KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: 'Gospel Truth?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Gospel Truth?'" by Nate Beeler, The Columbus Dispatch.

Here's today's health policy haiku:


Who will be Speaker?
Choice may set tone for budget
And key health issues.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.


CMS Releases Star Ratings For 2016 Medicare Advantage Plans

Almost three out of four beneficiaries are enrolled in medical and drug coverage plans that received at least a four-star quality rating, according to the Centers for Medicare and Medicaid Services. The rankings did show a drop for some companies, especially in regard to prescription drug benefits.

Modern Healthcare: Medicare Advantage Star Ratings Reveal Mix Of High, Low Performers
More Medicare Advantage plans nabbed top quality marks for their 2016 plans than last year, a potential sign that private insurers are trying to meet the federal government's standards for high-quality products and coordinated healthcare for seniors. But the CMS' star ratings, released Thursday, also showed that private Medicare plans are still failing on many levels, particularly when it comes to prescription drug benefits. (Herman, 10/8)

Meanwhile, 2016 Medicare Part D premiums will rise for many -

Reuters: Unwelcome News About Medicare's Rising Drug Costs
Seniors have received some unpleasant news in their mailboxes in recent weeks: premiums for many Medicare prescription drug insurance plans will rise at double-digit rates next year. Premiums for the ten most popular Medicare Part D prescription drug plans (PDPs) will rise an average of 8 percent next year - the fastest clip in five years, according to Avalere Health, a consulting and research firm. And five of the top plans will boost their average premiums anywhere from 16 percent to 26 percent. (Miller, 10/8)

Health Law Issues And Implementation

Insurers Seeking More Obamacare Aid Could Wait Years

Insurers who hoped to get billions in aid after opening-year losses from their participation in the health law's insurance marketplaces are only getting 12.6 percent of what they requested after the fund to pay them fell short. In the meantime, Obamacare dropouts get picked up by employer coverage in California, and Wyoming loses one of its two health law insurers.

Pittsburgh Post-Gazette: Affordable Care Act Aid Could Take Years To Reach Insurers
Health insurers that lost millions of dollars last year under the Affordable Care Act may wait years for the government to deliver the aid it promised them. Companies, including Downtown-based insurer Highmark, want about $2.87 billion to help cover their first-year losses from online insurance marketplaces — a centerpiece of the landmark health care law. But a federal relief program meant to limit their risk is more than $2 billion short, leaving the companies to collect only 12.6 percent of those requests late this year, the Centers for Medicare & Medicaid Services said this month. (Smeltz, 10/8)

Los Angeles Times: Many Obamacare Dropouts In California Picked Up Employer Coverage, State Says
Nearly half of the estimated 700,000 Californians who have dropped their Obamacare policies during the past two years have enrolled in an employer-based plan, a new report from the Covered California exchange shows. In a news conference Thursday, Peter Lee, the organization’s executive director, said there were about 1.3 million Californians enrolled in the exchange’s plans as of June 30. That was about two-thirds of the 2 million who have enrolled in the exchange since it opened Oct. 1, 2013. (Sisson, 10/8)

The Associated Press: Wyoming Loses 1 Of Its 2 Affordable Care Act Insurers
One of the two companies offering health insurance coverage in Wyoming under the federal health care law has decided to drop out of the program after receiving word that the federal government would be providing drastically less financial help than it expected. The news comes as state leaders debate whether the federal government can be trusted to help pay for expansion of a health insurance program for the working poor. (Moen, 10/8)

Also, lawmakers in New Jersey ask the attorney general there to delay proposed insurance plans from Horizon Blue Cross Blue Shield that are meant to save money --

The Associated Press: New Health Insurance Plan Sparks Debate In New Jersey
Two New Jersey senators have asked the state attorney general to delay the biggest health insurer in the state from offering a set of insurance plans that are being sold as money-saving ways to cover health care. Critics fear the Horizon Blue Cross Blue Shield plans could hurt some patients and hospitals. Democratic Sens. Nia Gill and Joseph Vitale say the state should first set up a way to oversee how health insurers rate health care providers when they set up tiered systems. Here's a look at the issue. (Mulvihill, 10/8)

Colorado's cooperative insurance plan faces an uncertain future over cost concerns, and a patient advocacy group rates California's best HMO and PPO plans --

The Associated Press: Low-Cost Health Insurer In Colorado Faces Uncertain Future
Colorado's biggest nonprofit health insurer faces an uncertain future, and its 80,000 or so customers don't know whether their insurer will be able to offer new polices when next year's enrollment period begins soon. Colorado HealthOP, which emerged from the Affordable Care Act, faces possible insolvency because the U.S. government said it won't be able to cover payments to help stabilize premiums in federal insurance markets. (Wyatt, 10/8)

Los Angeles Times: California Agency Ranks Kaiser As Best HMO, Anthem And Cigna As Best PPOs
Kaiser Permanente was the highest-rated HMO and Anthem Blue Cross and Cigna the top-rated PPOs in a new state report. The California Office of the Patient Advocate released ratings Wednesday of 10 HMOs, six PPOs and more than 200 medical groups, just as Californians prepare to choose their health plans for next year from their employers or Covered California, the state's Obamacare exchange. (Pfeifer, 10/8)


Bill Would Require Drug, Device Makers To Disclose Pay To Nurses, Physician Assistants

The legislation, introduced in the Senate, would close a loophole in the law that requires public disclosure of such payments to doctors and some other health providers.

ProPublica: Bill Would Add Nurses, Physician Assistants To Pharma Payments Database
A bill proposed Wednesday by two U.S. senators would require drugmakers and medical device manufacturers to publicly disclose their payments to nurse practitioners and physician assistants for promotional talks, consulting, meals and other interactions. The legislation would close a loophole in the Physician Payment Sunshine Act, which requires companies to report such payments to doctors, dentists, chiropractors, optometrists and podiatrists. Companies have so far released more than 15 million payment records, covering August 2013 to December 2014. (Ornstein, 10/8)

And on prices for medical services -

Kaiser Health News: Medical Prices Higher In Areas Where Large Doctor Groups Dominate, Study Finds
Prices for many common medical procedures are higher in areas where physicians are concentrated into larger practice groups, according to a new study. The October Health Affairs study examined the average county prices paid by preferred provider insurance organizations in 2010. It focused on 15 high-volume, high-cost medical procedures across a variety of specialties, including vasectomy, laparoscopic appendectomy, colonoscopy with lesion removal, nasal septum repair, cataract removal and knee replacement. The prices studied reflected the negotiated prices between the PPOs and the physician groups, including payments made by both the plan and the patient. The average price ranged from $2,301 for a total knee replacement to $576 for a vasectomy. (Andrews, 10/9)

Med Schools Trying To Adapt To New Health Care Environment

With a revolution in U.S. health care -- in both how care is delivered and paid for -- schools that train doctors are scrambling to revamp. Also, a Michigan paper examines the burden on nurses at an understaffed state hospital, and a study analyzes patient attitudes about being discharged from the hospital.

The Washington Post: A Different Kind Of Care Package
U.S. health care is in a revolution that is starting to shake up one of the most conservative parts of medicine: its antiquated model for training doctors. Once paid a la carte for the procedures and services they perform, physicians are beginning to be reimbursed for keeping their patients healthy. ... The AMA is worried enough about the problem that it has been giving out millions of dollars to prod new kinds of teaching, in the hope that doctors’ training can adapt as quickly as the system they will soon join. (Johnson, 10/8)

The Lansing State Journal: Michigan Mental Health Nurses Say OT Hurts Patient Care
The well-being of some 700 patients in state psychiatric hospitals is in the hands of nurses who say they're overworked, overtired and overstressed because of excessively mandated double shifts. Sometimes several days a week, nurses in Michigan's five state-run hospitals end their regular eight-hour shifts only to be ordered to cover staffing shortages by working another eight hours. Against the recommendations of nursing groups and one of the state's own task forces, several current and former nurses at the Michigan Department of Health & Human Services told the State Journal they're worked to the point of exhaustion and ragged nerves, more prone to errors or poor judgment as they deal with unpredictable, sometimes violent patients. (Hinkley, 10/8)

Reuters: Patients Who Feel Ready To Leave The Hospital Are More Satisfied
In a small study of hospitilized patients, those who felt ready to go home when they were discharged were more satisfied with the hospital and their caregivers than those who didn’t feel ready to go. It may be useful to use patient readiness for discharge as one measure of quality of care, the authors write in the Journal of the American College of Surgeons. (Doyle, 10/8)

Capitol Hill Watch

House Panel Finds No Financial Wrongdoing By Planned Parenthood, Rep. Chaffetz Says

Chairman of the House Oversight and Government Reform Committee Jason Chaffetz (R-Utah) says his committee's hearings have not found that the reproductive health organization is improperly handling its finances. He says investigations may continue. At a hearing yesterday, a former employee said that Planned Parenthood did bill Medicaid for abortion services. The woman made similar claims in a lawsuit that in 2014 an Iowa appeals court said did not have enough evidence to go forward.

The Huffington Post: GOP Probe Into Planned Parenthood Funding Comes Up Empty
Rep. Jason Chaffetz (R-Utah), chairman of the House Oversight and Government Reform Committee, said Thursday [during a Judiciary Committee hearing] that the GOP's investigation into Planned Parenthood's use of federal funds hasn't turned up anything. ... Chaffetz said Thursday that he still supports digging into Planned Parenthood's activities, even if they're using their money appropriately. "I think there will continue to be investigations," he said. (Bendry, 10/8)

The Hill: Planned Parenthood Billed Medicaid For Abortion Services, Ex-Employee Claims
A former Planned Parenthood employee told lawmakers Thursday that she had firsthand knowledge that the organization has billed the federal government for abortion-related ultrasounds and medications, in violation of federal law. Susan Thayer, who spent 17 years working as a clinic manager for Planned Parenthood in Iowa, told lawmakers Thursday that the group had overbilled Medicaid by about $28 million, reasserting claims that have been the subject of a drawn-out court battle in Iowa. ... an appeals court in Iowa ruled in fall 2014 that Thayer did not have detailed enough evidence to accuse Planned Parenthood of submitting false claims. (Ferris, 10/8)

From Planned Parenthood To Obamacare: Speaker Race Will Impact Key Health Care Issues, Funding

House Republicans will meet Friday morning to discuss next steps in electing a leader following Rep. Kevin McCarthy's surprise withdrawal from the race Thursday. Rep. Paul Ryan has resisted recruitment appeals so far.

The New York Times: Republicans To Meet Amid Turmoil After Kevin McCarthy's Exit From Speaker Race
House Republicans will meet Friday morning at the Capitol to begin charting a path forward after Representative Kevin McCarthy of California’s stunning withdrawal from the race for speaker dashed expectations of an orderly succession and threw Congress deeper into turmoil. The struggle to restore order to their leadership comes as they confront major fiscal issues with rapidly approaching deadlines, and Republican leaders are casting about for a candidate for speaker who can both bring along restive conservatives and maintain the backing of the far larger ranks of the rest of their conference. (Herszenhorn, 10/9)

Wall Street Journal: Paul Ryan Resists Calls To Run For House Speaker
Deprived of a clear pick for House speaker, many Republican lawmakers turned Thursday to Paul Ryan, the 2012 GOP vice presidential nominee, an architect and lead salesman of the party’s conservative economic policies. While the Ways and Means committee chairman, said in a statement Thursday that he was “grateful for the encouragement,” Mr. Ryan added that he wouldn’t be a candidate. ... He has described the chairmanship of the Ways and Committee, a panel that oversees issues such as tax and government health-care policy, Social Security and trade, as an ideal post for him. (McKinnon and Hughes, 10/8)


Ariz. Weighs Medicaid Work Requirement, But HHS Has Rejected That For Other States

Arizona has already expanded its Medicaid program, but lawmakers there want to set tougher standards for those who are eligible. News outlets also report on the wait in Montana for the federal government to consider the state's expansion plans and a controversial statement by an aide to the Kansas governor.

Stateline: Should Medicaid Recipients Have To Work?
If Arizona gets its way, its able-bodied, low-income adults will face the toughest requirements in the country to receive health care coverage through Medicaid. Most of the those Medicaid recipients and new applicants would have to have a job, be looking for one or be in job training to qualify for the joint federal-state program for the poor. They would have to contribute their own money to health savings accounts .... Some of Arizona’s proposals have been made in other states, and the federal government has signed off on them. It has rejected work requirements, however. (Ollove, 10/8)

The Great Falls Tribune: Waiting For Medicaid Costly To Some Montanans
Holly Blouch wants to be working, and she wants to be healthy. But right now, it’s almost impossible to do both. Diagnosed with carcinoid disorder eight years ago, Blouch needed to work to have health insurance to pay for her medical care, which will some day involve needing a kidney transplant. But she can’t work enough hours to keep medical insurance because of her health. “There are a lot of people out there like me,” said the 37-year-old Kalispell woman. She’s referring to herself and the 69,999 other Montanans who now qualify for Medicaid coverage after the Montana Legislature approved the expansion plan this year. But she’s got to wait a little while longer to get that coverage while the federal government reviews Montana’s waiver application. (Cates, 10/8)

Wichita Eagle: Governor’s Press Office Calls Medicaid Expansion ‘Morally Reprehensible’
Gov. Sam Brownback’s press office blasted Medicaid expansion as an “Obamacare ruse” in an e-mail to supporters Tuesday, signaling that the governor won’t back expansion anytime soon. Melika Willoughby, the governor’s deputy director of communications, pushed back against the claim that the state’s refusal to expand Medicaid helped cause the closure of Mercy Hospital in Independence. “Those who say Medicaid Expansion would save the Independence Hospital are lying. It wouldn’t,” Willoughby said in an e-mail to the governor’s supporters. “Instead, this Obamacare ruse funnels money to big city hospitals, creates a new entitlement class, and fails to rightly prioritize service for disabled citizens.” (Lowry, 10/7)

And in other Medicaid news -

Los Angeles Times: Blue Shield's Deal With Regulators On $1.2-Billion Acquisition Draws Fire
Beleaguered insurer Blue Shield of California won state approval for its $1.2-billion acquisition of a Medicaid health plan, but the nonprofit company’s deal with regulators drew heavy criticism. The California Department of Managed Health Care said it extracted several key concessions from Blue Shield in an agreement unveiled Thursday. Ending a high-stakes and lengthy battle, the company agreed to permanently relinquish its longtime state tax exemption. (Terhune, 10/8)

The Associated Press: DHS Director Says He Will Leave Department By End Of Year
The director of Arkansas' Department of Human Services said Thursday that he will leave his job by the end of the year. John Selig said in a news release that he told Gov. Asa Hutchinson about his plans to leave the department that has overseen the implementation of the state's "private option" Medicaid expansion plan. Hutchinson said in an emailed statement that he met with Selig on Wednesday and asked him to stay on through January to help with the transition. (Lauer, 10/8)


Big Pharmaceutical Companies Withhold Support Of Trans-Pacific Trade Deal

Negotiators struck a compromise on the major issue of patent protections for biologics and vaccines that left no party completely happy.

The Wall Street Journal: Business Groups Withholding TPP Support On Lack Of Details
Major U.S. business groups, citing internal frictions and uncertainty over the details of President Barack Obama’s 12-nation Pacific trade deal, are withholding their support for now, hobbling the administration’s early efforts to win congressional backing. With big pharmaceutical companies and several other major industries disappointed by the Trans-Pacific Partnership, the broader business coalitions that have long backed the talks say they first must consult with their members. (Mauldin, 10/8)

NPR: TPP Negotiators Reached Agreement With Sticky Compromise On Biologics Drugs
A big sticking point in the negotiations over the Trans-Pacific Partnership involved biologics medicines and vaccines created from living organisms. The dispute centered on patent protection: how many years drug companies should have before facing competition from generics. The negotiators ended up with a complicated compromise that gives drug makers five to eight years of protection. But nobody is really happy with the outcome. (Zarroli, 10/8)

Biotech Stock Poised For Big Gain Or Big Fall

One Wall Street analyst says there's no middle ground forward for investment in biotech firms, whose products are becoming the focus of scrutiny after big price hikes. Elsewhere, a new multiple sclerosis drug from Roche shows promise, and there's news on a takeover bid by Blackstone and an impending sale by Clayton, Dubilier & Rice of a drug-compounding firm.

The Wall Street Journal: Biotechs Are A ‘Strong Buy’ Or ‘Strong Sell,’ Wall Street Strategist Says
Biotechnology stocks can’t catch a break. And one Wall Street strategist says the volatile price action recently has him expecting one of two things: A sharp turnaround or a deeper plunge. “The group isn’t a ‘Buy’ or ‘Sell’ here – it is either ‘Strong Buy’ or ‘Strong Sell,’” wrote Nicholas Colas, chief market strategist at brokerage Convergex. Biotechs have long been a volatile sector, well outperforming the large-cap S&P index during good times and significantly underperforming during bad times. (Scholer, 10/8)

The Wall Street Journal: Roche’s MS Drug Reports Promising Results
Roche Holding AG’s Genentech unit said its experimental drug ocrelizumab proved effective in three late-stage studies against multiple sclerosis, potentially heralding an important new treatment option for the debilitating disease. In two of the studies, which included 1,656 patients with relapsing multiple sclerosis, the most common form of the condition, ocrelizumab proved superior to the commonly used drug, Rebif, in reducing the annual rate of relapse of major symptoms and other measures of the status of the disease, Roche said. (Winslow, 10/8)

Bloomberg: Blackstone To Acquire BioMed Realty Trust For $4.8B
Blackstone Group agreed to buy landlord BioMed Realty Trust Inc. for $4.8 billion, betting on growth in real estate demand from the life sciences and biotechnology industries. Shares of REITs have been battered this year as investors gird for the first interest-rate hike since 2006, creating opportunities for buyers like New York-based Blackstone to acquire companies relatively cheaply. Health-care spending is rising quickly in the United States, boosting demand for laboratory space that can accommodate pharmaceutical developers and manufacturers. (Callanan and Mulholland, 10/8)

The Wall Street Journal: PharMEDium A Hit For CD&R As Firms Renew Interest In Sector
Clayton Dubilier & Rice’s planned sale of drug-compounding company PharMEDium Healthcare Holdings Inc. for $2.58 billion stands to land the private equity firm a nice return on its investment. It also reflects revived interest in compounding pharmacies, which mix or dilute pharmaceutical agents to create hospital-grade dosage forms that aren’t commercially available. (Or, 10/8)

Public Health And Education

Oncologists Skipping Expensive Cancer Drugs That Offer Little Or No Benefit

Meanwhile, news outlets report on other cancer care developments like the impact of life-expectancy questions on patients and what elephant genes could teach researchers about fighting the disease.

Reuters: Cancer Doctors Drop Pricey Drugs With Little Effect
U.S. oncologists, aware that patients are paying more of the costs of expensive cancer drugs, are increasingly declining to prescribe medicines that have scant or no effect, even as a last resort. At least half a dozen drugs, including colon cancer treatments Cyramza, from Eli Lilly & Co, and Stivarga, sold by Bayer AG, aren't worth prices that can exceed $100,000 a year, top cancer specialists said in interviews with Reuters. (Beasley, 10/8)

Reuters: Discussing Life Expectancy Gives Advanced Cancer Patients Realistic View
When doctors discuss prognosis with advanced cancer patients, those patients have more realistic views of their life expectancy and don’t seem to experience a decrease in emotional wellbeing, according to a new study. “That the vast majority of cancer patients who are dying say that they want to know their prognosis seems surprisingly courageous,” said senior author Holly G. Prigerson of Weill Cornell Medical College in New York City. (Doyle, 10/8)

Los Angeles Times: What Elephants Can Teach Scientists About Fighting Cancer In Humans
You've heard that elephants never forget, but did you know they almost never get cancer either? It turns out just 4.8% of known elephant deaths are related to cancer. For humans, cancer-related deaths are much higher — between 11% and 25%, scientists say. The low cancer rate among elephants is particularly intriguing because all things being equal, elephants should get more cancer than we do. (Netburn, 10/8)

Proposed Measure To Repeal California Vaccine Law Fails To Get Enough Signatures To Make Ballot

Also in California, Gov. Jerry Brown signs three bills aimed at limiting prescriptions of antipsychotics for foster children. Meanwhile, the Food and Drug Administration faces criticism for its continued approval of OxyContin for kids. And the growing heroin epidemic puts more minors into the state foster systems.

The Associated Press: Measure To Repeal California Vaccine Law Won’t Be On Ballot
Proponents of an effort to repeal California’s new stricter law requiring mandatory vaccines for schoolchildren failed to submit enough signatures to qualify a ballot initiative asking voters to repeal the law. County election clerks reported receiving fewer than 234,000 of the 366,000 signatures needed to ask California voters to repeal the law, according to figures provided to the secretary of state’s office and posted online Thursday. The new state law struck down the state’s personal belief exemption for immunizations, a move that requires nearly all public schoolchildren to be vaccinated. (Williams, 10/8)

NPR: Calfornia Approves Laws To Cut Use Of Antipsychotics In Foster Care
Efforts to protect children in foster care from being inappropriately medicated with powerful antipsychotic drugs got a big boost forward on Tuesday, when California Gov. Jerry Brown signed three bills into law designed to reform prescribing. Overprescribing of psychiatric meds for foster youth is a persistent problem nationwide, with children given the drugs at double or triple the rate of those not in foster care. (Korry, 10/8)

The New York Times: F.D.A. Approval Of OxyContin Use For Children Continues To Draw Scrutiny
Ever since the Food and Drug Administration approved the use of the narcotic painkiller OxyContin for certain children in August, it has faced unabated criticism from lawmakers and public officials who are wrestling with devastating rates of prescription opioid abuse in their communities. ... The crux of the issue is whether the agency’s approval will lead to more prescriptions for OxyContin in young patients. (Saint Louis, 10/8)

Stateline: How Heroin Is Hitting The Foster Care System
Timothy Dick’s office receives all kinds of reports of child abuse and neglect. Perhaps a child has a broken bone, or is underfed, or has been left home alone for too long. But when caseworkers drive to the child’s home to investigate, they often discover the same root cause. “What we’re finding more and more is that the parents are addicted to opiates. And more often than not, it’s heroin,” said Dick, assistant director of child protective services in Clermont County, Ohio. (Quinton, 10/9)

In other children's health news -

CNN: Anti-Bullying Laws Appear To Be Working
Roughly 20% of high school students report being bullied at school in the past year, according to the Centers for Disease Control and Prevention, and 15% of high school students said they were bullied online. That number has gone down significantly since the federal government started collecting data on the problem in 2005. A decade ago, 28% of students reported being bullied. Why? One reason is that anti-bullying laws seem to actually work. That's what a new study in JAMA Pediatrics suggests, although not all bullying laws are equally impactful. (Christensen, 10/8)

The New York Times: Eating Organic Lowers Pesticide Levels In Children
Researchers have found that when children eat organic fruits and vegetables, the amount of pesticides in their bodies declines significantly. Most organophosphorus pesticides have been phased out for residential use, but they are still widely used in agriculture. High doses in agricultural workers can be deadly. (Bakalar, 10/8)

The Associated Press: Researcher: Children's Cancer Linked To Fukushima Radiation
A new study says children living near the Fukushima nuclear meltdowns have been diagnosed with thyroid cancer at a rate 20 to 50 times that of children elsewhere, a difference the authors contend undermines the government’s position that more cases have been discovered in the area only because of stringent monitoring. Most of the 370,000 children in Fukushima prefecture (state) have been given ultrasound checkups since the March 2011 meltdowns at the tsunami-ravaged Fukushima Dai-ichi nuclear plant. The most recent statistics, released in August, show that thyroid cancer is suspected or confirmed in 137 of those children, a number that rose by 25 from a year earlier. Elsewhere, the disease occurs in only about one or two of every million children per year by some estimates. (Kageyama, 10/8)

FDA Recognizes Salt As Generally 'Safe'; Advocacy Group Wants That Status Removed

In other public health news, researchers find that intense early intervention can lead to recovery for people diagnosed with schizophrenia.

McClatchy: Consumer Group Sues FDA For Inaction On Salt
A prominent consumer advocacy group sued the U.S. Food and Drug Administration on Thursday for failing to regulate the amount of salt in the nation’s food supply. The Center for Science in the Public Interest wants the FDA to act on the group’s 10-year-old petition to lift salt’s status as “generally recognized as safe.” Doing so would reclassify salt as a food additive, which subjects it to more stringent regulation, like limits on the amounts allowed in processed foods. The legal action is the latest chapter in the group’s decades-long efforts to combat excessive sodium consumption. Eating too much salt can lead to high blood pressure, a major risk factor for heart disease, kidney failure and stroke. (Pugh, 10/8)

The St. Louis Post-Dispatch: Intense Early Intervention For Schizophrenia Leads To Recovery
When the Places for People outreach team found Chandra Thirdkill, she was about 40 years old and had been homeless for two years. Her struggles, however, began as a teen. Everyone looked at her like she was ugly, she thought. No one liked her. She constantly got into fights. Thirdkill dropped out of high school, turned to alcohol and drugs, and was in and out of jail as the fights grew to involve dishes, knives and bricks. Shooting and injuring her then-husband landed her in prison for three years. That's when she was finally diagnosed with schizophrenia. (Munz, 10/8)

State Watch

State Highlights: Another Rural Hospital Closes; N.Y. Expands Low-Cost Health Care To Immigrants; Fla. Kids Losing Special-Needs Services

News outlets report on health issues in Missouri, New York, Florida, California, Georgia, New Jersey, Pennsylvania, Minnesota and Maine.

The New York Times: Closing A Hospital, And Fearing For The Future
By this weekend, the last patients will be discharged and Mercy Hospital Independence will close, joining dozens of rural hospitals around the country that have not been able to withstand the financial and demographic challenges buffeting them. The hospital and its outpatient clinics, owned by the Mercy health care system in St. Louis, was where people in this city of 9,000 turned for everything from sore throats to emergency treatment after a car crash. Now, many say they are worried about what losing Mercy will mean not just for their own health, but for their community’s future. (Smith and Goodnough, 10/8)

Reuters: New York To Offer Low-Cost Healthcare To Immigrants
New York will become one of the first major U.S. cities to expand low-cost healthcare to uninsured immigrants regardless of their legal status under a pilot program to launch next spring, Mayor Bill de Blasio said on Thursday. The pilot, called Direct Access, will initially apply to 1,000 immigrants. Some of them are in the country legally but still ineligible for support under the Patient Pro­tec­tion and Afford­able Care Act, popularly known as Obamacare. The program is expected to expand in the following years. (10/8)

The News Service Of Florida: Senate Panel Wants Answers From DOH On Children's Health Programs
A Florida Senate panel on Wednesday demanded answers from a state Department of Health official about how many special-needs children have recently lost services as the state transitions to a new Medicaid system --- and why. Several members of the Senate Health and Human Services Appropriations Subcommittee said they'd had calls from constituents --- "in tears," in the words of Sen. Aaron Bean, R-Fernandina Beach --- over losing critical health-care services for their children. (Menzel, 10/8)

Georgia Health News: 'Balance Billing' Draws Legislative Scrutiny
A patient scheduled for surgery makes sure that both the hospital and surgeon are in the health plan’s network prior to the operation. But after the surgery, a surprise bill arrives for hundreds of dollars. It turns out that the anesthesiologist used in the procedure was not in the patient’s insurance network – and the patient had no idea. Such “balance billing’’ situations often confound and upset consumers receiving medical care – and can lead to tough collections practices. (Miller, 10/8)

Los Angeles Times: Death With Dignity Act In Oregon: A Preview Of What California Might Expect
California's new law, which the 77-year-old former Jesuit seminarian struggled with before signing, was modeled after legislation enacted in Oregon nearly 18 years ago. Whether they call it "death with dignity" or the "corruption of the medical profession," "physician-assisted suicide" or "medical killing," those on both sides of the end-of-life debate do agree on one thing: That Oregon's example offers important lessons for California and its 38.8 million residents, who in the near future will be able to ask a doctor to prescribe them a lethal dose of medication so they can hasten their own deaths. (La Ganga, 10/8)

The Philadelphia Inquirer: Camden County Program To Boost Post-Overdose Care
Camden County is launching a pilot program to support drug-overdose victims who are revived by police only to then wait weeks for a spot in an inpatient treatment center. Dubbed Operation SAL - an acronym for Save A Life and also a tribute to the son of a local addiction-issues advocate - the $150,000 program is designed to help up to 50 people receive intensive outpatient treatment during that waiting period after an overdose. (Lai, 10/8)

NJ Spotlight: Bid For Saint Michael's Could Let State Reshape Future Of Newark Hospitals
In the span of three years, the number of hospitals that the state owns could go from zero to two -- both in Newark, potentially allowing it determine exactly what healthcare in that city will look like for decades to come. The New Jersey Health Care Facilities Financing Authority has emerged as a potential bidder for Saint Michael’s Medical Center in Newark, just two years after the University of Medicine and Dentistry of New Jersey handed over University Hospital to the state. (Kitchenman, 10/8)

Minnesota Public Radio: CVS Offering Anti-Overdose Drug Without Prescription
Pharmacists at one of the largest drugstore chains in Minnesota can now distribute an antidote over the counter that can reverse opiate overdoses. CVS has announced that pharmacists at stores in Minnesota and 11 other states are now able to distribute the anti-overdose drug naloxone without a prescription. Another pharmacy based in southern Minnesota is exploring a similar program that's expected to launch before the end of the year. (Collins, 10/8)

Health News Florida: Lawmakers Prepare For Familiar Health Battles
Health care has been a hot-button policy issue for years in the Florida Legislature, and it’s starting to look like the session scheduled to start on Jan. 12 will be no different. Battles over Medicaid expansion and payments to hospitals treating low-income patients were so bitter in the spring, it brought the Legislature to a halt. (Shedden, 10/8)

The Associated Press: 3 Working Groups Start Tackling Heroin Problem In Maine
A task force formed to address the state's heroin epidemic held its first meeting on Thursday, with 35 people on three teams focusing on law enforcement, education and treatment, officials said. The three working groups will hold additional meetings to come up with solutions and strategies to turn back the tide of overdose deaths, addiction and drug-related crimes, said U.S. Attorney Thomas Delahanty, who volunteered to establish the working groups after a pair of drug summits in August. (Sharp, 10/8)

The Associated Press: Snyder Supports Switching Flint Water System Back To Detroit
Michigan Gov. Rick Snyder on Thursday called for Flint to switch back to Detroit’s water system to address a public health emergency over lead and grapple with broader concerns about the effects of the aging pipes distributing the city’s water supply. Flint stopped using water from the Detroit system last year as a cost-cutting measure, opting instead for a supply direct from the Flint River. But since the swap, residents have complained of the water’s funky smell, taste and appearance, as well as adverse health reactions, and doctors discovered that the corrosive river water was drawing lead from aging pipes in some homes. (Karoub and Eggert, 10/8)

Health News Florida: Arizona Homeopathic Doc Faces FL Board
A doctor who says she is “dedicated to the natural treatment of cancer” has been ordered to appear before the Florida Board of Medicine on Friday to explain the death of a toddler from an unapproved drug. Martha Grout MD, who left Florida 20 years ago after catching flak for her alternative methods, nevertheless holds a current Florida license. The incident occurred at her alternative medicine center in Scottsdale, Ariz., where she practices “homeopathy,” a style of medicine that is not legal in Florida. (Gentry, 10/8)

The Associated Press: Petitions Filed To Allow Medical Marijuana Use In Missouri
The first step to put medical marijuana to a statewide vote next year came Thursday, with supporters filing initiative petitions with the Missouri secretary of state. The two petitions from pro-medical marijuana group New Approach Missouri, would ask voters whether to amend the state constitution to allow physicians to recommend the drug to patients with certain illnesses, such as cancer, epilepsy and post-traumatic stress disorder, as well as "any other chronic, debilitating or otherwise equivalent condition." (Ballentine, 10/8)

St. Louis Public Radio: Effort Underway To Legalize Medical Marijuana Use In Missouri
Backers of medical marijuana want Missourians to decide if doctors can be allowed to prescribe the drug to critically ill patients. Two ballot initiatives that would do just that were filed on Thursday. Sheila Dundon of Columbia is a registered nurse and a breast cancer survivor. She says past cancer patients advised her to try marijuana to help curb the effects of chemotherapy. (Griffin, 10/8)

Health Policy Research

Research Roundup: Observation Care At VA; Meeting Charity Standards; Medicare Drug Plans

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: Observation Rates At Veterans’ Hospitals More Than Doubled During 2005–13, Similar To Medicare Trends
When neither inpatient admission nor prompt discharge is clearly indicated for a patient in the emergency department, physicians place the patient under observation in a hospital for diagnosis and treatment. The increasing prevalence of observation stays at hospitals reimbursed by Medicare is receiving considerable attention, but the prevalence remains unexplored in Veterans Health Administration (VHA) hospitals, which are subject to different payment policies. Using VHA data for fiscal years 2005–13, we identified trends and variations in observation rates across twenty-one Veteran Integrated Service Networks and 128 VHA hospitals nationwide. We found that observation rates across VHA hospitals more than doubled, from 6.5 percent to 13.8 percent, and that there was substantial variation across both Veteran Integrated Service Networks and hospitals. (Wright et al., 10/5)

Health Affairs: Connecticut’s ‘Money Follows The Person’ Yields Positive Results For Transitioning People Out Of Institutions
[T]he federal Money Follows the Person Rebalancing Demonstration helps qualified individuals living in institutions make the transition to life in the community. The Connecticut Money Follows the Person program is an unusually rich source of data, with information on the 2,262 people who transitioned to the community under that state’s program during 2008–14. ... for the majority of respondents who remained in the community, quality of life and life satisfaction improved significantly after transition, and they stayed high. About half of the participants visited hospitals or emergency departments after transition; however, only 14 percent had returned to an institution one year after transition. Predictors of reinstitutionalization included some not previously observed: mental health disability, difficulties with family members before transition, and not exercising choice and control in daily life. (Robison et al., 10/5)

Brookings: A Floor-And-Trade Proposal To Improve The Delivery Of Charity-Care Services By U.S. Nonprofit Hospitals
Many uninsured Americans rely on charity care provided by nonprofit hospitals, which receive substantial tax benefits in exchange for providing community benefits. In this discussion paper we show that the hospitals that receive the largest tax benefits tend to be located in wealthier communities, whereas the demand for uncompensated care is highest in poorer communities. To ameliorate this geographic mismatch between the supply of charity care and the demand for charity care, we propose a floor-and-trade system whereby nonprofit hospitals would be required to meet charity-care standards, either by providing care to local patients or by purchasing credits from other hospitals. (Ody, Dranove and Garthwaite, 10/7)

The Kaiser Family Foundation: Medicare Part D At Ten Years: The 2015 Marketplace And Key Trends, 2006-2015
This report presents findings from an analysis of the Medicare Part D marketplace in 2015 and changes in features of the drug benefit offered by Part D plans since 2006. ... In 2015, more than 39 million Medicare beneficiaries are enrolled in Medicare drug plans. Since 2006, the share of Medicare beneficiaries enrolled in a Part D plan has increased from 53 percent to 72 percent of all eligible Medicare beneficiaries. ... The average Part D enrollee had a choice of 30 PDPs and 15 MA-PD plans in 2015. ... In 2015, most plans use five cost-sharing tiers: preferred and non-preferred tiers for generic drugs, preferred and non-preferred tiers for brand drugs, and a tier for specialty drugs. ... Cost sharing for brand-name drugs has been relatively stable in recent years. (Hoadley, Cubanski and Neuman, 10/5)

The Commonwealth Fund: U.S. Health Care From A Global Perspective: Spending, Use Of Services, Prices, And Health In 13 Countries
This analysis draws upon data from the Organization for Economic Cooperation and Development and other cross-national analyses to compare health care spending, supply, utilization, prices, and health outcomes across 13 high-income countries .... These data predate the major insurance provisions of the Affordable Care Act. In 2013, the U.S. spent far more on health care than these other countries. Higher spending appeared to be largely driven by greater use of medical technology and higher health care prices, rather than more frequent doctor visits or hospital admissions. In contrast, U.S. spending on social services made up a relatively small share of the economy relative to other countries. Despite spending more on health care, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions. (Squires and Anderson, 10/8)

CDC's Preventing Chronic Disease Journal: Health Status of Older US Workers and Nonworkers, National Health Interview Survey, 1997–2011
Many US workers are increasingly delaying retirement from work .... We examined the association of older adults’ health status with their employment/occupation and other characteristics. National Health Interview Survey data from 1997 through 2011 were pooled for adults aged 65 or older .... Employed older adults had better health outcomes than unemployed older adults. Physically demanding occupations had the lowest risk of poor health outcomes, suggesting a stronger healthy worker effect: service workers were at lowest risk of multiple functional limitations ... and blue-collar workers were at lowest risk of multimorbidity ... and multiple functional limitation .... A strong association exists between employment and health status in older adults beyond what can be explained by socioeconomic factors (eg, education, income) or health behaviors (eg, smoking). (Kachan et al., 9/24)

Here is a selection of news coverage of other recent research:

The Wall Street Journal: How Economic Downturns May Be Good For Your Health
Economic downturns, it turns out, appear to be good for health, according to a study released this week by the National Bureau of Economic Research. The research by Christopher Ruhm, a professor at the University of Virginia, builds upon earlier studies looking at the impact of economic downturns on health. “There is considerable evidence that harmful behaviors–like heavy drinking and smoking–decrease in bad economic times, whereas health-enhancing activities such as exercise and social interactions increase,” Mr. Ruhm said. (Sparshott, 10/7)

Reuters: Women Are Missing From HIV Drug Trials
Although women make up roughly half of the world’s HIV cases, they remain largely excluded from clinical trials testing drugs, vaccines and potential cures for the virus, a research review confirms. In an analysis spanning several decades that included work done as recently as 2012, researchers found that women typically comprised about 11 percent of participants in trials investigating cures for HIV. Similarly, drug studies were only about 19 percent female and just 38 percent of vaccine trial subjects were women. (Rapaport, 10/2)

Reuters: Caring For Loved One With Alzheimer's May Be Most Stressful For Spouse
Caring for a loved one with Alzheimer’s disease isn’t easy under the best of circumstances, but it may be much more stressful for spouses and people who suffer from depression, a Finnish study suggests. Researchers followed 236 family caregivers of Alzheimer’s patients for three years after the diagnosis. Caregiving appeared to be much more stressful for people who were married to the patients or who suffered from depression when the study began. (Rapaport, 10/2)

Reuters: Perceived Discrimination Linked To Smoking And Poor Diet
Feeling like the target of discrimination may increase a person’s odds of harmful behaviors like smoking, eating fatty foods and getting less sleep, a study of African-Americans suggests. Researchers examined the connection between discrimination and these unhealthy habits among almost 5,000 African-American residents of the Jackson, Mississippi metropolitan area. (Rapaport, 10/8)

The Oregonian: Oregonians Billed By Out-Of-Network Health Providers At High Rates, Insurer Group Says
Patients who use health providers outside of their insurer's network can expect bills to be as much as 1,200 percent more than what those services would cost under Medicare, according to a new study from an insurer lobbying group. In Oregon, for instance, a session of computer-targeted radiation therapy to treat tumors costs, on average, $2,409. That's about six times the average Medicare reimbursement rate of $397 — a key benchmark for health care costs. (Budnick, 10/5)

The Wall Street Journal: Study: Attempted Suicide Rises After Weight-Loss Surgery
People who undergo surgery for weight loss are 50% more likely to attempt suicide after the operation than before it, according to a large Canadian study published Wednesday in the journal JAMA Surgery. The popular procedures, which were performed nearly 200,000 times in the U.S. last year, result in significant weight loss for most patients and often bring about reductions in Type 2 diabetes, hypertension and sleep apnea as well. Many patients also report improved mood and self-esteem. But a small group experience a worsening of depression, substance abuse and eating disorders, past studies have found. (Beck, 10/7)

Reuters: Type Of Weight Loss Surgery Matters For Diabetes Remission
Diabetics considering weight-loss surgery to help send their disease into remission should opt for the most popular procedure, a gastric bypass, researchers suggest. In their study of different types of so-called bariatric surgeries, the biggest impact on diabetes remission was seen with gastric bypass, which can reduce the size of the stomach from about three pints to roughly the size of a shot glass. (Rapaport, 10/6)

The Associated Press: Gene Test Finds Which Breast Cancer Patients Can Skip Chemotherapy
Many women with early-stage breast cancer can skip chemotherapy without hurting their chances of beating the disease, a major new study has found. The 21-gene test accurately identified a group of women whose cancers are so likely to respond to hormone-blocking drugs that adding chemo would do little, if any, good while also exposing them to side effects and other risks, the researchers found. “You can’t do better than that,” says the study leader, Dr. Joseph Sparano of Montefiore Medical Center in New York. (Marchione, 10/3)

The New York Times: Heart Scan Can Fine-Tune Risk Estimate For Patients Considering Statins
Treatment guidelines suggest that nearly half of those over age 40 — nearly 50 million people in the United States — at least consider a cholesterol-lowering statin to reduce heart attack risk. But a new large study of people who had an inexpensive heart scan found that half of those who were statin candidates had no signs of plaque in their heart and very little chance of having a heart attack in the next decade. (Kolata, 10/5)

The Associated Press: Report: More US Hospitals Are Encouraging Breast-Feeding
Health officials say more hospitals are encouraging new mothers to breast-feed. A new report found more than two-thirds of hospitals in 2013 helped women start breast-feeding within an hour after birth. That's up from 44 percent six years earlier. Roughly 90 percent of hospitals teach moms breast-feeding techniques and how to recognize and respond to infant feeding cues. But only about a quarter refrain from giving infants breast milk alternatives — like formula or water — unless medically necessary. (Stobbe, 10/6)

Editorials And Opinions

Viewpoints: War Of Words On Kansas Medicaid; Sebelius' Legacy; Mental Health Care Reform

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

Huffington Post: This GOP Governor's Comments About The Poor Are Incredibly Revealing
Some Republicans want their party to stop bashing poor people as lazy and undeserving of public assistance. Sam Brownback, the conservative governor of Kansas, doesn’t appear to be one of them. Brownback and his allies are in the middle of a major fight over Medicaid, the government-run health insurance program for the poor and disabled. ... And while conservatives who oppose the expansion sometimes rely exclusively on arguments about Medicaid’s efficacy -- or perceived lack thereof -- Brownback has been putting his rhetorical emphasis elsewhere. On Tuesday, the governor's deputy communications director, Melika Willoughby, distributed a letter laying out in detail the heart of Brownback’s argument -- namely, that expanding Medicaid would be “morally reprehensible” because it would help “able-bodied adults … who choose not to work" and would send money to “big city hospitals.” (Jonathan Cohn, 10/7)

Kansas City Star: Gov. Sam Brownback’s Missive On Medicaid Expansion Was Wrong, Cruel And Divisive
Kansas Gov. Sam Brownback’s office sent out one of its trademark propaganda pieces on Tuesday, this one on the subject of Medicaid expansion. In its effort to score political points, it maligns low-income Kansans and pits citizens with disabilities against the working poor. As with other recent messages, the email signed by the governor’s deputy communications director, Melika Willoughby, is rife with inaccurate information. (10/6)

Kansas City Star: Gov. Sam Brownback Takes The Low Road On Medicaid Expansion
In Kansas Gov. Sam Brownback’s world, expanding Medicaid eligibility to more low-income Kansans would create “new government entitlements” for “able-bodied adults” and benefit a small number of “big city hospitals.” I’ll say this for Melika Willoughby, the deputy communications director who penned that incendiary language in an email on behalf of the Brownback administration: She’s got the code words down pat. ... By spewing this sort of vitriol, the governor’s office is choosing to argue a complex issue with the lowest forms of talking points. (Barbara Shelly, 10/8)

Forbes: Three Major Problems Left By Sec. Sebelius' Legacy: Obamacare's Medicaid Expansion
While [former HHS Secretary Kathleen] Sebelius resigned in the shadow of a disastrous roll-out of, her more damaging legacy is the temptation for state leaders to embrace a bigger welfare state and accept an injection of federal dollars funded by Medicare cuts and deficit spending. Medicaid expansion, like Obamacare, fails to deliver on its promises of quality health care that improves the health of enrollees. Even more troubling, ballooning Medicaid expansion costs threaten every other service and will trap millions in a cycle of dependency and poverty. (Tarren Bragdon, 10/7)

Deseret News: Let The People Decide On Medicaid Expansion
I listened with interest to Tuesday’s Health Reform Task Force, where members of the Gang of Six presented their “Utah Access” plan for Medicaid expansion. This new proposal, built on the premise that health care providers should pay the majority of the state’s expansion costs, did not go over well. Providers are upset, and they have a right to be. Most providers will see no economic benefit from Medicaid expansion. They should not have to pay more than any other Utahn to cover its costs. (Dan Liljenquist, 10/8)

Des Moines Register: Medicaid Savings Are Increasingly Suspect
Perhaps Gov. Terry Branstad thought he could quietly privatize Iowa’s Medicaid program. Instruct a state agency to hand over administration to managed care companies, issue a few press releases about “modernization,” quickly secure federal approval and hope no one raises a fuss. Except when 4.2 billion public dollars and health care for 560,000 Iowans are on the line, people eventually pay attention to the details. It doesn’t take long to realize privatization makes no sense. (10/8)

The Wall Street Journal: Mass Shootings And A Mental-Health Disgrace
We all know how this plays out in Congress: a moment of silence on the House floor and a fraternal feeling of melancholy when the flag over the Capitol is lowered to half-staff. But that moment of silence will not heal the hearts of those who lost a loved one, and it will not stop the next tragedy. Here and now we need action; we need real change. That’s why I’ve authored the Helping Families in Mental Health Crisis Act. The bill focuses resources and reform where they are most needed: to foster evidence-based care, fix the shortage of psychiatric hospital beds, empower patients and caregivers under HIPAA privacy laws, and help patients get treatment well before their illness spirals into crisis. (Rep. Tim Murphy, R-Penn.)

The New York Times: Getting The Diagnosis Wrong
Diagnostic accuracy is fiendishly difficult to measure precisely, but it is estimated that doctors get it wrong in one out of 10 to one out of 20 cases. Up until now, the focus of the patient safety movement has been on errors of medical treatment — incorrect medications or dosages, postoperative complications, hospital-acquired infections. But diagnostic errors — incorrect or delayed diagnoses — may be more common and potentially more deadly. The Institute of Medicine has taken up the subject, and its new report offers the chilling observation that nearly everyone will experience at least one diagnostic error in their lifetimes. (Ofri, 10/8)

Politico: Planned Parenthood's Cecile Richards Blasts GOP 'Total Lack Of Civility'
Cecile Richards, the president of Planned Parenthood, says she was "stunned by the total lack of civility and use of raw power" by Republican members of Congress during last week's House Oversight and Government Reform hearing on her organization's federal funding, Richards fired back at Congress and Republicans in general in a Guardian article published Thursday, warning that the Supreme Court's 1973 decision in Roe v. Wade is "on the ballot" for next year's presidential election. (Nick Gass, 10/8)