KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Kaiser Health News Original Stories

Political Cartoon: 'Now That You Mention It'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Now That You Mention It'" by Hilary Price.

Here's today's health policy haiku:


Unplanned pregnancies
Are a public health concern.
Here’s an idea.

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Summaries Of The News:

Health Law Issues And Implementation

Obama Urges Fixes To Signature Legislation: It Isn't Perfect -- But 'No Law Is'

The president spoke of the law's successes while also urging lawmakers and governors to make the changes necessary to make it better. "When one of these companies comes out with a new smartphone and it had a few bugs, what do they do? They fix it," he said. "You don’t say, well, we're repealing smartphones."

The Associated Press: Obama: Health Care Law Worked, But Improvements Needed
President Barack Obama on Thursday defended his namesake health care program, long a target of Republicans and recently criticized by some Democrats, saying millions of Americans "now know the financial security of health insurance" because of the Affordable Care Act. "It's worked," he said, even while allowing that the program isn't perfect. "No law is." (Superville, 10/20)

USA Today: Obama Offers Prescription For Affordable Care Act 'Growing Pains'
President Obama acknowledged "growing pains" with his signature health insurance law on Thursday, offering a number of proposals that he said would expand health insurance and reduce premiums. ... He compared it to a "starter home" that needs improvements over time, and even to the Samsung Galaxy Note 7, a smartphone recalled last month after they started catching fire. "When one of these companies comes out with a new smartphone and it had a few bugs, what do they do?  They fix it. They upgrade, unless it catches fire. Then they pull it off the market," he said. "But you don’t go back to using a rotary phone. You don’t say, well, we're repealing smartphones." (Korte, 10/20)

The Washington Post: Obama Says The Affordable Care Act Works But Has Affordability ‘Growing Pains’
The president said rising premiums and diminished competition in ACA insurance exchanges in some states are especially problematic for people who do not qualify for federal subsidies that the law provides. He proposed that his successor in the White House and the next Congress provide larger tax credits to encourage young adults to buy coverage through the marketplaces and raise the income thresholds to make the subsidies available to more middle-class families. (Goldstein, 10/20)

Politico: Obama Defends Obamacare, Acknowledges Problems With The Law
Obama renewed calls for every state to expand Medicaid, which 19 states have refused to do. Roughly 4 million low-income Americans would be eligible for coverage if every state adopted Medicaid expansion. In addition, Obama reiterated support for a government-run insurance plan that could bolster competition in the Obamacare marketplaces. Without offering specifics, Obama also called for additional subsidies to make coverage more affordable. Both ideas have encountered strong resistance from Republicans. (Demko, 10/20)

Modern Healthcare: Obama Calls For Public Option, More Subsidies To Improve ACA 
Obama on Thursday said there should be more premium tax credits for middle income families who currently make too much money to qualify for a subsidy. He also said there should be a fallback public option for states where there is not enough competition among insurers. Clinton has campaigned on this idea, but it would probably only be possible at a state level, especially if Republicans retain control of the House. (Muchmore, 10/20)

The Hill: Obama Confronts ‘Growing Pains’ Of Healthcare Law 
He carefully sought to separate that criticism from the inflamed political rhetoric of the GOP, blasting the House for voting 60 times to repeal Obamacare without producing a replacement bill. And he was quick to blame Republican leaders in statehouses across the country for blocking some of the law’s central programs, such as Medicaid expansion and state-run marketplaces. (Ferris and Fabian, 10/20)

The Wall Street Journal: Obama Defends Health-Care Law
Republicans pointed to some of the law’s challenges before Mr. Obama even finished the speech, delivered at Miami Dade College. “Obamacare is collapsing. Insurance companies are abandoning the program, leaving stranded families to face higher premiums and fewer choices,” said Wyoming Republican Sen. John Barrasso, in a statement sent out about halfway through the remarks. (Radnofsky, 10/20)

Politico Pro: GOP Rebuffs Obama's Entreaties To Fix Health Law 
Republicans have been bashing Obamacare for more than six years and there is no sign that they’re going to break that habit — let alone vote for legislative repairs. House Speaker Paul Ryan said Thursday that the law “can’t be fixed.” Obamacare is the reason “we’ve seen record premium hikes,” Ryan said in a statement. “That's why millions of people—including millennials—have lost their plans, or been forced to buy plans they don’t like. That's why we've seen waste, fraud, and abuse. And at this point, one thing is clear: This law can't be fixed.” (Haberkorn, 10/20)

Minnesota Residents Should Shop For Insurance Early To Avoid Enrollment Caps

Insurance analysts warn that some plans could fill up in a matter of weeks. In other regional insurance news, some Missouri companies are dropping domestic partner coverage, saying they are no longer necessary as same-sex couples can now legally wed.

Pioneer Press: What To Know About Enrollment Caps On Minnesota Health Insurance Plans
To avoid being locked out of the health plan they want, Minnesotans buying insurance on the individual market will need to shop early next month.That’s because all but one of the plans selling insurance on Minnesota’s individual market have set enrollment caps — and could fill up in a matter of weeks.“ The choices are going to be so incredibly limited,” said Heidi Mathson, past president of the Minnesota Association of Health Underwriters, which represents insurance agents and brokers. “I think those caps are going to be met very quickly.” This means options for health insurance could narrow to one or two choices soon after the open enrollment period begins Nov. 1. (Montgomery, 10/20)

St. Louis Post Dispatch: Employers Drop Domestic Partner Coverage, Citing Legalization Of Same-Sex Marriage 
As many local companies head into open enrollment season, some employees may notice that their employer is no longer offering domestic partner coverage. The shake-up comes in the wake of the Supreme Court decision that now allows same-sex couples to legally marry. For many employers, extending domestic partner coverage was viewed as a workaround, a way to offer same-sex couples benefits that married couples were enjoying. (Liss, 10/20)

Administration News

Watchdog: EPA Lacked Urgency On Flint, Failed In Oversight Role

The agency had sufficient authority to issue an emergency order as early as June 2015, but it didn't take action until January 2016, the report finds.

The New York Times: E.P.A. Waited Too Long To Warn Of Flint Water Danger, Report Says
In a pointed rebuke to the Environmental Protection Agency, an internal watchdog concluded on Thursday that the agency should have acted more swiftly to warn residents of Flint, Mich., that their water was contaminated with lead. The report, issued by Arthur A. Elkins Jr., the inspector general for the E.P.A., blamed the federal government for inaction in Flint, echoing the sentiments of many Republicans who have said for more than a year that the agency failed in its oversight role. (Bosman, 10/20)

NPR: Watchdog: EPA Action To Protect Flint Residents From Lead Was Delayed 7 Months
By June 2015, the EPA regional office "had information that the city of Flint exceeded the lead level at which corrosion control is required, and that Flint was not using a corrosion inhibitor." It also knew that testing showed high levels of lead in at least four homes. Finally, the regional office "knew that the state and local authorities were not acting quickly to protect human health." That is enough to issue an emergency order, the report says. (Kennedy, 10/20)

The Associated Press: Watchdog: EPA Delayed For 7 Months In Flint Water Crisis
The Environmental Protection Agency had sufficient authority and information to issue an emergency order to protect residents of Flint, Michigan, from lead-contaminated water as early as June 2015 — seven months before it declared an emergency, the EPA's inspector general said Thursday. The Flint crisis should have generated "a greater sense of urgency" at the agency to "intervene when the safety of drinking water is compromised," Inspector General Arthur Elkins said in an interim report. (10/20)

The Washington Post: EPA Should Have Intervened In Flint Water Crisis Months Earlier, Watchdog Says
“These situations should generate a greater sense of urgency,” Inspector General Arthur A. Elkins said in a statement Thursday. “Federal law provides the EPA with the emergency authority to intervene when the safety of drinking water is compromised. Employees must be knowledgeable, trained and ready to act when such a public health threat looms.” Thursday’s findings come amid a broader inquiry into the federal agency’s actions in Flint. Elkins recommended the EPA update its 25-year-old internal guidance on the use of that emergency authority and require drinking-water staff to attend training on when to use it. (Dennis, 10/20)

Capitol Hill Watch

Lawmakers Seek Explanation For 'Staggering,' 'Outrageous' Price Hikes

Sen. Bernie Sanders and Rep. Elijah Cummings wrote to Ariad Pharmaceuticals demanding data on their cancer treatment.

The Associated Press: Lawmakers Demand Answers On Leukemia Drug Price Hikes
Two top lawmakers on Thursday demanded information from a drug company that has raised prices on a leukemia drug, calling increases of tens of thousands of dollars a sign the company puts profits before patients. Sen. Bernie Sanders, I-Vt., and Rep. Elijah Cummings, D-Md., the top Democrat on the House Oversight and Government Reform Committee, wrote ARIAD Pharmaceuticals and asked about price hikes for Iclusig, which is used to treat chronic myeloid leukemia in some people. (10/20)

Stat: Sanders Asks Ariad For Data To Explain Price Hikes In Cancer Drug
Call it Bernie Sanders vs. Ariad Pharmaceuticals, Act Two. The Vermont senator and erstwhile presidential candidate, who has helped make prescription drug pricing a high-profile issue, sent the company a letter on Thursday asking for a plethora of data that might explain a string of “staggering” and “outrageous” price hikes for an expensive cancer treatment. The move comes six days after Sanders tweeted about the price hikes, which sent Ariad stock plummeting and wiped out $387 million in its market capitalization in one day. (Silverman, 10/20)

The Hill: Sanders Presses Drug Company To Explain Price Hike For Leukemia Drug 
Sen. Bernie Sanders (I-Vt.) and Rep. Elijah Cummings (D-Md.) are pressing a drug company to explain a sharp price increase to its drug to treat leukemia. The lawmakers sent a letter to Ariad Pharmaceuticals questioning an increase in the price of the leukemia treatment Iclusig from $115,000 a year to $199,000 a year. The lawmakers say that the company also cut the number of doses in a package while keeping the price the same, effectively increasing the cost. (Sullivan, 10/20)


Gilead Presses For Exclusivity On HIV Drug After Judge's Ruling That FDA Policy Is 'Capricious'

Gilead wants the agency to retroactively grant it five years of exclusive marketing. Meanwhile, groups say the gaps in FDA's biosimilar policies are creating untenable situations.

Stat: Gilead Asks FDA To Expand Exclusivity For A Key HIV Drug
In the latest development in a heated battle between Gilead Sciences and the US Food and Drug Administration, the company petitioned the agency this month to retroactively grant five years of exclusive marketing for an HIV medicine. And the drug maker argues that it otherwise faces lost sales and added expense from fending off a pending generic threat to its Stribild medication. The move follows a complicated legal battle in which Gilead challenged an FDA policy toward so-called fixed-dose combination drugs, which consist of two or more chemical entities. At stake are untold amounts of revenue as Gilead and other drug makers have battled the agency over its policy, which a federal judge recently ruled is  “arbitrary and capricious.” (Silverman, 10/20)

Politico Pro: Groups Press FDA For Biosimilar Policy, Resources 
FDA must move faster to develop policies for cheaper versions of biologic medicines, and Congress should provide more resources to enable faster agency review, a broad array of health care groups told FDA. Gaps in FDA policy on biosimilars are creating challenging situations for states, providers and health insurers who must deal with already approved biosimilars, the agency was told at a Thursday meeting on a recently announced user fee agreement. The groups said the agency should finalize its guidance on key biosimilar policies — such as how to name and label treatments, and when biosimilars can be considered "interchangeable" with their brand counterparts — ahead of deadlines specified in that agreement. (Karlin-Smith, 10/20)

And in other pharmaceutical news —

The Wall Street Journal: Alkermes Shares Surge On Favorable Data For Depression Drug
Alkermes PLC said its depression drug helped patients not responding to standard treatments, news that added more than $3 billion to the company’s market value in after-hours trading. The company said that in a late-stage trial, its ALKS 5461 treatment significantly improved depression scores in patients who had an inadequate response to standard therapies. The most commonly reported adverse events associated with the treatment were nausea, dizziness and fatigue. (Beckerman, 10/20)

Women’s Health

Trump's Claim About Abortions Taking Place Days Before Birth 'Absurd,' Expert Says

If, very late in pregnancy, a fetus was found to be nonviable the woman might continue the pregnancy and deliver a stillborn baby, or she might decide not to continue the pregnancy, says Dr. Aaron B. Caughey. “Would you call that an abortion? I think most of us wouldn’t use that language."

The New York Times: Trump Said Women Get Abortions Days Before Birth. Doctors Say They Don’t.
In the presidential debate Wednesday night, Donald J. Trump expounded on pregnancy and abortion, asserting that under current abortion law, “You can take the baby and rip the baby out of the womb in the ninth month, on the final day.” Doctors say the scenario Mr. Trump described does not occur. “That is not happening in the United States,” said Dr. Aaron B. Caughey, chairman of obstetrics and gynecology at Oregon Health and Science University. “It is, of course, such an absurd thing to say,” he said. (Belluck, 10/20)

In other women's health news, a judge sides with Planned Parenthood over Medicaid funding, and KHN offers a look at contraception choices —

Kaiser Health News: To Curb Unintended Pregnancy, States Turn To IUDs — In The Delivery Room
Health officials are trying to rebuild [Texas’s] women’s health program, a complicated project launched after Texas in 2011 cut funds for family planning that had been going to Planned Parenthood and other clinics affiliated — even loosely — with abortion providers. As part of the new program, the state is trying to bolster low-income women’s access to birth control to curb unintended pregnancies. Nationally, about half of pregnancies are unintended. And Texas is one of nearly two dozen states changing their Medicaid programs, the federal-state insurance plan for low-income people, to pay hospitals for inserting an IUD or contraceptive implant in the delivery room. (Luthra, 10/21)

Kaiser Health News: Long-Term, Reversible Contraception Gains Traction With Young Women
Nurse practitioner Kim Hamm talked in soothing tones to her 14-year-old patient as she inserted a form of long-acting contraception beneath the skin of the girl’s upper arm. ... Hamm works at the Gaston County Teen Wellness Center, in Gastonia, N.C., which provides counseling, education and medical care. The teenager had already talked through her birth control options with another health care provider and chosen the implant — a flexible rod, about the size of a matchstick, that slowly releases low levels of hormones to prevent pregnancy. (Tomsic, 10/21)


The Patients Behind Theranos' Dubious, Unreliable Test Results

Theranos failed to maintain basic safeguards to ensure consistent results — according to regulators, independent lab directors and quality-control experts — and patients suffered.

The Wall Street Journal: Agony, Alarm And Anger For People Hurt By Theranos’s Botched Blood Tests
Sheri Ackert worried she might have a new tumor. Steve Hammons stopped taking his blood-thinning medication. Kimberly Toy emptied the pasta and sweets from her cupboards and said: “I can’t believe this happened.” What they have in common are dubious test results from Theranos Inc. A review of regulatory records and interviews with patients shows the Palo Alto, Calif., company didn’t just burn investors who bought into its promise to revolutionize the world of blood testing. (Weaver, 10/20)

In other health industry news —

Boston Globe: Alere-Abbott Marriage May Be Headed For Divorce 
There were good feelings all around when Abbott Laboratories said in February it would pay $5.8 billion for Alere Inc., a Waltham company that had emerged as a global leader in “point-of-care” medical tests performed at doctors’ offices, pharmacies, and patients’ homes. Eight months later, the upbeat tone and cordiality have given way to acrimony, and the deal itself appears to be on life support. As Alere shareholders prepare to gather at the Westin Waltham hotel Friday to vote on the acquisition, the parties are caught up in a welter of lawsuits and federal probes that could take months or more to untangle. (Weisman, 10/21)

Naming And Shaming Fails To Curb Hospitals' Practice Of Overcharging Patients

“There’s nothing stopping them,” says Karoline Mortensen, one of the authors of a study that looked at charges before and after hospitals received negative publicity about the high costs. If anything, they got more expensive after being shamed publicly.

The Washington Post: Despite Being Shamed For Overcharging Patients, Hospitals Raised Their Prices, Again
A year ago, a study about U.S. hospitals marking up prices by 1,000 percent generated headlines and outrage around the country. Twenty of those priciest hospitals are in Florida, and researchers at the University of Miami wanted to find out whether the negative publicity put pressure on the community hospitals to lower their charges. Hospitals are allowed to change their prices at any time, but many are growing more sensitive about their reputations. What the researchers found, however, was that naming and shaming did not work. (Sun, 10/20)

Meanwhile, media outlets report on hospital news out of North Carolina, Maryland and Massachusetts —

Modern Healthcare: Quorum Is Selling Eight Of Its 38 Hospitals. Deals On Two Of Them Are Already In The Works.
Quorum Health, the embattled hospital spinoff of Community Health Systems, has agreed to sell two of at least eight rural hospitals it has for sale to reduce debt and refine its portfolio. Quorum announced Thursday that it has a definitive agreement to sell its 64-bed Sandhills Regional Medical Center in Hamlet, N.C., to FirstHealth of the Carolinas. Terms were not disclosed. (Barkholz, 10/20)

The Baltimore Sun: Upper Chesapeake Health Will Seek State Approval For Havre De Grace, Bel Air Hospital Changes In Early 2017
A long regulatory road remains ahead as University of Maryland Upper Chesapeake Health seeks state approval to open a stand alone medical center at the Havre de Grace exit off of Interstate 95, close Harford Memorial Hospital and expand its Bel Air hospital, despite the approval earlier this year of state legislation designed to make the application process less cumbersome. Officials with the Harford County-based health system plan to file their applications for various approvals with the Maryland Health Care Commission during the first three months of 2017. The regulatory process is expected to take at least one year, Martha Mallonee, a spokesperson for Upper Chesapeake Health, said Wednesday. (Anderson, 10/20)

The Baltimore Sun: University Of Maryland Medical System To Own New Hospital In Prince George's 
After years of negotiations and lobbying, state health officials voted Thursday to allow Dimensions Health Corp. to replace Prince George's Hospital Center with a new $543 million regional medical center in Largo that will be owned and operated by the University of Maryland Medical System. The New Prince George's Regional Medical Center will include 205 acute-inpatient beds and offer services available at the current hospital, including a 15-bed special pediatric unit at Mt. Washington Pediatric Hospital  which is part of the current hospital center complex. (McDaniels, 10/20)

Boston Globe: Boston Children’s Hospital Expansion Receives Final Clearance From State
Massachusetts health officials Thursday gave final approval to Boston Children’s Hospital for a $1 billion expansion, rejecting arguments by opponents that project would undercut the state’s efforts to contain medical spending. The 10-0 vote by the Massachusetts Public Health Council gives the hospital a green light but imposes conditions that would penalize Children’s if it fails to keep health cost increases within limits. The council’s decision followed the recommendation of the state Department of Health and support from Governor Charlie Baker. (Vaccaro, 10/20)

WBUR: Boston Children's Hospital's $1B Expansion Gets Final Approval
After a six-year planning process, Boston Children's Hospital has the green light to begin construction on a $1 billion clinical building. The hospital got the final go-ahead on Thursday from the Massachusetts Department of Public Health's Public Health Council. The project has been controversial because it will result in the demolition of a half-acre healing garden, which was bestowed to Children's Hospital 60 years ago, and because of concerns about how the expansion will affect health care costs. (Joliocoeur, 10/21)


After Flood Of Reactions To Kentucky's Medicaid Changes, CMS Extends Comment Period

Federal records show Kentucky is the first state to receive such an extension. Media outlets also report on other Medicaid developments in Louisiana and Florida.

Modern Healthcare: In Unusual Move, CMS Extends Comment Period On Controversial Kentucky Medicaid Waiver 
The CMS is taking the unusual step of extending the comment period on a proposal to change Kentucky's Medicaid program to include controversial provisions such as job requirements, cost-sharing and six-month lockouts for missed payments. The agency has received nearly 1,800 comments on the waiver. In comparison, Ohio's recent request generated 103 comments, while Arizona's drew 98 comments. (Dickson, 10/20)

New Orleans Times-Picayune: Medicaid Expansion Enrollment Exceeds 326,000 New Members
More than 326,000 people have enrolled in Louisiana Medicaid Expansion since it went into effect July 1, marking a new milestone for the program, Louisiana Department of Health announced Thursday (Oct. 20). More than 24,000 of those new members have received preventative care visits with a provider. Such visits allow health care providers to preempt costly illnesses and other health problems through immunizations, lab tests, physical exams and prescriptions. They also allow physicians to educate patients about possible health risks. (Lipinski, 10/20)

Miami Herald: Nearly Half Of Nation's Uninsured Could Get Medicaid Or Marketplace Subsidies 
Nearly 12 million of roughly 27 million non-elderly people who lack health insurance – 43 percent - are eligible either for Medicaid or financial assistance for marketplace coverage, according to a new issue brief from the Kaiser Family Foundation. About 14 percent of those without coverage – 3.8 million - are working-age adults eligible for Medicaid, the state/national health insurance program for low-income Americans. Another ten percent – 2.6 million - are children eligible for either Medicaid or the Children’s Health Insurance Program. (Pugh, 10/20)

Public Health And Education

How Much Screen Time Is Too Much Screen Time For Kids?

The American Academy of Pediatrics has released its recommendations for how much children and teenagers should be exposed to TVs, computers and smartphones.

Los Angeles Times: Pediatricians Weigh In On A Fraught Issue Facing Parents Today: How Much Screen Time Is OK?
If you have kids or teenagers at home, chances are you have a complicated relationship with screens. On one hand, you know that capturing monsters in Pokemon Go or taking a portal to the Nether in Minecraft is probably not the healthiest way for your kids to spend the afternoon. On the other hand, they are so happy and quiet when they are bathed in the glow of a smartphone, tablet or TV. And some of those apps and shows have educational value, right? What if your child is tracing letters or learning to count? Can screen time ever be beneficial? (Netburn, 10/20)

NPR: Pediatricians Launch Online Tool To Help Parents Manage Screen Time
Whether your kid is 3 and obsessed with Daniel Tiger videos or 15 and spending half her conscious hours on Snapchat, you are probably somewhat conflicted about how to think about their media habits. How much time? What kind of media? What should our family's rules be? When the American Academy of Pediatrics released its latest recommendations on these burning questions Friday, it also did something pretty cool: it launched an online tool that parents can use to create their own family media plan. (Hobson, 10/21)

Stat: Pediatricians Soften Guidelines On Screen Time For Kids
The American Academy of Pediatrics is out with new recommendations to help kids maintain a healthy diet — of tablets and smartphones. Previous guidelines focused on stricter limits: No screen time for kids under 2, and just two hours a day for older kids. But with the media landscape shifting, the physician group decided flexibility was in order. The organization now recommends that parents keep infants and toddlers away from screens until they hit 18 months. The exception: video chatting, which is now seen as a healthy form of communication. (Thielking, 10/21)

Compared To Other Sedentary Behaviors, Watching TV Strongly Linked To Belly Fat

Commercials may play a role, the study's author says. “Seeing those ads showing food can prime you to eat more later." In other news, researchers key in on certain cells that may lead to the development of effective obesity drugs.

The Star Tribune: Belly Up To The TV: Binge Watching Could Lead To More Stomach Fat
Binge watchers, you may want to hit the pause button for this: watching TV has been linked to more belly fat — even for people who exercise regularly and maintain a healthy weight. For every hour and a half spent watching TV, abdominal fat increased by about 3 cubic centimeters, according to a study from the University of Minnesota School of Public Health. Abdominal fat is a concern because it is a risk factor for diabetes and heart disease. (Shah, 10/20)

Stat: Obesity And The Brain: New Findings Could Spur Future Drug Development
There hasn’t been a lot of innovation in the obesity drug market. Sure, a smattering of companies have come out with weight loss medications — but their results have been middling and their financial performance poor. But new research from the Massachusetts Institute of Technology might help researchers pick a new target for obesity drugs. Scientists have found that glial cells — long thought to simply serve as supportive foil for neurons — play a role in appetite and feeding. Here’s what they’re doing: In mice, the scientists have engineered astrocytes — a type of glial cell — that produce a surface receptor that binds to a chemical compound called CNO, which is similar to the drug clozapine. Giving the mice CNO turns on astrocyte activity — and makes them gorge on food. (Keshavan, 10/20)

And in other public health news —

NPR: Pulmonary Embolism Can Be The Overlooked Cause Of Fainting Spells
Unexplained fainting episodes may be caused by a dangerous blood clot in the lung more frequently than many doctors suspect, according to an Italian study. Episodes of fainting (known as syncope) are quite common in elderly people. About half the time, doctors identify an underlying heart condition. Other cases are caused by shock or some other passing cause. But many cases remain mysterious. (Harris, 10/20)

Kaiser Health News: Researchers Unlock Mystery Of How Zika Spreads In Human Cells
Researchers have discovered a piece in the puzzle of how the Zika virus spreads in human cells and neutralizes the body’s defenses. A study by scientists at the University of California, San Diego School of Medicine answered a fundamental question posed by biologists: What happens when the virus enters a human cell? (Bluth, 10/20)

State Watch

State Highlights: Detailing A Possible Childhood Cancer Cluster In Georgia; A Health Enterprise Zone In North Philadelphia

Outlets report on health news from Georgia, Pennsylvania, Arizona, California, New Hampshire, Illinois, Missouri, North Carolina, Texas, Ohio and Florida.

Georgia Health News: Why Are Kids In Waycross Getting Cancer? 
All told, within 60 days in 2015, four children with rare sarcoma cancers were being treated with intensive chemotherapy, fighting for their lives, family members said. In the southeast Georgia community where the children live in and around, some suspected it was more than just a coincidence. But in trying to prove that, worried residents didn’t know they would be facing obstacles nearly as formidable as the cancer itself. (Goodman and Miller, 10/20)

The Philadelphia Inquirer: Massive Health Collaboration Launched In North Philly
Pennsylvania officials announced Thursday a broad collaboration to improve health care in North Philadelphia and a swath of surrounding neighborhoods where at least half the residents receive Medicaid, costing more than $1 billion last year. The North Philadelphia Health Enterprise Zone encompasses an area from around Spring Garden Street north to Olney and from Frankford in the east to Germantown in the west. It is home to five hospitals that struggle financially under a heavy load of Medicaid patients. (Brubaker, 10/20)

Chicago Tribune: Special Ambulances Will Scan, Treat Stroke Victims In Western Suburbs
New types of ambulances will likely speed through the western suburbs soon, in hopes of delivering lifesaving care to stroke victims sooner. Unlike typical ambulances, the new mobile stroke treatment units of Rush University Medical Center and Northwestern Medicine Central DuPage Hospital will carry CT scanners, cameras for communicating with stroke neurologists from afar and medication that can begin to dissolve clots and restore blood flow to the brain. The stroke units will be the first of their kind in the Chicago area and likely among the first dozen or so in the country, said Rush officials who demonstrated Thursday how Rush's unit will work. (Schencker, 10/20)

Arizona Republic: Mayo Clinic, ASU Join Forces On New Medical School
The Mayo Clinic is recruiting its first class of 50 students for a new medical school that will begin next summer on its campus in Scottsdale. It's a tangible step in what Mayo and Arizona State University leaders say will be a growing effort to bring innovative medical education to Arizona and beyond. The two entities described the arrangement as the Mayo Clinic and Arizona State University Alliance for Health Care. (Alltucker, 10/21)

NH Times Union: More State Workers Entitled To Coverage For Sex-Change Surgery Following Governor's Executive Order 
Workers and retirees covered under the New Hampshire state employee health care plan have had access to gender reassignment surgery since July 1, shortly after Gov. Maggie Hassan issued an executive order forbidding discrimination on the basis of gender identity, a top state official said this week. The surgery became available ahead of a Jan. 1 deadline established by federal regulations, said Administrative Services Commissioner Vickie Quiram. She said the decision to provide early coverage was based upon Hassan’s executive order and Anthem Blue Cross, the company that administers the state’s health plan. (Hayward, 10/20)

NPR: A Whole City May Help Test A Treatment For Shooting Victims
Dr. Zoe Maher has never been busier. In addition to being a trauma surgeon and a new mom, she's spent the last year and half talking to hospital patients and community groups across Philadelphia about a study she's confident will save more adult gunshot and stab wound victims. On a recent Saturday morning, Maher stood before a dozen members of a North Philadelphia neighborhood association to walk them through the specifics of the Philadelphia Immediate Transport in Penetrating Trauma Trial. (Moselle, 10/20)

The Desert Sun: The Allure Of Cheap Doctors, Drugs And Dentists In Mexico
In Southern California, if people haven't gone to Mexico for health care, they probably know someone who has. People overburdened by the price of getting what's supposed to be some of the best health care in the world are willing to seek out options that would have seemed overly risky not long ago. And while more Americans now have health insurance than ever before, the high price of seeing a doctor, dentist or filling a prescription have not slowed the annual growth in the amount of money Americans spend on health care in foreign countries. (Newkirk, 10/20)

California Healthline: Orange County Man Dies After Apparent Failure Of Artificial Heart Compressor
The Food and Drug Administration is investigating repeated problems with a portable compressor for artificial hearts that may have played a role in the death earlier this month of a 57-year-old Orange County man. Officials at Cedars-Sinai Medical Center in Los Angeles, where the man’s artificial heart was implanted, said they believe the apparent failure of the compressor may have caused his death. The hospital said it has stopped using the device with new patients, pending guidance from regulators. (Gorman, 10/20)

St. Louis Post Dispatch: A Grassroots St. Louis Movement Seeks To Tackle High Infant Mortality 
A group of 17 mothers and one father from some of the poorest neighborhoods in the region sat around a conference table Thursday to tell stories about birth and early parenting to one of the top health administrators in the federal government. Dr. Michael Lu, of the Maternal and Child Health Bureau, was making good on a promise he made nearly two years ago on St. Louis’ high infant mortality rate...In Missouri, 6,373 babies under the age of 1 died from 2000 to 2010, which resulted in an infant mortality rate of 7.4 per 1,000 live births during that period, according to the Missouri Department of Health and Senior Services. The national rate in 2010 was 6.15, according to the Centers for Disease Control and Prevention. (Cambria, 10/21)

North Carolina Health News: NC Infant Mortality Rate Remains Stubbornly High 
After years of continual improvement in the health and birth outcomes for newborns in North Carolina, the rate of babies who died in their first year of life has inched upwards for the second year running. After reaching an all-time low of 7.0 deaths per 1,000 live births in 2010, and hitting that mark again in 2013, the rate crept upwards to 7.3 deaths per 1,000 babies. This keeps North Carolina with one of the worst infant mortality rates in the country. (Hoban, 10/21)

Austin Statesman: State Health Officials Confirm Case Of West Nile In Bastrop County
State health officials confirmed one case of West Nile neuroinvasive disease in Bastrop County, according to a report released this week. The death of a 13-year-old Bastrop County boy this month is blamed on the virus, according to the teen’s parents. West Nile neuroinvasive disease is the severest form of West Nile virus, with symptoms including disorientation, tremors, coma and paralysis. (Huber, 10/20)

Cincinnati Enquirer: Drop Off Unused Meds This Weekend To Prevent Misuse
Numerous Cincinnati area communities are participating in National Take-Back Day, 10 a.m.-2 p.m. Saturday. To find out which of your communities is participating, go to the Drug Enforcement Administration's Drug Take Back Day site and type in your location. Numerous prevention organizations and law enforcement agencies are asking people to safely dispose of medications at designated locations. (DeMio, 10/20)

Health News Florida: Fact-Checking The Medical Marijuana Debate 
United For Care’s John Morgan and Jessica Spencer squared off Tuesday night in a televised medical marijuana debate.The debate, hosted by Orlando television station WESH, lasted 30 minutes. Florida voters will decide whether to legalize full-strength medical marijuana in  November. You can watch the debate here.Here is a transcript of the debate, with fact checking from health reporter Abe Aboraya. (10/20)

Editorials And Opinions

Viewpoints: More Health Exchange Battles; What About Insurance And State Lines?

A selection of opinions on health care from around the country.

The New England Journal Of Medicine: Trouble On The Exchanges — Does The United States Owe Billions To Health Insurers?
Yet another bruising fight has erupted over health care reform. On September 9, 2016, the Obama administration offered to open settlement negotiations with health insurers that have sued the United States to recover billions of dollars that they claim they are owed. Congressional Republicans are incensed, believing that any settlement would illegally squander taxpayer dollars in a last-gasp effort to save the Affordable Care Act. (Nicholas Bagley, 10/19)

JAMA Forum: Those Pesky Lines Around States
In the recent presidential debate, moderator Anderson Cooper asked Donald Trump how he would “make coverage accessible for people with preexisting conditions” if the Affordable Care Act (ACA) is repealed. Trump responded: “Once we break out—once we break out the lines [around the states] and allow the competition to come…when we get rid of those lines, you will have competition, and we will be able to keep preexisting, we’ll also be able to help people that can’t get—don’t have money because we are going to have people protected.” (Larry Levitt, 10/19)

JAMA: Investing Wisely In Health Care Capital
Health care expenditures increase for 2 reasons: patients consume more services, and the cost of those services increases. Costs of services have 2 components: operating costs and capital costs. Capital represents the total pool of funds expended by a health care organization to build, acquire, or upgrade physical assets such as property, buildings, technology, or equipment. In 2014, US health care capital expenditures exceeded the Organisation for Economic Co-operation and Development average, totaling US $88.8 billion, about 3% of US $3 trillion spent on all health care.1,2 In the same year, Canada spent CAD $8.8 billion on health care capital, representing 4.1% of the CAD $214.9 billion spent on all health care, compared with 15% spent on physician services and 16% on drugs.3 Perhaps because they are numerically smaller, capital expenditures, while clearly noticeable, usually generate less controversy compared with the well-known public debate about drug prices or physician and hospital fees. (David J. Klein, Adalsteinn D. Brown and Allan S. Detsky, 10/18)

The New England Journal Of Medicine: Wartime Lessons — Shaping A National Trauma Action Plan
Since the end of major combat operations in Iraq and Afghanistan, analysis of the lessons learned from those wars has focused largely on the wisdom of various foreign-policy decisions, the wars’ financial and human costs, and their repercussions for U.S. national security. Although it’s long been held that “the only victor in war is medicine,” until recently there had been little consideration of the effect of war on military and civilian trauma care. (Todd E. Rasmussen and Arthur L. Kellermann, 10/19)

JAMA: The Ethics Of Behavioral Health Information Technology
A subpopulation of individuals with serious mental health conditions makes repeated and frequent visits to emergency departments and psychiatric crisis centers. These so-called super utilizers often have financial problems and present with chronic or untreated comorbid psychiatric and substance use disorders.1 These patients are often well known to clinical staff and are sometimes colloquially labeled “frequent flyers.” A pejorative branding, “frequent flyers” are often assumed to be problem patients. In psychiatric settings, these patients are sometimes said to be “borderlines,” “drug seekers,” “malingerers,” or “treatment resistant.” (Michelle Joy, Timothy Clement and Dominic Sisti,10/18)

RealClear Health: Opioids: Can We Unlock The Potential Of Prescription Drug Monitoring Programs?
A recent report from the Substance Abuse and Mental Health Services Administration indicates that in 2015 more adults used prescription painkillers than cigarettes, cigars, and smokeless tobacco combined. Politicians, government agencies, and policymakers have touted prescription drug monitoring programs as a way to curb the over-prescription and side effects of opioids. (Jason Fodeman, 10/21)

The Washington Post: What Could Stop Antiabortion Momentum? Trump Winning.
Things are looking good for the antiabortion movement. We have almost completed the struggle of disentangling ourselves from the toxic, simplistic, binary culture wars of the 1970s. Twenty-million Democrats identify as “pro-life.” The voices of people of color, disproportionately against abortion when compared with whites, are finally being heard by our movement. Almost every major antiabortion organization has women’s issues at the center of their concern and is being led by a woman. (Charles Camosy, 10/20)

The New York Times: Late-Term Abortion Was The Right Choice For Me
I was 21 weeks pregnant when a doctor told my husband and me that our second little boy was missing half his heart. It had stopped growing correctly around five weeks gestation, but the abnormality was not detectable until the 20-week anatomy scan. It was very unlikely that our baby would survive delivery, and if he did, he would ultimately need a heart transplant. (Meredith Isaksen, 10/20)

Los Angeles Times: A Yes Vote On Proposition 61 Will Send A Strong Message To Big Pharma And Washington
Prescription drug prices in the United States are the highest in the world — by far. Californians on Nov. 8 have a chance to stand up to the pharmaceutical industry’s greed and spark a national movement to end this price-gouging. Today, no laws prevent drug companies from doubling or tripling prices. So they just do it. The most recent flagrant example is the emergency allergy injection, EpiPen. Its maker, Mylan, jacked up the price of this 40-year-old medication by 461% between 2007 and 2015. During that same period, compensation for Mylan’s CEO rose 671%. And that’s just one company and one drug. (Bernie Sanders, 10/21)

The New England Journal Of Medicine: Effect Of Medicaid Coverage On ED Use — Further Evidence From Oregon’s Experiment
The effect of Medicaid coverage on health and the use of health care services is of first-order policy importance, particularly as policymakers consider expansions of public health insurance. Estimating the effects of expanding Medicaid is challenging, however, because Medicaid enrollees and the uninsured differ in many ways that may also affect outcomes of interest. Oregon’s 2008 expansion of Medicaid through random-lottery selection of potential enrollees from a waiting list offers the opportunity to assess Medicaid’s effects with a randomized evaluation that is not contaminated by such confounding factors. In a previous examination of the Oregon Health Insurance Experiment, we found that Medicaid coverage increased health care use across a range of settings, improved financial security, and reduced rates of depression among enrollees, but it produced no detectable changes in several measures of physical health, employment rates, or earnings. (Amy N. Finkelstein, Sarah L. Taubman, Heidi L. Allen, Bill J. Wright and Katherine Baicker, 10/20)