KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Political Cartoon: 'But I'm Not Laughing'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'But I'm Not Laughing'" by Steve Kelley and Jeff Parker, from 'Dustin'.

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Good evidence is
Hard to find, U.S. task force
Says. Doctors protest.

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Summaries Of The News:

Campaign 2016

How A Democrat Who's Against Abortion Became Clinton's VP Pick

Tim Kaine's personal beliefs on abortion are in contrast with Hillary Clinton's and the Democratic platform. But it's his actions that have assuaged any fears from abortion rights groups. “He’s been not only a solid vote but really an ally," Planned Parenthood President Cecile Richards says.

The Washington Post: Why Tim Kaine Can Oppose Abortion And Still Run With Hillary Clinton
Eleven years ago, as he ran for governor of Virginia, Tim Kaine made clear his stance on abortion: “I have a faith-based opposition,” he wrote on his campaign’s website. “I will work in good faith to reduce abortions.” Kaine went on to laud adoption as the best solution to an unwanted pregnancy. He promoted abstinence-only sex education (and later slashed funding to the program, citing research that found it wasn’t effective). He authorized the sale of “Choose Life” license plates to fund religious counseling clinics that discouraged abortion. He backed Virginia’s “informed consent” law, which requires women seeking the procedure to undergo medically unnecessary ultrasounds. In short, he was conservative on reproductive issues, by his party's standards. (Paquette, 7/26)

Bloomberg: After VP Selection, Kaine Endorses Repeal Of Hyde Amendment On Abortion
Democratic vice presidential pick Tim Kaine has privately told nominee Hillary Clinton he will support repeal of the Hyde Amendment, a 1976 provision that bans the use of federal dollars for abortion services, Clinton spokesman Jesse Ferguson and Kaine spokeswoman Amy Dudley said Tuesday. The position is a reversal for Kaine, who earlier this month told The Weekly Standard, a conservative magazine, that he's "traditionally been a supporter of the Hyde amendment." (Kapur, 7/26)

Bloomberg: Kaine Brings Record Of ACA Support To Ticket
The selection of Sen. Tim Kaine as Hillary Clinton's running mate gives Clinton a reliable liberal partner who complements her experience in health-care policy. Unlike the choice of Indiana Gov. Mike Pence as Republican candidate Donald Trump's running mate, experts say Kaine doesn't add as much to the Democratic ticket from a health policy perspective, because Clinton herself has an extensive record. (Weixel, 7/26)

Kaiser Health News: Clinton Veep Pick Tim Kaine Bolstered Mental Health System After Va. Tech Shooting
Tim Kaine is in Hillary Clinton’s camp — and his party’s — on the big health care issues, with a defining moment in his tenure as governor coming in 2007 after the mass shooting at Virginia Tech. His response to the shooting was a $42 million legislative package to reform the state’s mental health system. As a U.S. senator who was elected in 2012, he’s backed the Affordable Care Act and has pushed for expanded Medicaid eligibility in his state and others. A Catholic, he’s said he opposes abortion personally, but supports a woman’s right to choose for herself. (Bluth, 7/27)

In other news, both the Democratic and Republican conventions spotlight the opioid epidemic and a look at where both parties stand on health care and abortion —

The Washington Post: The Nation’s Opioid Crisis Garners Attention At Party Conventions
The nation’s epidemic of opioid abuse, which has killed thousands of people over the past decade through powerful prescription painkillers and heroin, has taken on a prominent role at the Democratic National Convention — a sign of the issue’s growing importance in both parties. On Monday night, a woman whose daughter has struggled with addiction gave a prime-time speech, followed by the former governor of New Hampshire, where more than 400 people died of drug overdoses last year. Then, on Tuesday afternoon, people packed into a Quaker conference center in Philadelphia to hear delegates, elected officials and others talk about recovering from substance abuse and what needs to be done to combat it. A similar forum was held at the Republican National Convention in Cleveland last week. Both conventions featured a recovery and wellness room for those suffering from addiction. (Zezima, 7/26)

The Wall Street Journal: Guns, China, Abortion: How The Democratic Platform Has Changed
The Democratic platform bears some of the hallmarks of the drive to the left that Sen. Bernie Sanders led this year on economic policy. And on social issues, the party has abandoned many of the views it held in the late 1980s and early 1990s. We compare and contrast highlights in this year’s Democratic platform with those of recent decades on the following issues: guns, drugs, abortion, China, trade, gay marriage, higher education and health care. (Rubin, 7/26)

Health Law Issues And Implementation

Bucking The Current Trend, Cigna Decides To Expand Into ACA Markets

In other health law news, Iowa's largest insurer says its accountable care organization contracts have saved $35 million in costs last year, a study finds that Covered California policyholders are being rejected by doctors and the court case that could spell trouble for insurers.

The Hill: Insurer Cigna Expanding ObamaCare Presence
The insurer Cigna is expanding into a few new ObamaCare markets, a countervailing force to some recent high profile exits by insurers. Cigna, one of the nation’s largest health insurers, said Tuesday that it has filed to offer insurance on the ObamaCare marketplaces next year in Chicago, the Raleigh/Durham area of North Carolina, as well as Northern Virginia and Richmond. (Sullivan, 7/26)

Chicago Tribune: Big News For Chicago-Area Obamacare Insurance Exchange: Cigna Seeks To Join
One of the nation's largest health insurance companies plans to enter the Obamacare marketplace in the Chicago area for the first time, bringing new competition as other insurers exit or go out of business. The Tribune has confirmed that Cigna, based in Bloomfield, Conn., has filed plans to sell health policies to individuals and families who purchase their own coverage in the individual market. If the plans are approved by Illinois regulators, Cigna will start selling policies Nov. 1, when enrollment for 2017 Obamacare coverage opens. (Sachdev, 7/26)

The Des Moines Register: Wellmark Sees $35 Million Savings From ACO Contracts
Iowa’s largest health insurer says it is seeing success from its efforts to reward hospitals and clinics for providing high quality care. Wellmark Blue Cross & Blue Shield announced Tuesday that its accountable care organization contracts with 13 hospital and clinic systems saved $35 million in health care costs last year. Under such arrangements, hospitals and clinics are paid for keeping patients well, instead of just for ordering more tests and providing more treatments. (Leys, 7/26)

Los Angeles Times: Study: Covered California Health Insurance Coverage Doesn't Guarantee Doctor Access
The recent announcement that Covered California premiums will rise by double digits in 2017 is only part of the challenge for the nation’s largest health exchange. A newly released study found that 4.38% of Covered California policyholders enrolled in Blue Shield or Blue Cross plans were rejected by doctors who were supposedly accepting their insurance, compared with 1.41% for people with the same plans purchased outside the exchange. (Sisson, 7/27)

Morning Consult: One Court Case That Could Really Hurt Obamacare Insurers
There’s been a lot of bad news about rising Obamacare exchange premiums over the past few months. But things could get much worse for insurers (and consumers) if a court ruling brought by House Republicans against the administration prevails. At issue in House v. Burwell is whether the administration has been illegally paying cost-sharing reduction subsidies to insurers. This issue was also the subject of a Republican House investigation, which resulted in a recent report concluding that the administration knowingly made the payments without a congressional appropriation, which is illegal. (Owens, 7/26)

Ky. Governor's Plan To Revamp Medicaid Expansion Raises Concerns

Patient advocates have told federal officials that the Kentucky plan is "a giant step backward for Kentucky." HHS Secretary Sylvia Burwell is also questioning it.

Louisville (Ky.) Courier-Journal: Feds, Advocates Question Bevin Health Changes
A coalition of health advocacy groups has blasted Gov. Matt Bevin's plan to restructure the state Medicaid plan "as a giant step backward for Kentucky." "This plan threatens to undermine the health and economic gains we have made in the past two years," said the written comments filed last week by Kentucky Voices for Health, a coalition of about 200 groups and individuals. ... Sylvia Burwell, U.S. secretary of health and human services, raised concerns about Bevin's plans for Medicaid expansion, citing the "historic improvements" in health coverage for Kentuckians. She also questioned Bevin's plans for dismantling kynect, the state health insurance exchange where people may shop for private plans or enroll in Medicaid. (Yetter, 7/26)

And in Florida —


New Medicare Payment Plan For Heart Attacks Will Press Hospitals To Monitor Post-Acute Care

The plan, which will be implemented in nearly 100 communities, will bundle Medicare reimbursements for coronary bypass surgery and heart attack treatments to include care delivered by skilled nursing and rehab facilities. Also in the news, some Medicare beneficiaries are surprised to find out that they have been automatically enrolled in a Medicare Advantage plan.

Modern Healthcare: Hospitals Will Pivot To Post-Acute Care To Thrive Under Cardiac Bundles
Under a proposed demonstration program that would start July 1 next year in 98 randomly selected areas, Medicare would pay hospitals under a bundled-payment model for coronary bypass surgery and treatment for heart attacks. The hospitals would get a set amount per medical episode to cover the hospitalization and all of the related care for 90 days after the patient is discharged. That puts hospitals at financial risk for managing the quality and efficiency of care delivered by a variety of post-acute providers, including skilled nursing and rehabilitation facilities and home health agencies. (Whitman, 7/26)

Kaiser Health News: Some Seniors Surprised To Be Automatically Enrolled In Medicare Advantage Plans
With Medicare’s specific approval, a health insurance company can enroll a member of its marketplace or other commercial plan into its Medicare Advantage coverage when that individual becomes eligible for Medicare. Called "seamless conversion,” the process requires the insurer to send a letter explaining the new coverage, which takes effect unless the member opts out within 60 days. (Jaffe, 7/27)


Democratic Lawmakers In Iowa Call Payment Delays By Private Medicaid Firms 'Shocking'

Some health care providers say the wait for payments is causing financial hardship. In other news, Kansas providers also raise concerns about the managed care Medicaid program, two new insurers plan to offer Medicaid plans in California and the Texas attorney general's ties to a managed care firm raise questions.

The Des Moines Register: Pay Medicaid Bills Quickly, Legislators Tell Managers
Legislators warned private Medicaid managers Tuesday that if they don't improve how they pay bills from service providers, some of those agencies could soon close their doors. “We’ve got to get to it. We cannot leave people behind here. … It’s going to be make or break for our state,” Sen. Liz Mathis told executives of the three national companies that took control of the state’s $4 billion Medicaid program in April. (Leys, 7/26)

Iowa Public Radio: Problems With Medicaid Privatization Called "Shocking"
Democrats in the Iowa Senate held a hearing on problems with Iowa’s new privately managed Medicaid program, which provides health care for the poor and disabled. The issues include delayed payments for providers, and claims denied for services. Hospitals and others say they’re borrowing money to cover expenses while they wait for reimbursement. (Russell, 7/26)

Kansas Health Institute: Federal Officials Hear KanCare Concerns As Renewal Looms
A pair of federal officials heard a litany of concerns from KanCare providers and clients Tuesday in Salina as the state prepares to apply for renewal of the managed care Medicaid program. James G. Scott, associate regional administrator for the Centers for Medicare and Medicaid Services, and Megan Buck, the agency’s program services branch manager, heard about problems with applying for Medicaid, cuts to services and provider reimbursements, and difficulties getting help from the state during the forum at the Bicentennial Center. (Marso, 7/26)

The Associated Press: Texas Attorney General Took Gift While Investigating Company
Texas Attorney General Ken Paxton, who is under indictment on felony charges of duping investors in a tech startup, accepted $100,000 for his criminal defense from the head of a medical imaging provider while his office investigated the company for Medicaid fraud. Dallas-based Preferred Imaging LLC settled a $3.5 million whistleblower lawsuit in a case handled by the U.S. Justice Department and Paxton’s Texas Civil Medicaid Fraud Division, the head of which co-signed the agreement in June. (Weber, 7/26)


Growth In Medicaid Business Helps Anthem Beat Q2 Profit Estimates

The St. Louis Post-Dispatch also covers news regarding insurer Centene. And The Washington Post looks at changes to premiums in the long-term care insurance program held by many federal employees.

Reuters: Anthem Profit Beats Estimates As Medicaid Memberships Rise
U.S. health insurer Anthem Inc (ANTM.N) reported a better-than-expected profit as enrollments rose in its Medicaid plans, which cater to low-income Americans. The company, whose proposed acquisition of rival Cigna Corp (CI.N) is being challenged by U.S. antitrust authorities, said overall memberships increased 3.2 percent in the second quarter. Anthem's memberships have been rising in the past couple of years as more Americans sign up for its Medicaid plans expanded under President Barack Obama's Affordable Care Act. (Penumudi, 7/27)

St. Louis Post-Dispatch: Legacy Health Net Business Causes $300 Million Headache For Centene
Centene Corp. has earmarked $300 million to cover potential losses from business the company picked up in its $6 billion acquisition of Health Net Inc. last year, company officials said Tuesday. During the company’s second-quarter conference call Tuesday morning, executives disclosed that they had discovered $300 million in “premium deficiency reserves,” or an estimate of a potential loss, mainly due to the increased use of substance abuse treatment centers in California and unfavorable results in the company’s individual commercial business in Arizona. (Liss, 7/27)

The Washington Post: Most Long-Term Insurance Care Enrollees Are Eligible For Little-Known Benefit
Three-fifths of enrollees in the Federal Long Term Care Insurance Program who are facing steep premium increases will be eligible to invoke a little-known feature of the program that will allow them to stop paying premiums but still keep some coverage, the Office of Personnel Management has said. The paid-up provision allows enrollees whose premium is increased beyond a certain percentage to stop paying premiums, with benefits then reduced. The triggering percentages vary according to the age at enrollment and take into account all increases since that time; FLTCIP rates also increased for many enrollees in early 2010. (Yoder, 7/26)

Only 3 States Get An 'A' On Health Care Price Transparency Report Card

Meanwhile, 43 states got failing grades, according to the 2016 Report Card on State Price Transparency Laws.

Modern Healthcare: Price Transparency Eludes Consumers In 43 States
Just seven states achieved a passing grade for making usable healthcare price information available to consumers, a new study finds. The other 43 states failed at price transparency because they didn't collect claims data from all payers or they failed to make the data accessible to the public through a website, according to the 2016 Report Card on State Price Transparency Laws. (Barkholz, 7/26)

New Hampshire Union Leader: NH Wins Praise For Access To Health Care Information
New Hampshire received national praise — and tied for top score — helping residents make educated choices on health care, according to an annual report card. “Only three states — New Hampshire, Colorado and Maine — received an A for providing detailed pricing on a variety of procedures through easy-to-use public websites, backed by rich data sources,” said the report by two nonprofit organizations focused on health reform, the Catalyst for Payment Reform and Health Care Incentives Improvement Institute. (7/26)

Administration News

FDA Signals Willingness To Shift On Blood Donation Restrictions For Gay Men

The agency opens the issue for public comment, encouraging alternative policy suggestions that are backed by scientific evidence. Meanwhile, other regulations are causing a severe blood shortage this year.

Reuters: U.S. Opens Door To A Change In Blood Donation Policy For Gay Men
The U.S. Food and Drug Administration opened the door on Tuesday to a change in its blood donor deferral recommendations, which currently prohibit donations from gay men for a year following their last sexual encounter in order to reduce the risk of transmitting HIV, the virus that causes AIDS. In December the FDA overturned a 30-year ban on all blood donations from men who have sex with men, saying the change was based on science showing an indefinite ban was not necessary to prevent transmission of the human immunodeficiency virus. The FDA is now signaling it may go further. (Clarke, 7/26)

The Hill: FDA Explores Changes To Blood Donation For Gay Men
The Food and Drug Administration is seeking comments on the possibility of changing its policy of requiring a one year deferral period before gay men can donate blood. The FDA said in a notice in the Federal Register that it is looking for comments on the potential to use “individual risk assessments” rather than the current blanket one year deferral for men who have sex with men, intended to guard against the spread of HIV. (Sullivan, 7/26)

Public Health And Education

Task Force: There's Insufficient Evidence To Recommend Routine Skin Cancer Screenings

There was immediate push back following the announcement. "Dermatologists know that skin cancer screenings can save lives," said Abel Torres, president of American Academy of Dermatology.

The New York Times: Should You Get Screened For Skin Cancer?
Every summer as Americans slather on sun lotion, they are reminded of the dangers of skin cancer. This year alone, more than 76,000 people in the United States will develop melanoma, the deadliest form of the disease, and about 10,000 will die from it. The U.S. Preventive Services Task Force said on Tuesday, however, that there still isn’t enough evidence to recommend total-body screenings and declined to take a position on the practice. (St. Fleur, 7/26)

The Washington Post: Expert Panel Declines To Recommend Routine Full-Body Screening For Skin Cancer
The federally appointed U.S. Preventive Services Task Force gave the visual screening a rating of "I" — meaning there was insufficient evidence for it to weigh the potential benefits against possible harms — for Americans of average risk. Yet its statement drew immediate pushback, with some physicians saying the outcome might encourage people to skip the awkward ritual of stripping down for an examination by their doctor for melanoma and other skin cancers. "We make recommendations based on evidence only, not on expert opinion, and we put equal weight on the potential benefits and the harms," said David Grossman, vice chairman of the task force and a senior investigator at Group Health Research Institute. "And we really don’t have good evidence on the benefits of screening." (McGinley, 7/26)

Med Schools Scramble To Adjust How They Teach Opioid Treatment As Epidemic Sweeps Nation

Addiction has been treated as a side note for budding doctors, but experts agree there needs to be an increased focus on the issue as the crisis gains momentum across the country. In other news, naloxone still has its critics even as it saves lives, an Obama administration official visits a Rhode Island women's prison to learn more about its opioid program and other regional stories.

NPR: As Opioid Epidemic Surges, Medical Schools Must Change To Keep Pace
Jonathan Goodman can recall most of the lectures he's attended at the Stanford University School of Medicine. He can recite detailed instructions given more than a year ago about how to conduct a physical. But at the end of his second year, the 27-year-old M.D.-Ph.D. student could not remember any class dedicated to addiction medicine. Then he recalled skipping class months earlier. Reviewing his syllabus, he realized he had missed the sole lecture dedicated to that topic. "I wasn't tested on it," Goodman says, with a note of surprise. (Jacewicz, 7/27)

The New York Times: Naloxone Eases Pain Of Heroin Epidemic, But Not Without Consequences
Every day across the country, hundreds, if not thousands, of people who overdose on opioids are being brought back to life with naloxone. Hailed as a miracle drug by many, it carries no health risk; it cannot be abused and, if given mistakenly to someone who has not overdosed on opioids, does no harm. More likely, it saves a life. ... But naloxone, also known by the brand name Narcan, has also had unintended consequences. Critics say that it gives drug users a safety net, allowing them to take more risks as they seek higher highs. Indeed, many users overdose more than once, some multiple times, and each time, naloxone brings them back. (Seelye, 7/27)

The Dallas Morning News: CVS Makes Overdose-Reversal Drug Available Without Prescription In Texas Pharmacies
The opioid overdose-reversal drug, naloxone, is now available without a prescription at all CVS locations in Texas, the pharmacy announced Tuesday. The company said that by August, pharmacies in a total of 31 states will be able to dispense the drug to patients. Naloxone is a Food and Drug Administration approved medication that has been used for decades by emergency medical personnel to reverse overdoses from drugs such as heroin, morphine, and prescription pain relievers like oxycodone. (Rice, 7/26)

The Associated Press: White House Drug Official Visits Rhode Island Prison Program
A new Rhode Island prison program that provides medication-assisted treatment for opioid addiction is getting attention from the Obama administration’s top drug control official. Michael Botticelli, director of the White House Office of National Drug Control Policy, toured the state women’s prison in Cranston on Tuesday. The state budget passed last month adds $2 million to a pilot program treating inmates with methadone and other medications that can reduce their dependence on opioids. (O'Brien, 7/26)

The Associated Press: Investigators: Heroin, Fentanyl Sting Leads To 24 Arrests
Authorities on Long Island say two dozen people have been arrested and nearly 4 kilograms of heroin and fentanyl have been seized in a 10-day drug sting. The Suffolk County district attorney is scheduled to announce the arrests on Wednesday in Hauppauge. Investigators say they found the narcotics at drug overdose scenes wrapped in lottery ticket paper stamped with the words Aleve, Brooklyn, Brooklyn Bridge or Clean Up. (7/27)

N.H. Court Questions Law To Report Mental Health Info To Federal Guns Background Check System

In other news on the health care challenges to policing efforts, a New Orleans man diagnosed with schizophrenia and manic depression was shot and killed by police during a breakdown. And CityLab reports on how environmental health issues connect to police violence.

Concord Monitor: N.H. Won’t Begin Reporting Mental Illness To Federal System For Gun Background Checks
The New Hampshire Judicial Branch will not comply with the state attorney general’s recent request to start reporting people with mental illness to the federal gun background check system. General Counsel Howard Zibel said in a letter last week that a new state law cited as cause for the change is “not sufficiently clear on its face for the judicial branch to begin the reporting that you request.” (Morris, 7/26)

The New Orleans Times-Picayune: Mental Breakdown Led To Fatal Police-Involved Shooting, Pointing To Challenge For NOPD
In the year since [Christopher] Olmsted's death, the department has implemented changes, including creating a Crisis Intervention Team, to better deal with mentally ill people. It's part of necessary measures, officials say, as patrol officers continue to face a rising number of mentally ill people – in part because of reduced mental services – even though they are not as equipped for those encounters as medical and mental health professionals. Mental disturbance calls, coded by police and 911 dispatchers as 103M calls, were up 21 percent in 2015 compared to two years before. (Lane, 7/26)

CityLab: How Environmental Injustice Connects To Police Violence
As the nation continues to process the deaths of Alton Sterling, Philando Castile and police officers in Dallas and Baton Rouge, Louisiana, it’s worth keeping in mind that the circumstances of those killings were not all the same. And demonstrators across the country aren’t protesting only police violence against black citizens. They’re also venting grievances about their own stifling living conditions, under which it’s often difficult to ride, walk, or even breathe without police suffocating black lives further. Place and environment matters when discussing police violence: This is the crux of the University of California, Davis professors Lindsey Dillon’s and Julie Sze’s argument in a forthcoming article for the academic journal English Language Notes. (Mock, 7/21)

In Specialized Facilities For Dementia Patients, Each Reminder Carries A Price Tag

When a daily prompt to take medication costs $25 a month, the bills can add up quickly. In other news, a smell test may help doctors diagnose Alzheimer's and a new study links gut bacteria to the disease.

Stat: $75 For Reminders To Eat: Alzheimer’s Patients Face Flurry Of Fees While Waiting For Specialized Care
engthy waiting lists for rooms for Alzheimer’s patients are forcing caregivers to put their loved ones in less specialized facilities — which often levy additional fees for every extra service required to keep those vulnerable residents safe. Does the patient need a daily prompt to take her medication? Tack $25 on to the monthly bill. Does he need to be reminded to go to lunch and dinner? That’ll be another $75 a month. Checking blood sugar might cost $55 a month. Double that if the staff is also in charge of injecting insulin. Showering. Dosing out medication. Clipping toenails. It all carries a fee. (Thielking, 7/27)

NPR: A Sniff Test For Alzheimer's Checks For The Ability To Identify Odors
Two studies released at an international Alzheimer's meeting Tuesday suggest doctors may eventually be able to screen people for this form of dementia by testing the ability to identify familiar odors, like smoke, coffee and raspberry. In both studies, people who were in their 60s and older took a standard odor detection test. And in both cases, those who did poorly on the test were more likely to already have — or go on to develop — problems with memory and thinking. (Hamilton, 7/26)

WBUR: Mouse Study Links Gut Bugs And Alzheimer's Disease
We tend to think about Alzheimer’s disease as affecting our brains. But as we try to arm ourselves against it, maybe we should be worrying about our bowels as well. According to a recent study done at the University of Chicago Medical Center, mice who underwent a long course of antibiotics had more diversity in the community of bacteria living in their guts than did mice who did not. They also showed significantly fewer "amyloid plaques” — a key element of Alzheimer's — in their brains. (Betuel, 7/26)

Copper: An Unlikely Weapon Against Hospital Infection

The metal kills 99.9 percent of bacteria on its surface within two hours. In other news, the World Health Organization moves toward changing its classification of transgender identity as a mental disorder, Americans are shrinking and a lawmaker pushes for tighter requirements on medical devices after more information comes out about the Olympus tainted scope outbreak.

The Wall Street Journal: Paging Doctor Copper: Metal Wins Fans In Health Care
A burgeoning opportunity for copper producers relies on a simple premise: that the base metal is good for your health. Copper is used in everything from construction to electrical wiring, but it also has antimicrobial properties that kill 99.9% of bacteria on its surface within two hours, according to the Environmental Protection Agency. That makes it a potential weapon for combating the spread of infections in hospitals and public areas. (Yang, 7/25)

The New York Times: W.H.O. Weighs Dropping Transgender Identity From List Of Mental Disorders
The World Health Organization is moving toward declassifying transgender identity as a mental disorder in its global list of medical conditions, with a new study lending additional support to a proposal that would delete the decades-old designation. The change, which has so far been approved by each committee that has considered it, is under review for the next edition of the W.H.O. codebook, which classifies diseases and influences the treatment of patients worldwide. (Belluck, 7/26)

WBUR: Honey, I Shrunk The Nation! New Study Shows Americans Are Getting Shorter
Americans are shrinking -- not as individuals, but as a population. In 1914, American men were the third-tallest group in the world, and American women ranked fourth. Today they rank 37th and 42nd respectively. And the average heights have stopped increasing, with men peaking in 1996 and women way back in 1988. (Chakrabarti, 7/26)

California Healthline: Congressman Decries Olympus' Failure To Warn U.S. Hospitals About Tainted Scopes
A U.S. lawmaker is renewing his push for Congress to toughen requirements on medical-device warnings, calling Olympus Corp.’s 2013 decision against issuing a broad alert to U.S. hospitals about scope-related superbug outbreaks “despicable.” U.S. Rep. Ted Lieu (D-Calif.) said internal Olympus emails about that decision, detailed for the first time in a Los Angeles Times/Kaiser Health News article, were “incredibly disturbing” and the company officials involved should face questions at a Congressional hearing. At least 35 patients in American hospitals have died since 2013 after developing infections tied to tainted duodenoscopes. (Terhune, 7/27)

Women’s Health

Prosecutors Drop Charges Against Activists Behind Planned Parenthood Videos

They agreed with defense attorneys that the grand jury exceeded its authority by investigating the activists after clearing Planned Parenthood of wrongdoing.

Reuters: Charges Dropped Against Anti-Abortion Activists For Texas Video
Houston-area prosecutors dropped charges on Tuesday against two anti-abortion activists indicted for using illegal government identifications to secretly film a Texas Planned Parenthood facility, saying they could not adequately investigate the case. David Daleiden and Sandra Merritt were indicted by a grand jury in January and faced up to 20 years in prison after being charged with tampering with a governmental record. Harris County District Attorney Devon Anderson said in a statement her office was limited in what it can investigate under Texas law due to procedural matters with the grand jury process. (Herskovitz, 7/26)

The Washington Post: Last Charges Dropped In Case Over Planned Parenthood Videos
“The grand jury took the investigation where the facts led it, however Texas law limits what can be investigated after a grand jury extension order is issued,” District Attorney Devon Anderson said in a statement. “In light of this and after careful research and review, this office dismissed the indictments.” Anderson, a Republican who ran as a “proud, pro-life Texan mother of two” during the 2014 election, supported the charges when they were handed down in January, stressing at the time that at the outset of the investigation, she stated that “we must go where the evidence leads us.” That didn’t sit well with many members of her party. (Graczyk, 7/26)

The Wall Street Journal: Judge Drops Charge Against Antiabortion Activists In Planned Parenthood Case
David Daleiden, one of the activists, said just hours after the ruling that he plans to release “more shocking and damning” footage involving Planned Parenthood once a gag order is lifted in a civil case in California. Mr. Daleiden, 27 years old, and Sandra Merritt, 63, each faced a felony charge of tampering with government records for using fake California driver’s licenses to access a Planned Parenthood clinic. The charge carried a possible sentence of up to 20 years in prison. (Hobbs, 7/26)

The Texas Tribune: Charges Dismissed Against Anti-Abortion Activists Who Made Video
Planned Parenthood had hailed the grand jury's actions as vindication of its vehement denials that its staff violated any laws. Tuesday’s dismissal of charges against the activists clears up a twist in Texas Republican’s ongoing fight against the women’s health organization, but Planned Parenthood officials said the charges were dismissed on a technicality and not because the activists are innocent. (Ura, 7/26)

State Watch

State Highlights: Pa. Audit Finds Deficiencies In Enforcement Of Nursing Home Staffing Rules; Common Calif. Mosquito Could Carry Zika

Outlets report on health news from Pennsylvania, California, Texas, Connecticut, Georgia and Virginia.

The Philadelphia Inquirer: Pa. Audit Finds Weakness In Nursing-Home Staffing Enforcement
An audit released Tuesday by Auditor General Eugene DePasquale found deficiencies in the way the Pennsylvania Department of Health enforced the state's minimum standard of 2.7 hours per day of direct nursing care. The audit covered the period from Jan. 1, 2014, through Oct. 31, 2015. Only last July did the health department start accepting anonymous complaints about nursing homes. (Brubaker, 7/26)

Sacramento Bee: California Household Mosquito Could Amplify Zika Virus Spread
A mosquito that’s common in California has become the latest identified carrier of the Zika virus, potentially multiplying the population of vectors capable of spreading the disease. Until last week, researchers believed the virus could only be spread by two types of aedes mosquito much rarer in California and the U.S. But new research by a UC Davis ecologist and a top Brazilian science institution pins the southern variety of the culex mosquito – known as the southern house mosquito – as a potential vector of the disease, which can only be transmitted when a mosquito bites an infected person and then bites someone else. (Caiola, 7/26)

Los Angeles Times: Amid Outbreak, Health Officials Want More Gay Men Vaccinated For Meningitis
Health officials in Los Angeles and Orange counties are recommending that all gay and bisexual men receive meningitis vaccinations, amid an outbreak of the potentially fatal disease disproportionately affecting men who have sex with men. Local health departments were previously recommending vaccinations only for people considered high-risk, such as men who are HIV positive. “We acknowledge this broadens our prior recommendations, but, after careful consultation with the CDC and health officers in other affected jurisdictions, we consider that this expansion of the vaccination recommendations is a necessary step to suppress this outbreak,” said Dr. Jeffrey Gunzenhauser, L.A. County Interim Health Officer, in a statement Tuesday. (Karlamangla, 7/26)

The Texas Tribune: Abortion Booklet Revisions Called Even More Inaccurate
Death and infertility were just two of the risks a doctor described to Kryston Skinner when she chose to have an abortion last year. ... But some of the information she was given was misleading or medically wrong, contained in a long, controversial booklet that state lawmakers require doctors to give women at least 24 hours before an abortion procedure. Medical experts have long denounced the booklet, saying important sections — such as those connecting abortions to the likelihood of breast cancer and infertility — are wrong. (Pattani, 7/27)

The CT Mirror: State To Probe Whether UConn Can End Pediatric Services
State health care regulators have launched an inquiry into plans by the University of Connecticut Health Center to end primary clinical pediatric services starting Oct. 1. And the top Republican in the state Senate, Minority Leader Len Fasano of North Haven, is questioning whether UConn improperly skipped the state certificate-of-need process before scheduling the end of primary pediatric services. But the university said Tuesday that this process is not required to cease services in this instance. (Phaneuf, 7/26)

Gwinnett Daily Post: Norcross Clinic Expands To Help More Uninsured Gwinnett Residents
[Douglas] Hernandez, who started volunteering with the Good Samaritan Gwinnett Health Center in April 2015, said the woman said she felt lonely and without purpose. ...[Paige] Havens said the current location will allow for more than 20,000 interactions with patients per year. She said the nonprofit gained six more staff members and now has 22 available for pediatrics, prenatal care, primary care, dentistry, and individual and family counseling. (Wells, 7/25)

Atlanta Journal-Constitution: Medical Marijuana Blunts Tax Bill, Say UGA Researchers
In a recent study, the father-daughter team of David and Ashley Bradford say in the 17 states with a medical marijuana law in place by 2013, Medicare saved approximately $165.2 million because of lower prescription drug use. If medical marijuana was approved in every state, the overall savings to Medicare would have been around $468 million. That’s a lot of green. (Mathis, 7/26)

The Philadelphia Inquirer: Suit Claims Dentist Was Fired For Reporting Unneeded Treatment
A dentist who was fired by Penn Dental Medicine is suing the University of Pennsylvania, alleging he was wrongfully terminated in retaliation for reporting that a fellow dentist was providing unnecessary treatment to make more money. In its legal response, Penn claims it fired Steven S. Pesis because he reviewed patients' records without permission, in violation of university policies and the federal law that protects the confidentiality of patients' medical information. (McCullough, 7/27)

The Washington Post: Va. Man Claimed He Had Cure For Cancer, Charged $1,200 Per Bottle. Cops Say It’s Bogus, Bust Him.
Though a low-slung medical office building in Manassas City, Va., may seem like an unlikely place to find a cure for cancer, that’s where Peter B. Adeniji was offering his miracles, police say. For only $1,200 a bottle, Adeniji’s special herbal mixture would do what science and proven medications could not, authorities say he promised numerous patients. The promises ended Monday when police from a Prince William County drug task force raided Adeniji’s office and his home in Bristow, seizing medicines, ingredients for Adeniji’s mixtures and $17,000 cash, authorities said. (Jackman and Shapiro, 7/26)

Prescription Drug Watch

Drug Cost Transparency Bills Shopped Around To States Keep Getting Squashed

News outlets report on the pharmaceutical drug industry.

Bloomberg: PhRMA Wins Most Battles Against States' Price Transparency Laws
A high-profile Massachusetts drug price transparency bill appears headed for the legislative graveyard. With just days to go before lawmakers were set to adjourn for the year, on July 31, the bill had not seen a vote. If it fails, it would join about a dozen similar bills introduced in legislatures by consumer advocates in 2015 and 2016, sometimes with help from the insurance industry. The bills were fiercely opposed by the pharmaceutical industry. (Appel, 7/25)

The Associated Press: Senator: Is Medicare Drug Plan Vulnerable To Exploitation?
A senior senator wants to know if Medicare's prescription drug benefit is vulnerable to manipulation by pharmaceutical companies that set very high prices for medications. In a letter Monday to Medicare's top administrator, Iowa Republican Sen. Charles Grassley, said policymakers must ensure the Part D prescription program serving some 38 million beneficiaries "is free from exploitation," and asked if it meets that test as currently structured. (Alonso-Zaldivar, 7/27)

The Wall Street Journal: Eli Lilly Revenue Helped By Sales Of New Drugs
Eli Lilly & Co. reported Tuesday that revenue rose more than expected in the most recent quarter, as sales of new drugs padded increases in established products. “Lilly is in the midst of one of the most productive periods of new product launches in our company’s history, with new medicines making a substantial contribution to our revenue growth for the first half of the year,” Chief Executive John Lechleiter said. Recently released drugs, including diabetes treatment Trulicity and cancer drug Cyramza, helped push 10% volume growth in the quarter. (Steele, 7/26)

Stat: Republican Convention Viewers Sure Saw A Lot Of Drug Ads
Nearly 40 percent of the spots that ran during ABC, CBS, and NBC’s broadcasts of the convention touted pharmaceutical companies, prescription medications, or over-the-counter drugs. Lots of those ads also popped up on cable networks CNN and Fox Business. All told, about 60 such spots ran during convention broadcasts over the week, according to the data from iSpot. (Robbins, 7/22)

Stat: New Tools For Assessing Drug Value Haven’t Caught On With Payers — Yet
As prices for prescription drugs keep rising, several organizations have developed different ways to assess the value of new medicines based on such attributes as cost, quality of life, and effectiveness. But a new survey finds that even as health plans continue to criticize drug prices, they have not yet embraced these new tools. None of the 11 plans queried actively rely on these new methods and a majority do not expect to do so next year either, according to the survey conducted by Avalere Health and released today. The tools are being developed by four groups — the American Society of Clinical Oncology, the Institute for Clinical and Economic Review, the National Comprehensive Care Network and Memorial Sloan Kettering Cancer Center. (Silverman, 7/26)

Boston Globe: Misadventures In Trying To Get A Shingles Vaccine
“If you had chickenpox, then the shingles virus is already inside you.” That’s what Terry Bradshaw says in that TV commercial, the one where he basically performs a home invasion on three middle-aged football fans and then frightens the bejesus out of them with medical scare talk. The ad promotes Zostavax, a vaccine sold by Merck & Co. that helps prevent shingles in people 50 or older. And when I first saw it, I found myself in the unusual position of actually agreeing with a Big Pharma company. ... It was the start of a hallucinatory journey that underscored, in its own small way, just how hard it is for patients to navigate today’s medical-industrial complex. In recent years, medical experts and policy makers have been telling us we need to become better health care consumers and think of medicine in the same way we think of other products and services we buy. I found that was almost impossible to do. (Krasner, 7/26)

FiercePharma: Novartis CEO Predicts Drug Pricing Overhaul In U.S. After The Election, Whoever Wins
With both U.S. presidential candidates promising action on drug prices, November’s election could trigger a sea change in the industry, Novartis CEO Joe Jimenez figures. In an interview with the Financial Times, Jimenez predicted that pricing pressures in the U.S. will only increase when a new administration takes over, whether that administration is helmed by Democrat Hillary Clinton or Republican Donald Trump. (Staton, 7/20)

Bloomberg: Facing Cancer Drug Shortage, U.S. Relies On Banned Chinese Plant
Last September, U.S. regulators faced a dilemma: whether to allow importation of drug ingredients from a Chinese factory with a history of poor quality controls, or face shortages of treatments for American cancer patients. Six months earlier, visiting Food and Drug Administration inspectors had uncovered what the agency later called “broad data manipulation” at the factory, located in Taizhou, about 200 miles south of Shanghai. Information about the potency and purity of some product batches had been deleted, making it difficult to investigate a significant increase in customer complaints, the FDA said in a warning letter to the plant’s owner, Zhejiang Hisun Pharmaceutical Co. The agency issued an indefinite ban on the factory in September, a first for Hisun, one of China’s leading exporters of pharmaceuticals products. Yet to avoid possible shortages of drugs, the FDA allowed the plant continue exporting about 15 ingredients for use in finished drugs in the U.S., including nine key cancer medicine components. Hisun says that it takes quality seriously and has complied with requirements. (Edney, 7/22)

Stat: State Department Accused Of Interfering With Efforts For Affordable Medicines
The US Department of State is being accused of inappropriately interfering with efforts by the United Nations and two countries to ensure access to affordable medicines for poor people. In a blunt letter sent on July 20, dozens of patient advocacy groups charged that State Department officials questioned the premise of a UN panel devoted to exploring wider access, pressured the Colombian government not to sidestep the patent on a Novartis cancer drug, and pressed India to adopt policies that could result in higher drug prices and eliminate the production of lower-cost generics. (Silverman, 7/25)

Kaiser Health News: Insurers May Share Blame For Some Generics’ Price Hikes
Generic drug price hikes have come under close scrutiny lately, as reports continue to surface of significant and seemingly inexplicable increases, often for widely used drugs like levothyroxine or digoxin, a heart medicine, whose out-of-pocket costs to consumers have been modest for years. What gives? Health care professionals like your pharmacist often blame drug manufacturers, claiming they raise prices simply because they can, said Dan Mendelson, president of Avalere Health, a consulting firm. There’s no question that happens. But there are other reasons that generic drug prices may increase as well. (Andrews, 7/26)

Perspectives On Drug Costs: PhRMA's Big Talk On Price Gouging Seems To Be Just That

Editorial and opinion writers offer their takes on drug-cost issues.

Stat: Pharma Trade Group Says Price Gougers Are Outliers, But Then Accepts Two More
For months, the trade group representing big drug makers has argued that Valeant Pharmaceuticals and Turing Pharmaceuticals, which was once run by Martin Shkreli, were outliers for brazen pricing practices that outraged Americans. At every turn, the Pharmaceutical Research and Manufacturers of America has worked hard to convince lawmakers and the public that its members are not the equivalent of “hedge funds” that exist to set sky-high prices while failing to sufficiently invest in developing new medicines. But earlier this month, the trade group made a curious move. Among five companies that were just added to its roster, two of them — Jazz Pharmaceuticals and Horizon Pharmaceuticals — have also relied on excessive pricing to fuel their growth, while investing much less than other drug makers in research and development. (Silverman, 7/26)

Morning Consult: Congress Should Put Taxpayers Before Insurers
Controlling healthcare costs was one of the main goals of the President’s healthcare law, but millions of American patients have seen quite the opposite happen over the past six years. Facing higher compliance and coverage expenses on top of onerous mandates, healthcare companies have increased costs dramatically. Pharmaceutical companies, for instance, have struggled with the large up-front costs associated with navigating life-saving medications through the convoluted approval processes at the Food and Drug Administration (FDA). And insurance companies, in order to meet all coverage requirements while insuring high-risk policy holders at the same rates as low-risk policy holders have hiked premiums while simultaneously increasing out-of-pocket costs for enrollees. (Christine Harbin, 7/26)

The Huffington Post: Drugmakers Give Big Money To Docs, Get Higher Drug Prices, More Opioids
If you wonder why doctors are not mobilizing against the opioid epidemic, or the ridiculously high price of prescription drugs, just look at this statistic: drug and medical-device makers made payments of more than a quarter of a billion dollars in 2015 to California doctors. That’s from federal records. Other research by the ballot initiative campaign to mandate lower price prescription drugs through Prop 61 shows the California Medical Association’s (CMA) president has a medical practice that in Riverside that received more than $1.6 million from drug and medical device makers from August 2013 through the end of 2015. Other CMA trustees got big payments too, and the Association’s foundation itself is funded big time by drugmakers. (Jamie Court, 7/21)

The Philadelphia Tribune: Americans Need To Take Action On Skyrocketing Drug Prices
As both political parties are completing the process of selecting their presidential candidates, we have a unique opportunity to draw attention to issues affecting all Americans. One topic so far overshadowed by the horse race election coverage is the skyrocketing cost of medicine. Out-of-control prices for prescription drugs are steadily bankrupting our healthcare system. Price hikes are putting treatment out of the reach of too many people, as well as raising health insurance premiums for all of us. And the rising costs are stealing from our state and federal healthcare programs, including Medicare. (Marian Tasco, 7/23)

Editorials And Opinions

Viewpoints: The Truth About Health Insurance Premium Costs; The Collapse Of A Co-Op

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

Los Angeles Times: The Truth About Healthcare Premiums: They'd Be A Lot Higher Without Obamacare
We’ve just entered the “sticker shock” season of healthcare reporting: News stories are brimming with reports of double-digit premium requests from insurance companies, amid dire warnings about the impact on consumers. Public health expert Benjamin Sommers of Harvard calls this “a new U.S. healthcare tradition: headlines about proposed premium increases under the Affordable Care Act and predictions of the law’s demise.” This year brings an additional theme — the trend’s putative effect on the presidential election. Some of the figures are certainly eye-catching — some insurers in some states are seeking increases of more than 30%. In California, where the state exchange negotiated increases of only 4.2% in 2015 and 4% this year, rates will rise by an average 13.2% next year. (Michael Hiltzik, 7/26)

The Wall Street Journal: Zika Funding: What If Political Gridlock Isn’t Why Congress Hasn’t Acted?
How did something that should have been uncontroversial – relatively modest funding to fight a new infectious disease in the U.S. – become so hard that Congress left Washington for the summer (mosquito season) without passing legislation to combat the Zika virus? The obvious answer – that our gridlocked political system cannot complete even the simplest task – does not fully explain things. ... The largest factor appears to be lawmakers’ failure to appreciate the risk Zika poses. (Ron Klain, 7/25)

Bloomberg: Accidental Science That Can Heal Or Kill
It’s tempting to believe that scientific discoveries can be weighed for their value to society. Then the good ones could be pursued and the bad ones set aside. That’s obviously hard to do. Think about progress that happens by accident. Who’s to judge whether its eventual use is most likely for healing or killing? (Faye Flam, 7/26)

The New York Times' Upshot: Building A Better Human With Science? The Public Says, No Thanks
Americans aren’t very enthusiastic about using science to enhance the human species. Instead, many find it rather creepy. A new survey by the Pew Research Center shows a profound distrust of scientists, a suspicion about claims of progress and a real discomfort with the idea of meddling with human abilities. The survey also opens a window into the public’s views on what it means to be a human being and what values are important. (Gina Kolata, 7/26)

Stat: Opioid Contracts, Meant To Curb Addiction, Can Harm Patients
The US Senate recently passed legislation designed to address the nation’s opioid addiction epidemic, and President Obama is expected to sign it into law. Among other things, the bill promotes the use of opioid contracts. These are written agreements between doctors and patients about the conditions for prescribing opioids long term for chronic pain. This is great news. It could also harm patients. Opioid contracts clarify for doctors and patients how to prescribe these dangerous medications. By doing so, they can formalize safer approaches to opioid prescribing. That’s why they are already required by law in New Hampshire and Massachusetts. (Tim Lahey, 7/26)

Houston Chronicle: Social Security And Medicare Reports Show Real Trouble Ahead
This year, trust accounting shows that Social Security and Medicare have a combined surplus of $17.1 billion. Just above that, you'll see the federal budget accounting. It shows that in spite of employment taxes, taxes on Social Security benefits, trust fund interest and premiums for Medicare B and D, these programs were short $354.5 billion. Their cash shortage represented 80 percent of the entire federal deficit for 2015. All other government programs, after tax collections, operated at a loss of $83.9 billion. (Scott Burns, 7/26)

Health Affairs Blog: What’s In A Word? The Evolution Of Effectiveness In Health Care
The health care world is full of colloquial terms like value or affordability that mean different things to different stakeholders. Often how you define them and what you think of them depends on your place within the overall health ecosystem. It’s a classic case of “beauty is in the eye of the beholder.” One such term is effectiveness. We all want medical treatment to be effective, and understanding what that word means to different stakeholders is critical to having a productive dialogue — whether you are in a hospital, a research center, or on the floor of Congress. Here is a brief history of the concept of effectiveness, a few insights about its many meanings, and the debates we can expect to have about it in the years ahead. (Murray Ross, 7/26)

Los Angeles Times: Another Bad Year For CalPERS
CalPERS is responsible for the retiree pension and health benefits for 1.8 million current and former employees on the payrolls of the state and 3,000 local governments (but not those serving Los Angeles city or county) and school districts. Its funding comes from three main sources: about 13% from public employees, 22% from state and local governments and 65% from investment returns. The employees’ contributions are set by contract (and guided by state law), so the main variables are the contributions from state and local employers and the amount earned by the fund’s investments. (7/27)

Raleigh (N.C.) News & Observer: Feds Should Reject NC’s Request To Privatize Medicaid
The Republican-led General Assembly has a long list of actions that compete for the title of most outrageous, but there’s no contest in choosing the one that ranks as most mysterious. That is the unwavering commitment of Republican leaders to changing the state’s Medicaid system. ... The proposed changes call for Medicaid to be managed, at least in part, by private companies, but the reasons for the changes are melting away. Medicaid costs are coming in under budget and the non-profit that oversees much of the program, Community Care of North Carolina, has had remarkable success in finding ways to save money and improve health care for children, pregnant woman and disabled people who are covered by the state-federal health care program. (7/26)

The New York Times: Prostate Cancer Isn’t Colorblind
In 1966, the Rev. Dr. Martin Luther King Jr. said, “Of all the forms of inequality, injustice in health care is the most shocking and inhuman.” While major advances have been made in health care, ethnic and racial disparities remain in the prevention, diagnosis and treatment of many illnesses, particularly prostate cancer. (Lannis Hall, Arnold D. Bulliock, Angela L. Brown and Graham Colditz, 7/27)

Georgia Health News: Why I Became A ‘Concierge’ Physician
A concierge practice refers to a practice in which the physician charges each patient an annual retainer fee. There are several types of concierge primary care practices. So called “direct care” describes a practice in which the annual fee covers all primary care services. Within that types of practice, the physician does not bill health insurance for services. In another type of concierge primary care practice, the physician does contract with a health insurer and submits claims to the insurer for covered services. However, the annual fee goes toward providing extra amenities, such as longer clinic visits, direct access 24/7 to one’s personal physician by cellphone, email or text, and the guarantee of prompt access for appointments — meaning either same-day or next-day appointments. (Juliet Mavromatis, 7/26)

Cleveland Plain Dealer: Ohio's Medical Marijuana Law Will Not Protect Patients In The Workplace
Ohio is now the 26th state to legalize medical marijuana -- a great accomplishment for advocates and patients. But does the bill go far enough? While the bill states that patient information will be kept confidential, there is a failure to protect patients working in zero-tolerance companies that perform drug testing. This is a clear inconsistency in the legislation's logic. By mandating that such information should be confidential, lawmakers acknowledge that stigma surrounding marijuana can threaten a patient's livelihood. However, because the law doesn't intervene with drug-testing policies, patients can be discovered anyway and fired from their job. (Samantha Santoscoy, 7/27)


KHN will have a new editor-in-chief starting in September, Kaiser Family Foundation president and CEO Drew Altman announced yesterday. Longtime New York Times reporter Elisabeth Rosenthal will succeed John Fairhall, who is stepping down after nearly five years. Rosenthal is an award-winning journalist with deep experience in health policy reporting.