KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Administration News

Trump Budget Slashes Medicaid Funding, Rejecting Some Conservatives' Pleas To Save Expansion

The White House also wants to give states more flexibility when it comes to imposing work requirements for people in the program.

The Washington Post: Trump To Propose Big Cuts To Safety-Net In New Budget, Slashing Medicaid And Opening Door To Other Limits
President Trump’s first major budget proposal on Tuesday will include massive cuts to Medicaid and call for changes to anti-poverty programs that would give states new power to limit a range of benefits, people familiar with the planning said, despite growing unease in Congress about cutting the safety net. For Medicaid, the state-federal program that provides health care to low-income Americans, Trump’s budget plan would follow through on a bill passed by House Republicans to cut more than $800 billion over 10 years. The Congressional Budget Office has estimated that this could cut off Medicaid benefits for about 10 million people over the next decade. (Paletta, 5/21)

The Associated Press: Huge Cuts To Food Stamps Part Of Trump’s Budget Proposal
Trump is also targeting the Medicaid health program that provides care to the poor and disabled, and nursing home care to millions of older people who could not otherwise afford it. The House had a bitter debate on health care before a razor-thin 217-213 passage in early May of a GOP health bill that included more than $800 billion in Medicaid cuts over the coming decade. Key Republicans are not interested in another round of cuts to the program. “I would think that the health care bill is our best policy statement on Medicaid going forward,” said Rep. Greg Walden, R-Ore., chairman of the House Energy and Commerce Committee, which has jurisdiction over the program. (Taylor, 5/21)

CNN: Trump Budget: $800 Billion In Medicaid Cuts
Donald Trump's budget that is expected to be unveiled on Tuesday will include $800 billion in cuts to Medicaid. ... The $800 billion reduction, confirmed to CNN Sunday evening by a senior administration official, assumes that the GOP health care bill that the House passed earlier this month would become law, that official said. (Lee and Luhby, 5/22)

Modern Healthcare: Trump Budget Proposal Would Slash Medicaid
By cutting Medicaid, Trump is rejecting the calls of some Senate Republicans who asked him not to stop expansion of Medicaid, which funneled billions into cash-strapped states. Even the most ardent opponents of the Affordable Care Act held out their hands when the federal government offered to subsidize the cost of expanding eligibility for Medicaid. Earlier this month, a bill to repeal the ACA that included massive cuts to Medicaid, passed by a razor-thin 217-213. Key Republicans have signaled they are not interested in another round of cuts to the program. (5/21)

Bloomberg: Trump To Propose Deep Cuts To Anti-Poverty Programs And Medicaid
During the presidential campaign, Trump promised not to cut Social Security, Medicare or Medicaid. He has already broken that promise on Medicaid by backing cuts to the program called for under the Obamacare repeal bill passed by the House on May 4. The White House has said that the president intends in his budget to keep his pledge on Medicare benefits and Social Security retirement benefits. (Wasson and Dennis, 5/21)

Hiring Freeze Leaves Nearly 700 Jobs Unfilled At CDC

The vacancies impact public health emergency readiness, infectious disease control and chronic disease prevention programs, The Washington Post reports. Other Trump administration moves at the Food and Drug Administration and the National Institutes of Health also make headlines today.

The Washington Post: Nearly 700 Vacancies At CDC Because Of Trump Administration’s Hiring Freeze
Nearly 700 positions are vacant at the Centers for Disease Control and Prevention because of a continuing freeze on hiring that officials and researchers say affects programs supporting local and state public health emergency readiness, infectious disease control and chronic disease prevention. The same restriction remains in place throughout the Health and Human Services Department despite the lifting of a government-wide hiring freeze last month. At the National Institutes of Health, staff say clinical work, patient care and recruitment are suffering. (Sun, 5/19)

The Hill: Health Groups Push FDA Not To Repeal E-Cig Rules
Health groups are lobbying the Food and Drug Administration (FDA) to keep in place e-cigarette regulations as Republicans press the administration for a repeal. The Campaign for Tobacco-Free Kids and 50 other health groups wrote a letter to Health and Human Services Secretary Tom Price this week asking him to defend and fully implement the rules finalized under former President Barack Obama. (Wheeler, 5/19)

CQ Roll Call: A Thorny Thicket Of Potential Conficts For New FDA Chief
The new commissioner of the Food and Drug Administration, Scott Gottlieb, has deep knowledge of the industries he oversees. That’s partly because he has unprecedented professional and financial ties to some of those companies from his career as an industry adviser. The companies that Gottlieb has worked for, advised or invested in encompass nearly every aspect of the FDA’s broad mission. Though he has promised to take steps to avoid conflicts of interest, Gottlieb will routinely confront potential ethical dilemmas. Further complicating matters are new policies the FDA is developing that will increase the influence of patient groups and change how clinical trials are conducted, which could offer opportunities for companies to influence the review process. (Siddons, 5/22)

Politico Pro: Republicans Urge Trump To Oust NIH Director Over Embryonic, Stem Cell Research
Forty House Republicans are urging President Donald Trump to fire the director of the NIH over his support for embryonic and stem cell research that they say conflicts with Trump’s “pro-life direction.” The Republican House members, in a letter led by Rep. Jim Banks (R-Ind.), question NIH Director Francis Collins’ support for embryonic cloning and for stem cell research that involves the destruction of human embryos. (Haberkorn, 5/22)

Health Law

‘Why The Hell Would We’ Continue Insurer Subsidy Payments, Trump Reported To Ask Advisers

Despite the potential political blowback, President Donald Trump is leaning toward cutting off billions in cost-sharing subsidies, according to sources who spoke to Politico. On Monday, there will be a hearing in the court case about the payments.

Politico: Trump Tells Advisers He Wants To End Key Obamacare Subsidies
President Donald Trump has told advisers he wants to end payments of key Obamacare subsidies, a move that could send the health law's insurance markets into a tailspin, according to several sources familiar with the conversations. Many advisers oppose the move because they worry it would backfire politically if people lose their insurance or see huge premium spikes and blame the White House, the sources said. Trump has said that the bold move could force Congressional Democrats to the table to negotiate an Obamacare replacement. (Dawsey, Haberkorn and Demko, 5/19)

The Hill: Trump Leaning Toward Ending Key ObamaCare Subsidies: Report 
President Trump is considering pulling the plug on key ObamaCare subsidies, Politico reported Friday, citing remarks the president has made to advisers...The Trump administration has reportedly told Congress that it will continue the subsidies through May, but it is not clear what will happen after that. If the payments do stop, it could cause premium costs to swell – a reality that would likely deal significant political damage to Trump and Republican lawmakers heading into the 2018 midterm elections. (Greenwood, 5/19)

USA Today: Obamacare Subsidies At Stake In Monday Court Hearing
A Monday court hearing offers the Trump administration its best opportunity to prevent significant increases in health care costs for about 7 million lower-income Americans who buy their plans on the Affordable Care Act exchanges. The administration's next move could prevent these insurance marketplaces from imploding as insurers are deciding which states, if any, to sell insurance in and at what price. (O'Donnell, 5/19)

Morning Consult: Trump Administration, House Set To Update Court In Obamacare Payments Case
The government reimburses insurance companies for offering cost-sharing reduction payments to help lower-income people afford certain health expenses. House Republicans brought a lawsuit against the Obama administration, arguing it improperly funded the subsidies without a specific appropriation from Congress. The administration argued there was a permanent appropriation in the ACA for the payments, but a district judge ruled with Republicans last year. (McIntire, 5/22)

The Hill: Trump Administration Faces Decision On ObamaCare Payments 
If the White House drops its appeal in a lawsuit over ObamaCare cost-sharing reduction (CSR) payments to insurers, it could fast-track the end of the health law — something Republicans have made a major campaign promise for years. But administration officials are wary of ending the lawsuit, because they know that doing so would send the insurance markets into chaos. Insurers have warned of massive premium hikes or threatened to exit the ObamaCare exchanges completely if the payments don’t continue, and recent polls suggest Republicans would be blamed. (Weixel, 5/21)

Senators Mull Short-Term 'Rescue' Bill For Health Law To Stabilize Marketplace

The upper chamber is quietly working toward coming up with their own version of a plan to repeal and replace the Affordable Care Act. And Congress awaits the Congressional Budget Office's score for the revised bill that passed the House.

The Associated Press: Senate Republicans Quietly Working On Health Overhaul Bill
Remember the Republican health care bill? Washington is fixated on President Donald Trump's firing of FBI chief James Comey and burgeoning investigations into possible connections between Trump's presidential campaign and Russia. But in closed-door meetings, Senate Republicans are trying to write legislation dismantling President Barack Obama's health care law. (Fram, 5/22)

Politico: McConnell Steps Into Obamacare Firing Line
Mitch McConnell has sidestepped the Russia controversy that’s dogged Donald Trump all year and eluded the wrath rained down on Paul Ryan over the GOP’s Obamacare repeal effort. But the health care reform battle is now squarely in McConnell’s court: He will decide the contents of the Senate’s plan, most likely behind closed doors. And he is on the hook for getting something through a sharply divided Senate Republican Conference in the midst of an increasingly imperiled presidency. (Everett and Haberkorn, 5/21)

CQ Roll Call: MacArthur Confident Health Care Bill Will Survive New CBO Score
A lawmaker who helped shape the latest version of the House GOP’s health care bill expressed confidence Friday that the ambitious measure remains within the dictates of complex Senate budget rules. Republicans need to keep it within bounds so they can try to pass it over unified Democratic opposition... The Congressional Budget Office on Friday said it will post an estimate on the House health care bill (HR 1628) on Wednesday. GOP leaders added several amendments affecting insurance rules shortly before the vote to win over reluctant Republicans. (Young, 5/19)

The Hill: Ryan Downplays Possibility Of Re-Vote On ObamaCare Repeal 
The House will probably not be forced to re-vote on the GOP's ObamaCare replacement bill despite a potential technical issue, Speaker Paul Ryan (R-Wis.) said Friday...The House, despite passing the American Health Care Act two weeks ago, is waiting to send the legislation to the Senate until the nonpartisan Congressional Budget Office (CBO) produces its analysis of the bill. (Hellmann, 5/19)

Kaiser Health News: Republicans Race The Clock On Health Care — But The Calendar Is Not Helping
Back in January, Republicans boasted they would deliver a “repeal and replace” bill for the Affordable Care Act to President Donald Trump’s desk by the end of the month. In the interim, that bravado has faded as their efforts stalled and they found out how complicated undoing a major law can be. With summer just around the corner, and most of official Washington swept up in scandals surrounding Trump, the health overhaul delays are starting to back up the rest of the 2018 agenda. (Rovner, 5/22)

Roll Call: New Mail Campaign Highlights AHCA Impact On Older Voters
Older voters in two GOP districts are the targets of a new direct mail campaign highlighting higher costs for seniors under the GOP health care bill. The liberal advocacy group Save My Care is launching a direct mail campaign this weekend aimed at 30,000 voters between the ages of 50 and 64 in Arizona’s 2nd District, home to Rep. Martha McSally, and Nevada’s 2nd District, represented by Rep. Mark Amodei. (Bowman, 5/19)

And in the states —

Denver Post: Effort To Repeal Obamacare Tests Colorado’s Cory Gardner
Three years after running on a pledge to repeal the Affordable Care Act, U.S. Sen. Cory Gardner of Colorado has a chance to do just that — having been named to a 13-member team of Senate Republicans tasked with dismantling the massive health care law. But Gardner isn’t approaching the assignment with the same kind of public gusto seen in lawmakers such as U.S. Sen. Ted Cruz of Texas, who has advocated for a strategy that would pull out all the stops to repeal Obamacare. Instead, Gardner has kept a lower profile — a reflection of both his policy goals and the political peril that comes with undoing President Barack Obama’s signature law. (Matthews, 5/22)

Nashville Tennessean: If Obamacare Is Repealed, Tennessee Faces A Big Decision
Two weeks ago, the U.S. House of Representatives passed the American Health Care Act (AHCA). It is now in front of the Senate. If it ultimately becomes law, Tennessee will have a big decision to make as a state. The decision relates to how Tennessee wants to approach two insurance regulations that have garnered a lot of controversy ever since Obamacare was passed. The AHCA would give Tennessee the ability to “opt out” of them. Many predict that this option will be “front and center” in Tennessee and all 49 other states if it becomes a reality. (Tolbert, 5/21)

Georgia Appears To Dodge A Bullet As Blue Cross Doesn't Signal Plans To Pull Back Operations

In its initial filings with the state, the company says it will continue to sell individual policies in all 159 counties. In other news, a New Hampshire paper reports indications that premiums could go up significantly and California Healthline examines which companies are enticing customers on that exchange.

Atlanta Journal-Constitution: Blue Cross Blue Shield May Stay In Georgia Obamacare Market
Blue Cross Blue Shield of Georgia, the only remaining company to serve all 159 counties in the state, has filed its annual plans for next year’s insurance market exchange under the Affordable Care Act. In its initial filing, it filed plans for the entire state, said spokeswoman Debbie Diamond. The decision can still change. Negotiations between insurers and the state will continue for several months. (Hart, 5/19)

NH Union Leader: Obamacare Rate Could See Big Spike In NH Next Year 
Some Obamacare exchange premiums could increase an average of 44 percent next year in New Hampshire due in large part to Medicaid expansion and the opioid and mental health crises, according to a document obtained by the New Hampshire Union Leader. The document -- stamped "Confidential" and marked "Draft Only" and "not for distribution" -- hints that New Hampshire soon could be hit with health-care premium increases it has not experienced since Obamacare coverage started in January 2014. Provided by a government official, the document appears to be written by an insurance carrier to explain the expected double-digit increase. (Hayward, 5/20)

California Healthline: Blue Shield Has Highest Share Of Enrollees In Covered California
Blue Shield of California has the largest number of enrollees in the Covered California health insurance exchange, widening its lead over rivals Anthem Blue Cross and Kaiser Permanente, according to recently released data. The data, from Covered California, show that Blue Shield had 389,480 enrollees in the exchange as of December 2016, about 31 percent of the market. Anthem was next with 310,690 members, for a 25 percent share. Kaiser Permanente was third with 297,030 exchange enrollees, or 24 percent. Health Net and Molina Healthcare were fourth and fifth, respectively. (Terhune and Bazar, 5/22)

Women’s Health

Texas Lawmakers Pass Strict Abortion Bill, Shifting Priority From Protecting Mother To Protecting Fetus

The legislation bans a commonly used procedure for second-trimester abortions, similar to laws that courts have blocked in other states. And Missouri asks an appellate court to step in over a judge's decision to block the state's abortion restrictions.

Texas Tribune: Texas House Approves New Abortion Restrictions
GOP House lawmakers took a sweeping approach to anti-abortion legislation on Friday, giving an initial OK to a measure that would ban the most common form of second-trimester procedure and change how health care providers dispose of fetal remains. Under the broad strokes of Senate Bill 8, any health care facility, including hospitals and abortion clinics, would have to bury or cremate any fetal remains whether from abortion, miscarriage or stillbirth, and they would be banned from donating aborted fetal tissue to medical researchers. (Evans, 5/19)

The Associated Press: Texas House Approves New Limits On Abortion
Texas’ Republican-controlled Legislature has advanced tough new limits on abortion, hitting back at a United States Supreme Court decision last summer that struck down most of the sweeping restrictions on the procedure that the state approved four years ago. (5/20)

Austin American-Statesman: Texas House Votes To Expand Abortion Regulations
After almost six hours of sometimes heated, sometimes tearful debate Friday, the Texas House approved legislation that would greatly expand abortion regulations in Texas. Senate Bill 8 would require abortion clinics and health centers to ensure that fetal tissue from abortions and miscarriages to be buried or cremated, with the ashes properly scattered — similar to a state agency rule that a federal judge voided earlier this year for limiting access to abortion without offering any health benefits. (Lindell, 5/19)

Meanwhile, in news about Planned Parenthood —

The Washington Post: Planned Parenthood To Close 10 Health Centers Across Midwest, Southwest
Planned Parenthood affiliates announced the closures of 10 health centers across the Midwest and Southwest this week, citing a variety of reasons including political attacks by antiabortion lawmakers. Planned Parenthood of the Heartland said it planned to close four clinics across Iowa because of the recent budget signed into law by Gov. Terry Branstad, who pledged to “defund” the women’s health organization. (Somashekhar, 5/19)

Denver Post: Planned Parenthood Will Close Clinics In Longmont And Parker, Blames Obamacare
Planned Parenthood says it will close clinics in Longmont, Parker and four others in the region, citing a tough financial landscape in the reproductive health care field due to effects of the Affordable Care Act. ... “They would come in and get a pap smear and pay out of pocket,” [spokeswoman Whitney] Phillips said. “Under the ACA, a lot of patients were given the opportunity to be on Medicaid. Again, that’s wonderful, but it meant that rather than bill them directly, we had to bill Medicaid. And Medicaid reimburses at a very low rate.” (Antonacci, 5/19)

Atlanta Journal-Constitution: Georgia 6th: Ossoff Slams Handel’s ‘Nonsense’ Planned Parenthood Stance 
Democrat Jon Ossoff held a roundtable Friday with women’s health advocates and breast cancer survivors as his campaign stepped up the attack on Republican Karen Handel’s stint at a breast-cancer charity. A split on abortion is one of the starkest contrasts between the two candidates in the nationally-watched June 20 runoff to represent suburban Atlanta’s 6th District. (Bluestein, 5/19)

Roll Call: Sparring Over Women’s Health In Georgia’s 6th District
As the June 20 runoff election in Georgia’s 6th district approaches, Democrat Jon Ossoff and Republican Karen Handel are facing off with competing ads on women’s health and anti-abortion groups have joined in the fight. Ossoff’s broadcast cable ad, released Tuesday, features an ob-gyn doctor criticizing Handel for her move to “cut off funding for Planned Parenthood cancer screenings when she was an executive at Susan G. Komen.” Handel, then senior vice president of public policy at Susan G. Komen Foundation, spearheaded the organization’s decision to stop funding cancer screenings at Planned Parenthood. When the foundation overturned that decision, Handel resigned. (Raman, 5/19)

Public Health And Education

Hospital Sepsis Protocols Can Increase Survival Chances, Study Finds

Many doctors have been skeptical about proposed regulations for screening and treating the life-threatening complication that afflicts tens of thousands of Americans.

Stat: Doctors Have Resisted Guidelines To Treat Sepsis. New Study Suggests Those Guidelines Save Lives
Even in the face of increased pressure from regulators, many doctors have failed to fully embrace early screening and treatment protocols for sepsis, an infection-related complication that afflicts tens of thousands of Americans every year and that can be life-threatening. Skeptics have argued that there haven’t been any comprehensive studies to support the notion that the protocols can actually save lives. On Sunday, however, the New England Journal of Medicine published a large study that could make doctors reconsider — and help hospitals address head-on one of the most common dangers their patients face. (Tedeschi, 5/21)

USA Today: 'Rory's Regulations' On Sepsis Require Hospital Checklists, Save Lives, Report Shows
New York regulations named after a 12-year-old victim of sepsis increased the chance of survival from the potentially deadly condition, a study out Sunday shows. "Rory's Regulations," named for the late Rory Staunton of New York City, requires hospitals to quickly perform a checklist of safety measures when people show up at hospitals with sepsis.  A report in the New England Journal of Medicine Sunday found the faster hospitals completed the checklist of care and administered antibiotics, the lower the risk of death in hospitals from sepsis. With each additional hour it took, the risk of death increased 4%. (O'Donnell, 5/21)

Carfentanil Intensifying Already Deadly Opioid Epidemic

The synthetic drug is 10,000 times more potent than morphine.

NH Times Union: Manchester Officials Gather To Battle Carfentanil 
Leaders in law enforcement, government, health care, public health, addiction recovery and emergency services huddled Friday over the lessons learned and the challenges that lie ahead following the carnage the new drug, carfentanil, caused in Manchester last month. Catholic Medical Center President and CEO Joe Pepe said his emergency room dealt with 10 overdoses in a single day, and in some cases overdoses required five times the usual dose of Narcan used to revive an unconscious addict. (Landrigan, 5/19)

In other news on the crisis —

NPR: Poll: Doctors Are Prescribing Back Pain Treatments That May Do More Harm Than Good
More than half of people say they've suffered lower back pain in the past year, according to the latest NPR-Truven Health Analytics Health Poll. That's not a surprise; low back pain is very common, and one of the biggest reasons that people seek medical care. But people told us that they're making very different choices in how they treat that pain, with some stark differences among age groups and income levels. (Shute, 5/19)

The Associated Press: Philadelphia To Mull Safe Injection Sites In Opioid Fight
A task force charged with outlining ways for Philadelphia to combat its opioid epidemic has recommended the city consider allowing safe sites, where drug users could inject heroin. Gov. Tom Wolf was on hand Friday as Mayor Jim Kenney outlined the task force’s findings. Kenney convened the 23-member group in January. (de Groot, 5/19)

The Washington Post: A Devastating Story Of Lives Ruined And Ended By Opioids
America’s opioid crisis is starkly laid out in the opening moments of HBO Documentary Films’ “Warning: This Drug May Kill You.” There’s a guy slumped over on a bus. A woman passed out on a street. Another guy collapsed backward across a bench. Then there’s a doctor, in a Perdue Pharma promotional video from 1999, explaining that “we doctors were wrong in thinking that opioids cannot be used long-term. They can be. And they should be.” (Hallett, 5/20)

Pediatricians: Babies Shouldn't Drink Juice In First Year Of Life

The doctors want to battle the misconception that children need the sugary drinks.

The New York Times: Pediatricians Say No Fruit Juice In Child’s First Year
The nation’s top pediatricians are advising parents to stop giving fruit juice to children in the first year of life, saying the drink is not as healthful as many parents think. In the past, the American Academy of Pediatrics had advised parents to avoid 100 percent fruit juice for babies younger than 6 months. On Monday, the group toughened its stance against juice, recommending that the drink be banned entirely from a baby’s diet during the first year. (Saint Louis, 5/22)

NPR: No Fruit Juice Until Kids Are One, Doctors Recommend
"We want to reinforce that the most recent evidence supports that fruit juice should be a limited part of the diet of children," says Steven Abrams, a professor of pediatrics at Dell Medical School at the University of Texas at Austin, and an author of the guidelines, which were published Monday in Pediatrics. (Hobson, 5/22)

Dwindling Supply Of Vital But Simple Drug Setting Hospitals On Edge

Because of the shortage, doctors are having to make tough decisions on how they treat their patients. “Does the immediate need of a patient outweigh the expected need of a patient?” one asked. “It’s a medical and ethical question that goes beyond anything I’ve had to experience before.” In other public health news: infertility, pumping breast milk, services for deaf patients, neuroscience, probiotics and more.

NPR: Scientists May Someday Fight Infertility With 3-D Printed Ovaries
The list of things that can be created with 3-D printers keeps getting longer: jewelry, art, guns, food, medical devices and, now, mouse ovaries. Scientists have used a 3-D printer to create a mouse ovary capable of producing healthy offspring. And researchers hope to create replacement human ovaries the same way someday. (Stein, 5/20)

The Washington Post: Unable To Pump Breast Milk On The Job, Airline Employees Turn To Dirty Closets And Bathrooms
In the months after her daughter was born, Jo Roby faced a serious dilemma: She wanted to provide her infant daughter with breast milk, but Frontier Airlines — where she’d worked as a flight attendant for more than a decade — forbids employees from pumping breast milk during flights. To avoid health complications and keep her daughter supplied with milk, Roby, who lives in Boise, Idaho, needed to be able to pump every three or four hours. But long, 10-hour days in the air with unpredictable flight schedules made that goal nearly impossible. (Holley, 5/19)

Stat: Deaf Patients Struggle To Get Adequate Interpretation Services In ERs
It’s challenging for hospitals to provide interpreters to the myriad patients and family members who speak different languages, from Spanish to sign language. On-site interpreters can be costly and hard to arrange, so hospitals have sought out alternatives, including video conferencing with remote interpreters, who can be helping a patient in Ohio one minute and in Oregon the next. Many deaf patients have taken to social media to complain about the use of video interpreting services in emergency rooms. Numerous patients tell stories about a blurry video feed and describe having to set up the video interpreting service themselves when nurses don’t know how to operate the equipment, or being unable to focus on a small screen in a crowded room. (Miller, 5/22)

NPR: The Curious Case Of Phineas Gage's Brain
It took an explosion and 13 pounds of iron to usher in the modern era of neuroscience. In 1848, a 25-year-old railroad worker named Phineas Gage was blowing up rocks to clear the way for a new rail line in Cavendish, Vt. He would drill a hole, place an explosive charge, then pack in sand using a 13-pound metal bar known as a tamping iron. (Hamilton, 5/21)

The Washington Post: People Love Probiotics, But Do They Really Help?
Probiotics are having a moment. They’re touted as the next big superstar in disease prevention and in treatment for ailments such as irritable bowel syndrome, gestational diabetes, allergies and obesity. Fans claim that these “good” bacteria will nourish your gut microbiome and crowd out the “bad” microbes. As a result, you’ll experience better digestion, a healthier immune system and a sunnier mood. (Yu, 5/20)

Orlando Sentinel: Zika Update: USF, Sanford Burnham Publish New Findings 
Earlier this month, scientists at University of South Florida and Stanford University reported that mosquito-borne diseases like Zika can spread at lower temperatures than previously thought. By studying models of Zika outbreak in South and Central America, researchers found that the virus’s transmission is highest around 84 degrees, and not 90 degrees as previously thought. (Miller, 5/19)

Columbus Dispatch: Virtual-Reality Game Helps Young Hemophilia Patients Endure Prickly Treatments
The calming effect came from a virtual-reality gaming system created to help pediatric hemophilia patients deal with the needles they face, sometimes as often as three times a week... The device, a disposable cardboard shell that holds a cellphone, slips over a patient’s eyes, providing a virtual-reality experience. Children, who need to hold their arms still while an IV line is placed, control game play with a movement of the head or by breathing into a sensor. (Viviano, 5/21)

The Baltimore Sun: Advocates Criticize 'Everything, Everything' Movie For Misinforming Public On Immune Disorders
The illness the movie features is severe combined immune deficiency, or SCID, but became better known as the "bubble boy" disease in the 1970s after the first in a series of shows based on a Texas boy forced to live germ free to prevent deadly infections...The romantic drama is the latest film to draw criticism for taking liberties with medical facts, misrepresenting disorders or portraying science incorrectly or even negatively. Advocates say such movies are not just missed opportunities to explain rare illnesses like SCID, they are hurtful and potentially harmful. (Cohn, 5/19)

State Watch

Merger Would Make Steward Health Care The Largest Private For-Profit Hospital Operator

Boston-based Steward Health Care System announces that it will acquire Franklin, Tenn.-based IASIS Healthcare for $2 billion.

Boston Globe: Steward Health Care Merges With Tenn. Hospital System 
Steward Health Care System, founded almost seven years ago to rescue a group of struggling Massachusetts hospitals, is making its biggest move yet to become a national player in the competitive for-profit hospital industry. Steward on Friday announced a nearly $2 billion deal with IASIS Healthcare of Franklin, Tenn., which would make it the largest private for-profit hospital operator in the country. (Dayal McCluskey, 5/19)

State Highlights: Texas Vaccination Bill Concerns Doctors; Major Reforms Sought In Iowa After Deaths Of Teens In Foster Care

Media outlets report on news from Virginia, Texas, California, Iowa, Kansas, Minnesota, Georgia, Florida, Ohio and Wisconsin.

Texas Tribune: Senate Passes Religious Protections For Child Welfare Agencies 
Texas senators voted 21-10 on Sunday to give child welfare providers protection from legal retaliation if they assert their “sincerely held religious beliefs” while caring for abused and neglected children in foster or Child Protective Services custody. House Bill 3859 would allow faith-based organizations to place a child in a religion-based school; deny referrals for abortion-related contraceptives, drugs or devices; and refuse to contract with other organizations that don't share their religious beliefs. (Evans, 5/21)

Des Moines Register: 'Heartbroken' Iowa Agency Asks Experts How To Prevent Child Deaths
Two of the girls died after becoming extremely malnourished. The third ran away, fearing for her life. Advocates for home-schooling parents will tell you that such cases are rare, and statistics back them up. Just one of the 20 Iowa children who died in preventable deaths last year was home-schooled: 16-year-old Natalie, Reader's Watchdog found. But revelations about the suffering of the three teens — and other cases nationally — have prompted Iowa legislators and advocates for children to call for major state reforms. Some want to bolster screening of potential foster and adoptive parents, as well as home-schoolers, to provide a better safety net. (Rood, 5/20)

Sacramento Bee: CA Nursing Board Quits Education Audit 
A California licensing board curtailed a massive audit of nursing credentials that it launched late last year, choosing not to finish a project that threatened to overwhelm the small department. The Board of Vocational Nursing and Psychiatric Technicians reviewed just 15 percent of the education records it demanded from more than 52,000 nurses and mental health workers last November before it elected to end the audit. (Ashton, 5/19)

KCUR: Kansas City Health Organizations Launch Collaborative Health Science District 
Some of Kansas City’s largest health organizations announced on Friday the launch of a collaboration centered on Hospital Hill. The “UMKC Health Sciences District” includes the University of Missouri-Kansas City School of Medicine, Truman Medical Centers, Children’s Mercy Hospital and the Kansas City, Missouri, Health Department, among other partners. At an event that included the signing of the collaborative agreement, institution and civic leaders highlighted the value of having so many health providers, educational institutions and local city health organization within a few blocks of each other working together. (Smith, 5/19)

WABE: New Program Teaches Ga. Educators Youth Suicide Warning Signs 
The Georgia Bureau of Investigation’s Child Fatality Review Program teamed up with state education and health officials to create a new training program for school personnel. The program focuses on teaching educators warning signs in students and figuring out way to get the issue of suicide out in the open at their schools. (Hawkins, 5/19)

Sacramento Bee: California Democrats Shout Down Tom Perez
State Democrats’ three-day convention had a raucous start Friday, as liberal activists booed and heckled Democratic National Committee Chair Tom Perez after marching from the state Capitol to promote a universal heath care program. The leader of the nurses’ union that opposed Perez’s recent election had just warned California Democrats that they would put up primary election challengers against lawmakers if they don’t support a bill to create public-funded, universal healthcare. (Cadelago and Hart, 5/19)

Milwaukee Journal Sentinel: Milwaukee's Infant Mortality Numbers Improve But The Racial Disparity Is Still Wide
The call to arms was first sounded in 2004, when the Wisconsin Medical Journal reported that Wisconsin’s black infant mortality rate had collapsed from the third best in the nation to the second worst. Most of those babies — 77% — died in Milwaukee...The new FIMR shows that by 2016, the African-American rate had dropped to 13.6 deaths per 1,000 live births, which places Milwaukee on par with Detroit, Dallas and Minneapolis. (Stephenson, 5/20)

Tampa Bay Times: Entrepreneurs Aren't Waiting For Lawmakers To Plan The Future Of Medical Cannabis 
The revolution started last year in Florida, when voters passed Amendment 2, a constitutional amendment designed to expand medical marijuana legalization beyond the limited use allowed under the Compassionate Use Act. But before departing Tallahassee earlier this month, the Florida Legislature failed to pass rules regulating marijuana's medical use. Negotiations over regulations that are needed to implement the amendment stalled because of disagreements on the number of dispensaries each marijuana grower would be allowed to open. (Solomon, 5/19)

Editorials And Opinions

Thoughts On Health Reform: Decision On Subsidies Due Today; Protect Kids In Medicaid

Opinion writers reflect on changes for the nation's health care system.

Los Angeles Times: The Entire Healthcare Industry Is Panicking That Trump Is About To Blow Up Obamacare
Organizations representing most of the healthcare industry — along with attorneys general from 15 states and the District of Columbia — took desperate steps Friday in a last-ditch attempt to keep President Trump from blowing up the Affordable Care Act. ... Monday is a crucial deadline. On that day, the Trump administration has to tell a federal appeals court whether it will continue to defend the ACA against a legal attack by the House of Representatives. (Michael Hiltzik, 5/20)

The Hill: Keep Kids Off The Negotiating Table In Medicaid Reform
Discussions around repealing the Affordable Care Act are now taking place in the Senate, and Medicaid will once again be in the spotlight. That could spell trouble for the nation’s children. There will be new ideas, extended discussions and ultimately negotiations that try to improve our healthcare system. But while we applaud discourse and debate, and encourage our elected officials to weigh the pros and cons of all proposals, we have a simple request — as you debate Medicaid, protect children. (Irwin Redlener and Dennis Walto, 5/20)

San Antonio Express-News: Who Has Absolute Health Care Moral Authority?
As ever, absolute moral authority only belongs to those who preach civility and compassion for others -- while ramming their own policy preferences and values down our throats. Millions of us who wanted our individual market health insurance plans left alone were branded selfish or liars for the past eight years. Our stories were stifled; our cancellation notices derided; our accounts of skyrocketing health insurance costs and diminished access to doctors mocked. (Michelle Malkin, 5/20)

Richmond Times-Dispatch: Better, Less Expensive Health Care Requires That We Reframe The Debate 
The divisive debate over federal health care legislation incorrectly assumes that health care is like a balloon — squeeze one side and the air pops out someplace else... It is possible to reduce spending by increasing medical practice that is guided by evidence-based medicine, by both increasing high-value care and reducing the considerable amount of care that evidence shows us is often of no or low value. (Beth A. Bortz, 5/19)

Miami Herald: ‘With Friends Like This, I Could Get Myself Unelected!’
An oddly timed political commercial has been appearing on West Palm Beach television stations, aimed at voters in Florida’s 18th congressional district. The ad urges people to call Rep. Brian Mast and thank him for courageously standing with President Trump and working to repeal Obamacare. ... Obviously, the last thing Brian Mast needs right now is for everyone living in his district to be reminded over and over that he voted for a healthcare law that would bankrupt lots of sick people and abandon others. So it made perfect sense that the Democrats would launch the “thank Brian Mast” commercials, just to punk the freshman congressman. Not so. Incredibly, the ads are real. (Carl Hiaasen, 5/19)

Viewpoints: Problems In The Meat Industry; Trump's 'Global Gag Rule'; Opioid Fight Stumbles

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

The New York Times: Health Leaders Must Focus On The Threats From Factory Farms
This week, the World Health Organization — which works globally to improve human health — will meet in Geneva to select a new director general. We have a mission for that leader: take on factory farms, a major threat to health and the environment. Starting just after World War II, animal production in the United States became increasingly industrialized. ... worldwide, meat production has tripled over the last four decades and increased 20 percent in just the last 10 years, according to research by the Worldwatch Institute, an environmental research group. This sweeping change in meat production and consumption has had grave consequences for our health and environment, and these problems will grow only worse if current trends continue. (Scott Weathers, Sophie Hermanns and Mark Bittman, 5/21)

Los Angeles Times: Trump's New Global Gag Rule Will Devastate Healthcare In Poor Countries
It is not surprising but it is deeply depressing that the Trump administration is reviving the “global gag rule” — so called because it bans U.S. financial assistance to non-governmental healthcare organizations in foreign countries if they provide abortions or even utter the word to their patients in counseling them or referring them elsewhere. ... The rule was bad enough in its earlier form, when it barred aid to family planning organizations that offered abortion or abortion counseling. ... But the new Trump administration incarnation of the rule is far more expansive. (5/22)

The New York Times: Donald Trump Vs. Women’s Health
When video surfaced last fall of Donald Trump boasting about sexual assault, outrage erupted. But if Trump’s words about women were offensive, his policies are incomparably more consequential — and may cost more lives than in any other area of his governance. Yes, the phrase “war on women” may seem hyperbolic, but it also reflects the devastating impact of Trump’s policies on women’s health. One danger is that we’re so focused on the battles at the White House that we neglect the administration’s policy impact at the grass roots — on, say, women who will die unnecessarily all over the world from cervical cancer. (Nicholas Kristof, 5/20)

Modern Healthcare: Trump Administration Undermines Own Efforts To Fight Opioid Addition With Crippling Budget Cuts
As with so much else, the Trump administration has stumbled in its initial efforts to combat opioid addiction. Given the magnitude of the crisis, healthcare professionals have an obligation to speak out against ill-considered policies. ... Citizens of all political persuasions have cried out for a comprehensive approach to this scourge. Not only must the healthcare system reckon with its misguided approach to treating pain, policymakers must address the reality that the worst of the addiction crisis is being felt in communities experiencing economic decline, poverty, violence and despair. (Merrill Goozner, 5/20)

Stat: Anti-Vaccine Activists Are Playing With Fire In Minnesota
"They are everywhere. Like, every event, every forum.”T his is how anti-vaccine activists were described by a community outreach worker in Minneapolis, where the Somali-American population was systematically and incessantly warned against vaccines. ... The campaign led to an increase in mistrust of vaccines, particularly measles, mumps, and rubella vaccine, among Somali-American parents, as well as dangerously low vaccination rates — 41 percent among 24-to-35-month-olds, according to one estimate. You don’t have to be an epidemiologist like me to comprehend the consequences of such drastic drops in vaccination rates. (Saad Omer, 5/19)

The New York Times: Who Should You Listen To On Abortion? People Who’ve Had Them
The need to terminate a pregnancy knows no political affiliation or religious faith. I’ve hugged, cried with and held the hands of hundreds of people who’ve had abortions, many of whom never thought they would. All were thankful that someone was there to provide care, sit with them when they were alone and hold their hair as the nausea took over. All felt the stigma and shame society thrusts on them. The abortion debate rages on, but the voices of those who’ve actually had abortions are ignored. Few people try to understand our lives. And we are never asked the most simple but important question: Why did you do it? (Renee Bracey Sherman, 5/20)

Los Angeles Times: Does A Woman's Right To Choose Apply To Breastfeeding?
For my generation, breastfeeding has become the ultimate status symbol. I could not possibly count the number of times I was asked while pregnant if I intended to breastfeed my child. ... Though I probably will never be asked if I graduated college with honors, I will be asked how I fed my child for decades to come. Breastfeeding is the Phi Beta Kappa of millennial motherhood. I wanted membership. But as I would soon learn, deciding to breastfeed is one thing, doing it quite another. (Lizzie Garrett Mettler, 5/21)

Boston Globe: Children Have A Right To Healthy Food At School 
As longtime advocates for healthy school meals for schoolchildren, we agree that school meals should be great — our children deserve nothing less. We respectfully differ with the secretary on one point. Children will eat meals that meet the higher nutrition standards — and there is ample evidence to support our claim. (Ellen Parker and Ronald E. Kleinman, 5/22)

Stat: Why Cities May Hold The Key To Living Longer, Healthier Lives
Around the world, noncommunicable diseases — including heart disease, cancer, and diabetes — and injuries from traffic crashes and other causes kill 44 million people a year. In fact, these illnesses and accidents kill more people than communicable diseases such as AIDS, tuberculosis, or malaria. Yet it’s much harder to get funding to tackle them. Noncommunicable disease cause two-thirds of the deaths in low- and middle-income countries, but less than 1 percent of total development assistance for health goes toward addressing them.  (Thomas R. Frieden, 5/19)