly 600,000 children have dropped off of states’ Medicaid and CHIP rolls over a one-year span. While states rush to assure anyone asking that it’s because the economy is improving, public health experts are alarmed at the disturbing trend.

Stateline: Child Enrollment in Public Health Programs Fell by 600K Last Year

• In a “craning your neck at the car wreck” sort of way, this profile on disgraced pharma bro Martin Shkreli is a wild read. Through the help of a contraband smartphone, Shkreli is, from his prison cell, still pulling the strings at his old company, schmoozing up his prison friends “Krispy” and “D-Block,” and planning his big comeback.

The Wall Street Journal: Martin Shkreli Steers His Old Company From Prison — With Contraband Cellphone

• Last year, doctors burst onto the gun-debate scene through the help of a viral tweet that directed them to “stay in their lane.” But a new analysis provides an interesting look at which lawmakers are getting the most money from physician-related PACs. (Hint: It’s overwhelming ones who are against tighter gun regulations.)

The Wall Street Journal: Doctors’ PACs Favored Candidates Opposing Gun Background Checks

• In slightly terrifying news, research that was halted over concerns it could create deadly flu viruses that could be used by terrorists was just given the green light again —without any explanation as to why. *Gulp*

The New York Times: Studies of Deadly Flu Virus, Once Banned, Are Set to Resume

• Everyone is expecting a big settlement in the sweeping opioid case against Purdue Pharma. But what happens if the opioid maker declares bankruptcy first?

Stat: If Purdue Pharma Declares Bankruptcy, What Happens to the Opioid Cases?

• Luke Perry’s early death from a stroke this week has many middle-aged Americans worried.

The New York Times: Here’s How Strokes Happen When You’re As Young As Luke Perry

• Drug companies and doctors are in a dirty war over fetal transplants. It may seem click-baity at first, but the issue is highly revealing of how the health industry works when it comes to something that could make people lots of money.

The New York Times: Drug Companies and Doctors Battle Over the Future of Fecal Transplants


That’s it from me! Have a great weekend!

Kaiser Health News

BEST DEAL UPDATE:

Must-Reads Of The Week From Brianna Labuskes

Happy first day of March! Yours truly could barely keep up with all the news coming off Capitol Hill this week (yes, there were other things going on besides a certain high-profile hearing, as hard as that is to believe). So let’s get right to it!

Seven Big Pharma executives were hauled in front of Congress this week during a Senate Finance Committee hearing on high drug prices. Everyone expected fireworks. The executives were lawyered to the gills, preparing for a public flogging the likes of which Big Tobacco and Big Banks have received in years past. Lobbyists packed the room, media jostled for positions, advocates of all stripes were watching with bated breaths. And then … nothing. Those fireworks amounted to nothing but fizzled sparklers. So what went down?

The executives’ strategy going in was essentially their version of: don’t hate the player, hate the game. The rebate system is broken, they argue. It’s not our fault, it’s the pharmacy benefit managers who are the root of all evil. In response to any tough line of questioning, they pivoted to old arguments, making sure to highlight the innovation and cures coming out of their companies.

Overall, the hearing lacked the grandstanding that’s been par for the course for lawmakers who see it as a winning issue with voters. Muted and respectful seemed to be the most common descriptors, and at the end of the day, not much was resolved, leaving some wondering what exactly the point was.

Stat: In Muted Hearing, Pharma Execs Dodge Attempts to Pin Blame for High Prices

Stat: Who Shined and Who Sank: How 7 Executives Fared in Defending Pharma

Side note: Even though the hearing has passed, this Stat piece on the “dark and elaborate art” of preparing for a congressional grilling is a fun read.

Stat: How Pharma Executives Are Preparing for Tuesday’s Congressional Grilling


To much fanfare, progressive Democrats in the House rolled out their ambitious “Medicare-for-all” plan this week. Here’s the meat of the bill: health care would be available to all Americans without premiums, copayments, deductibles or similar charges. There would be a two-year span of moving consumers over to a government insurer, and then people would be automatically enrolled at birth. It would be illegal for a private health insurer or an employer to provide the same medical insurance benefits as the new program. And the bill includes a crackdown on the pharmaceutical industry aimed at lowering drug prices, as well as the creation of a new government-run long-term care program to help people with disabilities.

The legislation is mostly symbolic, as it faces certain death in the Senate. But it also serves as the signal that progressives are drawing battle lines, as cracks continue to deepen in the Democratic Party. Leadership is walking a tightrope trying to keep the far-left happy, but also to mitigate any political fallout that could come from the aggressive proposal. Progressives, meanwhile, thrilled and invigorated from their announcement, are charging full-tilt in the direction they see their voters wanting to go.

The New York Times: As Over 100 House Democrats Embrace ‘Medicare For All,’ A Party Division Appears

Politico: Establishment Dems Give Medicare-For-All the Brush Off

As that all plays out, the health industry is quietly assembling a small army of lobbyists to kill the idea.

The New York Times: Health Care and Insurance Industries Mobilize to Kill ‘Medicare for All’


The House passed two gun control bills (both closing gaps in background checks) this week in what is the most sweeping legislation on the issue in decades. That sounds impressive, and is more than lawmakers have attempted in the past, but advocates say that Democrats, despite feeling more emboldened on guns, are still carefully and strategically picking their fights. And those fights usually have to do with low-hanging fruit, such as the above-mentioned restrictions on background checks or the “boyfriend loophole,” which allows some domestic abusers to own guns.

CNN: House Passes ‘Charleston Loophole Bill’ on Gun Background Checks

The Washington Post: Hard-Charging Democrats’ Cautious Strategy on Gun Control Reflects Limits of Political Change


Scott Lloyd, former head of the HHS Office of Refugee Resettlement and a controversial figure who has avoided testifying in front of Congress for months, finally faced lawmakers Tuesday. During the hearing, Lloyd admitted he hadn’t passed on information to his superiors regarding the psychological trauma of the separations. It also emerged that there have been at least 4,500 accusations of sexual abuse and harassment of migrant children in government-funded shelters over the past four years.

The Associated Press: At Least 4,500 Abuse Complaints at Migrant Children Shelters

Meanwhile, the House Oversight Committee voted to subpoena Trump administration officials over the family separations. “I believe this is a true national emergency,” said Chairman Elijah Cummings of Maryland. Federal officials however, say they’ve already sent over thousands of pages of documents and wrote off the subpoenas as a “political stunt.”

The Associated Press: House Targets Family Separations in First Trump Subpoena


Minnesota Sen. Amy Klobuchar, a 2020 hopeful, has built a reputation for herself as a champion for consumers. But her long history with the medical device industry may throw a wrench in that particular talking point.

The Associated Press/International Consortium of Investigative Journalists: Klobuchar Defends Her Record on Regulating Medical Devices


There was so much movement in the states this week on abortion that I’m going to link you guys to the newsletter roundups instead of individual stories. One trend to note is that red states are getting a move on with “trigger laws.” The measures would essentially ban — to different extents, depending on the state — abortion the minute Roe v. Wade were overturned. It might be posturing, but the uptick provides insight into just how high the anti-abortion movement’s hopes are these days. At the federal level, Democrats blocked a bill that would have threatened prison for doctors who don’t try saving the life of infants born alive during abortions.

Oklahoma Moves Forward Measure That Would Automatically Ban Abortions In State If Roe Is Overturned

The Associated Press: Dems Block Senate GOP Bill On Infants Surviving Abortions

Fact Checking Rhetoric On Infants Surviving Abortions: Babies Are Rarely Born Alive And When They Are Doctors Don’t Kill Them

And in case you missed it late last week: The Trump administration announced that it will cut off family planning funding for organizations that offer abortion referrals. The move was largely viewed as targeting Planned Parenthood, and it has already drawn court challenges.

The New York Times: Trump Administration Blocks Funds for Planned Parenthood and Others Over Abortion Referrals


Time’s Up for the health care industry: The organization formed by women in the entertainment industry to deal with sexual harassment and assault is turning its attention to health care. After a string of shocking stories about doctors’ inappropriate behavior, advocates say it’s important to look at the environment that spawned them. “They had a rich petri dish,” says Dr. Esther Choo, one of the doctors in the eight-person steering committee leading the effort. Choo went on to liken the atmosphere in hospitals and medical facilities to that of locker rooms.

In Style: Time’s Up Takes on Sexual Abuse and Discrimination in Healthcare

Stat: Time’s Up Targets Gender Bias and Harassment in Health Care

On that note, a science conference sparked fierce backlash when it made the point to invite only women to speak at the event. Critics said it violated anti-discrimination policies, but the organizers defended the decision as wanting to show that it could be done.

Stat: A Science Conference Invited Only Women on Stage. Then Came a Backlash


In this very busy news week, I have quite a full miscellaneous file for you:

• Why are there so many stories of uber-successful bosses exhibiting bullying behavior? It’s been shown that it’s a terrible management style in terms of eking out productivity from workers, and yet the behavior persists.

The New York Times: When the Bully Is the Boss

• If you are not following along with the Insys opioid trial in Massachusetts, you’re doing yourself a disservice. It is a train wreck of terrible revelations, including this week’s, which is that the call center designed to help patients with reimbursements was essentially built all on lies.

Bloomberg: Insys Call Center Revealed at Trial as Hotbed of Opioid Lies

• Speaking of revelations, the dirty laundry between Anthem and Cigna is being aired at court proceeding over their failed merger, and Anthem isn’t pulling any punches. The company says Cigna did everything in its power to sabotage the deal, calling Cigna CEO David Cordani a “bully.” It’s an interesting peek inside the inner workings of a huge health care merger.

Bloomberg: Anthem Says Bid to Save $ 49 Billion Deal Was ‘Cut Off at Knees’

• Readers of The Friday Breeze are well aware that medical scams and too-good-to-be-true “miracle cures” are thick on the ground these days. So how do you protect yourself?

The Washington Post: How to Stay Up-to-Date on Medical Scams, Quackery, Deadly Treatments

• While on the topic of scams: Check out this hilarious article about a health care reporter who was offered a “Top Doctor” award for the low, low cost of $ 289. (Hint: He is not a doctor.)

ProPublica: I’m a Journalist. Apparently, I’m Also One of America’s ‘Top Doctors.’

• Why do hospital patients who have scheduled procedures get prioritized for hospital beds over actual emergencies? If you guessed for financial reasons, you’d be right.

The Washington Post: Sorry, ER Patients. People With Elective Procedures Get the Hospital Beds First.

• And a quick plug for KHN’s new database that lets you look up if your hospital was hit with a penalty from Medicare. It’s super snazzy, so make sure to check it out!

Look Up Your Hospital: Is It Being Penalized By Medicare?


Have a great weekend, and be safe if you’re out there walking around! Pedestrian deaths have skyrocketed to the highest rate in decades.

Kaiser Health News

BEST DEAL UPDATE:

Must-Reads Of The Week From Brianna Labuskes

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

On to the news from the week.

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

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

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

The Associated Press: Parkland Anniversary Highlights Democratic Shift on Guns

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

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

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

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


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

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

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

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

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


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

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


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

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


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

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


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

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

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

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

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

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

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


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

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


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

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

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

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


In the miscellaneous file for the week:

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

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

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

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

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

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

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

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


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

Kaiser Health News

BEST DEAL UPDATE:

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! It seems we have a new example of just how broken the health system is every week, and here’s today’s: A school superintendent was arrested after allegedly using her insurance to cover a sick student. She took him to the clinic after noticing he had signs of strep throat, and then filled a prescription for him. The total cost of the claim? $ 233. Now she’s facing felony charges.

(It should be noted, though, that she is being put on a pretrial diversion program, so the charges may be expunged from her record.)

Here’s what else you might have missed this week:

While health care has been somewhat insulated from the shutdown, the industry hasn’t been immune — and insurers, providers and others are starting to fret. For one, the standoff could rock the (just-starting-to-stabilize) health law marketplace because IRS staffing shortages may jeopardize tax credits for people who rely on them to subsidize their care. On top of that, it could delay application reviews for people eligible to sign up for coverage outside of open enrollment. What’s more, we’re nearing the time when insurers need to make crucial decisions on participating in the exchanges next year, but rule-making delays leave them without any guidance.

The Wall Street Journal: Shutdown Poses Risk to Health Care


New polling shows the country’s uninsured rate has climbed to a four-year high, and, as you can probably imagine, both sides of the aisle were eager to point fingers at each other. The talking points were similar to the messaging we’ve heard for years: Republicans said it’s the fault of the health law being inherently unsustainable, while Democrats blamed the administration’s “sabotage” efforts.

The New York Times: After Falling Under Obama, America’s Uninsured Rate Looks to Be Rising


The idiom “the devil’s in the details” was never more true than in this week’s poll gauging what Americans think of “Medicare-for-all.”

The majority of people support the idea in theory (56 percent, which shoots up higher when framing MFA as a guarantee of health insurance as a right). But when the cons were laid out (it could lead to delays in care and an increase in taxes, for example) that number plunged.

The results seem to reflect the core debate that’s been going on within the Democratic Party in general: Everyone deserves health care, progressives say. The moderates respond: Yes, but how do we pay for it?

Whatever the mixed messages from the public are, 2020 contenders certainly see it as a winning issue.

The Associated Press: Poll: Support for ‘Medicare-for-All’ Fluctuates With Details

Politico: Democrats’ Plan to Neuter Medicare for All Irks Liberals

The Associated Press: Democrats Lurch Left on Top Policies As 2020 Primary Begins


As you Breeze readers know, insulin has become the poster child for the outrage over high drug costs (it’s an old drug that shouldn’t be expensive, lots of people need it, patients can die if they have to ration it).

Well, a new study gives some hard numbers to back up that anger. The average cost per patient for insulin nearly doubled over a five-year span — even though there haven’t been improvements to justify that increase. In a quote that sums it up (from Stat’s coverage): “It must be nice to be part of the American economy where you can raise the price of your product almost 100 percent over five years,” said Niall Brennan, who heads the Health Care Cost Institute.

Stat: Patients’ Insulin Costs Doubled From 2012 Through 2016, But Usage Was Flat

If consumers are dinged for buying a brand-name drug when a generic version is available, will it change their patterns of behavior? That’s what a new strategy from the Trump administration could be relying on. Under the new proposal, if a person filled a prescription for a brand-name drug with a $ 25 copayment, rather than using a generic medicine with a $ 5 copayment, the consumer might get credit for only $ 5 in out-of-pocket spending. That means they would have to pay more out-of-pocket before hitting their annual limits.

The New York Times: Trump Proposals Could Increase Health Costs for Consumers

And in a sign that Big Pharma is reading the tea leaves and starting to sweat a bit, the industry’s big trade group, Pharmaceutical Research and Manufacturers of America, of PhRMA, disclosed that it spent a record amount in 2018.

Bloomberg: Big Pharma Lobby Group Spent Record Amount As Reform Push Grows


How does a midlevel executive who’s never even met the CEO of a company spark a trade secrets lawsuit? By joining the health venture led by Dr. Atul Gawande and launched by Amazon, Berkshire Hathaway and JPMorgan. The lawsuit filed by Optum is a glimpse into how worried the health industry is about this new potential threat, which has been mostly shrouded in secrecy.

Stat: Lawsuit Involving Gawande Venture Raises A Question: Who Counts As a Threat?


The Supreme Court lifted an injunction against the Trump administration’s restrictions on transgender troops as the case continues to work its way through the courts. Court watchers suggest that the conservative justices may have been swayed by the complaint that injunctions coming from lower courts (which, according to the solicitor general, were “previously rare”) have become a growing trend.

The New York Times: Supreme Court Revives Transgender Ban for Military Service


President Donald Trump plucked at some low-hanging fruit this week by announcing he wants to eliminate surprise medical billing. The topic has garnered a lot of attention lately with eye-popping personal stories about bills north of $ 100,000. The good news for Trump is that there’s already bipartisan legislation that’s been introduced in Congress.

The Hill: Trump Calls for Cracking Down on Surprise Medical Bills

Meanwhile, Vox’s Sarah Kliff has spent the past year investigating emergency room billing, and she breaks down why it can be such a nightmare.

Vox: Sarah Kliff Answers 7 Key Questions About Why American Health Care Is So Screwed Up

(P.S. Make sure to check out KHN and NPR’s excellent “Bill of the Month” series on just this topic.)


In the miscellaneous file for the week:

• Have you ever gotten the flu shot, felt proud of yourself for being a responsible adult and then … gotten the flu anyway? It used to be that doctors said the vaccine must have been a bad match for the strain going around, but the problem really might be … you.

Stat: Flu Science Points to Another Culprit When Vaccines Fail — Us

• The Los Angeles Times follows an abortion doctor in California who travels to Texas once a month to perform the procedure.

Los Angeles Times: 60 Hours, 50 Abortions: A California Doctor’s Monthly Commute to a Texas Clinic

• Anti-rejection medicines have undoubtedly saved many lives — before the drugs, organ transplants were nearly impossible. But they do take an enormous toll on the body. Within 10 years of a liver transplant, 35 to 40 percent of patients will die, in part from the anti-rejection meds. Scientists are hoping there’s a better way.

The New York Times: Scientists Are Teaching the Body to Accept New Organs

• A Chinese scientist’s decision to edit human embryos’ genes may have sent shock waves through the research world, but the announcement didn’t come as a surprise to everyone. In fact, others knew about the work, warned him off of it and were left with nowhere to turn to stop the rogue scientist.

The New York Times: How to Stop Rogue Gene-Editing of Human Embryos?

• Kalief Browder was a young man from the Bronx when he was arrested over accusations that he stole a backpack. He was detained on Rikers Island for three years without being tried or convicted of a crime — and spent two of those years in solitary confinement. Now his suicide is shining a light on the mental health crisis in prisons.

The New York Times: Kalief Browder’s Suicide Brought Changes to Rikers. Now It Has Led to a $ 3 Million Settlement.

• A new study finds a link between gum disease and Alzheimer’s. Scientists have to dig deeper whether its correlation or causation, but it never hurts to floss in the meantime!

The Hill: Gum Disease Bacteria May Be Cause of Alzheimer’s: Study


Have a great weekend!

Kaiser Health News

BEST DEAL UPDATE:

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

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