KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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From Kaiser Health News - Latest Stories:

Kaiser Health News Original Stories

A Practical To-Do List For Family Caregivers

In order to maximize the important role they play, family caregivers must be proactive in speaking up, planning and documenting their ability to meet their loved one’s health care needs. (Judith Graham, 9/29)

Political Cartoon: 'One And The Same?'

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

Here's today's health policy haiku:


Lawmakers OK
Zika funding, finally …
But is it too late?

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.

Summaries Of The News:

Capitol Hill Watch

Zika Battle Finally Funded As Congress Passes Stopgap Spending Bill

After House leaders reach an agreement over the Flint water crisis funds, Congress averts a government shutdown by passing a bill that includes $1.1 billion for the fight against Zika.

The Washington Post: Congress Acts To Avert Government Shutdown After Striking Deal On Flint Aid
Congress staved off an Oct. 1 government shutdown Wednesday, passing a stopgap spending measure after House Republicans agreed to address the drinking-water crisis in Flint, Mich., removing a major obstacle in negotiations. The bill extends current government funding levels until early December, giving appropriators time to negotiate 2017 spending measures. It also provides year-long funding for veterans programs, $1.1 billion to address the Zika virus and $500 million in emergency flood relief for Louisiana and other states. (DeBonis, 9/28)

The Wall Street Journal: Congress Passes Spending Bill To Keep Government Running Through Dec. 9 
Congress avoided a partial government shutdown at week’s end after both chambers passed a short-term spending bill that would keep the government running through early December. A weekslong partisan impasse over the bill broke when lawmakers agreed to provide federal assistance for residents of Flint, Mich., in separate legislation this year. That deal quickly paved the way for the Senate to pass a short-term spending bill, also known as a continuing resolution, that would keep the government funded through Dec. 9. (Peterson and Hughes, 9/28)

Politico: Congress Clears Bill To Prevent Shutdown
The biggest hurdle to a quick getaway was Democrats’ demand that money be added to the CR to help the 100,000 people in Flint who faced lead-contaminated drinking water. But Republicans wouldn’t budge, and said Flint should be dealt with in a water infrastructure bill moving through Congress. Ryan and Pelosi worked out an agreement Tuesday evening to allow a floor vote on an amendment to authorize $170 million for Flint in the water bill. (Bade, Kim and Weyl, 9/29)

NPR: Congress Stops Bickering And Approves $1.1 Billion To Fight Zika
It brings to an end a partisan fight that has had the unusual effect of delaying funding to deal with what all sides agree is a public health emergency. The delay came out because of disagreement over side issues like funding for Planned Parenthood and whether the money should be considered "emergency" spending. Wednesday's deal drops language barring the money from going to Planned Parenthood clinics. The Senate passed the measure Wednesday; it is pending in the House. (Kodjak, 9/28)

The Hill: Congress Approves $1.1B In Zika Funds
House passage of a government funding bill late Wednesday night means that funding for the Zika virus has finally been approved. The measure included $1.1 billion in funding to fight the virus, capping a fierce months-long debate over the money that dismayed public health experts who called for speedily approving funding. (Sullivan, 9/28)

In other news from Capitol Hill —

The Hill: Top Dem: Cures Bill Funding Cut To $4B 
A top Democratic negotiator said Wednesday that new funding in a major medical cures bill has been cut significantly as lawmakers look for a path for passage. Rep. Gene Green, the top Democrat on the House Energy and Commerce health subcommittee, told The Hill that a new version of the 21st Century Cures bill will allocate about $4 billion over five years for research at the National Institutes of Health (NIH), down from the original $8.75 billion. (Sullivan, 9/28)

Morning Consult: Johnson’s Right To Try Legislation Fails In Senate
Sen. Ron Johnson tried, but failed, to have the Senate approve Right to Try legislation by unanimous consent Wednesday. Senate Minority Leader Harry Reid (D-Nev.) objected to S. 2912, legislation from the Wisconsin Republican that would provide experimental drugs to terminally ill patients. The bill would increase access to drugs that have cleared initial safety tests but are not approved by the FDA. (McIntire, 9/28)

Researchers: Zika Can Be Passed Through Sweat, Tears

The son of a man who died of the virus contracted it after sitting by his father's bedside, touching his skin and wiping his eyes. Meanwhile, the Centers for Disease Control and Prevention responds to a whistleblower's claims that it is not using the most effective test for Zika.

The Washington Post: Mystery Zika Case In Utah Was Likely Spread Through Sweat Or Tears
New details are emerging about the mysterious Zika case in Utah where a son caring for his sick father became infected with the virus. The father's death in June was the first related to Zika in the continental United States. His son's infection was unusual because, unlike all other known adult cases, he had not traveled to a Zika-infected region or had sex with a partner who had done so. Instead, he had remained at his father's side in the hospital. (Sun, 9/28)

The Hill: CDC Dismisses Whistleblower Claims On Zika Test
A leading official at the Centers for Disease Control and Prevention (CDC) is rejecting claims that the agency has been knowingly promoting a less effective test for the Zika virus. The public health agency has been hit with criticism this week after one of its own top scientists alleged that CDC officials had recommended the use of a Zika test that is far less effective than another existing test. (Ferris, 9/28)

Orlando Sentinel: Zika Update: Travel-Related Case Total Reaches 700 
The state health department confirmed eight new travel-related Zika cases on Wednesday, two of which are in Orange County. This brings up the Orange County total to 79, and the four-county total to 132 travel-related cases since earlier this year. No local cases have been confirmed in Central Florida, and local mosquitoes haven't tested positive for Zika. (Miller, 9/28)


Senators Urge DOJ To Investigate Whether Mylan Acted Illegally By Gaming System

In the letter to the Justice Department, senators say the company "may have knowingly misclassified EpiPens, potentially in violation of the False Claims Act and other statutes."

The Associated Press: Senators Ask Justice Department To Investigate EpiPen Maker
Senators are asking the Justice Department to investigate whether pharmaceutical company Mylan acted illegally when it classified its life-saving EpiPen as a generic drug and qualified for lower rebate payments to states. The chairman of the Senate Judiciary Committee, Sen. Charles Grassley, R-Iowa, and Democratic Sens. Richard Blumenthal of Connecticut and Amy Klobuchar of Minnesota sent a letter to Attorney General Loretta Lynch on Wednesday and suggested the company may have gamed the system to divert millions of dollars from taxpayers. (9/28)

Reuters: Senators Ask Justice Dept To Consider Probe Of EpiPen Medicaid Classification
U.S. Senators Richard Blumenthal, Charles Grassley and Amy Klobuchar asked the Justice Department to investigate whether Mylan NV may have misclassified its EpiPen in order to pay lower rebates to the states. In a letter released on Wednesday, the lawmakers noted that Mylan classified the EpiPen with the Medicaid Drug Rebate Program as a non-innovator multiple source drug, which pays a rebate of 13 percent to states, rather than innovator, which pays a rebate of a minimum of 23.1 percent. (Bartz, 9/28)

The Star Tribune: Senators Want To Know If EpiPen Maker Violated Law
Several U.S. senators, including Minnesota Democrat Amy Klobuchar, have asked the Justice Department to determine whether Mylan Pharmaceuticals broke the law in classifying its brand name EpiPen as a generic device in order to lower rebates the company paid to Medicaid... In the case of innovator drugs, which are in essence brand names, the rebate amount is at least 23.1 percent of what the company received in Medicaid payments. In the case of non-innovator multiple source drugs, which are in essence generic, the rebate amount is 13 percent. That means a company can keep 10 percent more of its Medicaid payments if it classifies its drug as non-innovator or generic. (Spencer, 9/28)

Des Moines Register: EpiPen Price Increases Hit Iowa Medicaid
The cost of EpiPens to the state of Iowa has nearly tripled since 2012, and one Iowa lawmaker says it’s hurting taxpayers. House Majority Leader Rep. Chris Hagenow, R-Windsor Heights, asked the Iowa Department of Human Services to look into how much the state pays for the lifesaving allergy treatment through its Medicaid program. He said he became interested in the issue after the drug’s manufacturer drew widespread criticism for significantly raising prices from less than $100 in 2009 to about $600 this year. (Pfannenstiel, 9/28)

Poll: Vast Majority of Americans Want Government Intervention On High Drug Prices

More than eight in 10 Americans favor allowing the federal government to negotiate with drugmakers to get lower prices on medications for people on Medicare, among other regulations. A separate poll finds that the public holds the pharmaceutical industry responsible for rising drug prices, but some critics say Congress should shoulder some blame.

Stat: Most Americans Believe Prescription Drug Prices Are Unreasonable
Roughly 8 in 10 Americans believe that prices for prescription drugs are unreasonable and support various ideas to lower costs, such as allowing Medicare to negotiate with drug makers and enforcing price caps on high-priced medicines for certain illnesses such as cancer, according to a new poll from the Kaiser Family Foundation. (Silverman, 9/29)

Kaiser Health News: Poll Finds Majority Of Americans Want Restraints On Drug Prices
An overwhelming majority of Americans favor government action to restrain prescription drug prices, according to a poll released Thursday. Eighty-two percent of those polled said they want Medicare to negotiate prices with the companies, which Congress does not allow. Seventy-eight percent favored limiting the amount companies can charge for high-cost drugs, such as those that fight cancer or hepatitis, according to the poll from the Kaiser Family Foundation. And more than two-thirds want to let Americans buy drugs imported from Canada. Support is strong no matter the political party. (Rau, 9/29)

The Associated Press: Did Landmark Laws From Congress Enable High Drug Prices?
Lawmakers are venting outrage over high prescription drug costs, but if Congress is looking for culprits, it might want to look in the mirror. Republican- and Democratic-controlled Congresses, and presidents of both parties, may have set the stage for the startling prices that have consumers on edge. (Alonso-Zaldivar, 9/29)

In California, specialty drug costs are on the rise. And Martin Shkreli is ready to make someone's dream come true —

California Healthline: Specialty Drug Costs Soar 30% For California Pension Fund
Specialty drug costs jumped 30 percent last year to $587 million for the California Public Employees’ Retirement System, one of the nation’s largest health care purchasers. Though they amount to less than 1 percent of all prescriptions, specialty drugs accounted for more than a quarter of the state agency’s $2.1 billion in total pharmacy costs. Those overall drug costs have climbed 40 percent since 2010. (Terhune, 9/28)

Drug Companies Tap Into The 'Power Of The Patient'

Biotechs see patients and advocacy groups as a resource to raise awareness and champion drugs to the Food and Drug Administration. A recent example is Sarepta's Duchenne medication which patient organizations helped move through the agency.

Boston Globe: Biotechs Leverage Patient Groups In Drug Development 
Ganot and other speakers at a panel hosted Wednesday by the Massachusetts Biotechnology Council cited the recent successful campaign to persuade the Food and Drug Administration to green-light Exondys 51, a Duchenne drug developed by Cambridge’s Sarepta Therapeutics Inc. Hundreds of patients and their families — including representatives of patient organizations that funded Sarepta’s clinical study — packed an FDA advisory committee meeting in April to offer emotional testimony in favor of the drug. The advisers and some FDA staffers contended the therapy had not been proved effective, but the agency overruled them and approved it. (Weisman, 9/29)

In other pharmaceutical news —

The Star Tribune: Medtronic Gets FDA Approval For Automated Insulin Delivery Device 
In a quick approval, the U.S. Food and Drug Administration on Wednesday gave a green light to the first medical device for type 1 diabetes that can automate varying doses of insulin 24 hours a day using a real-time sensor and an advanced computer program that learns a patient’s personal needs. Medtronic PLC’s MiniMed 670G “hybrid closed-loop” system received approval from the FDA just three months after the Minnesota-run device maker submitted its premarket application for approval. (Carlson, 9/28)

Health Law Issues And Implementation

Sen. Grassley Hints At GOP's Willingness To Work With Democrats On Health Law Changes

The change in tone by the influential Republican may signal changing battle lines on the Affordable Care Act.

Morning Consult: Senate Republicans Change Tone On Obamacare Debate
For the first time in six years, some congressional Republicans are willing to engage in conversations about fixing — not repealing — Obamacare, should another Democrat occupy the White House. Republicans uniformly believe the next Congress must do something to address the Affordable Care Act. ... "There’s two ways” that action on Obamacare could play out, said Sen. Chuck Grassley (R-Iowa) in an interview with Morning Consult. “One, if a Republican’s elected, we’re going to have to deliver on our promise to dramatically change the health care system. ... The second one is, if the Democrats elect a president, there’s some changes – there’s some bipartisan support – that ought to be made. But it’d have to have the White House support. So I think it’s going to be pretty much driven by what Hillary would say,” Grassley said. (Owens, 9/28)

And on the debate over Medicaid expansion —

Idaho Statesman: Pleas From Uninsured, Physicians Don’t Sway Idaho Lawmakers On Medicaid Expansion
Following more than two hours of impassioned public testimony, a legislative panel reviewing health care options for thousands of Idaho’s working poor acknowledged Wednesday that it does not expect to reach consensus on what if any action to recommend to the full Legislature. ... At issue before the Legislature — yet again — is how Idaho should address the needs of 78,000 lower-income residents who don’t qualify for standard Medicaid or for subsidized health coverage on the state exchange. The Legislature has been unable to reach consensus on what boils down to two options: approving a modified expansion of Medicaid, with conditions, to cover the so-called gap population, or instituting a more limited, state-financed program. (Dentzer, 9/28)

Campaign 2016

Galas And 'Grand Benefactors': Trump's Relationship With Cancer Institute Draws Scrutiny

Although he hasn't donated any of his own money to the Dana-Farber Cancer Institute, Donald Trump's business ties to it are raising some eyebrows. In other election news, Hillary Clinton reiterates her health care plan in the New England Journal of Medicine.

The Dallas Morning News: Clinton Outlines Health Policy In Medical Journal, Trump Declines
Democratic presidential candidate Hillary Clinton laid out her vision for the future of health care in an editorial posted Wednesday in the New England Journal of Medicine. The three-page post reiterated her plans to strengthen the Affordable Care Act, combat rising out-of-pocket health costs, expand Medicaid, and let Americans age 55 and over buy into Medicare. (Rice, 9/29)

Administration News

Obama Administration Cracks Down On Nursing Home Arbitration Clauses

A new rule from the Centers for Medicare & Medicaid Services would bar nursing homes from turning over claims of elder abuse, sexual harassment or even wrongful death to a private system to settle disputes.

The New York Times: U.S. To Bar Arbitration Clauses In Nursing Home Contracts
The federal agency that controls more than $1 trillion in Medicare and Medicaid funding has moved to prevent nursing homes from forcing claims of elder abuse, sexual harassment and even wrongful death into the private system of justice known as arbitration. An agency within the Health and Human Services Department on Wednesday issued a rule that bars any nursing home that receives federal funding from requiring that its residents resolve any disputes in arbitration, instead of court. (Silver-Greenberg and Corkery, 9/28)

Veterans' Health Care

Over 600,000 Uninsured Veterans Fall In 'Medicaid Gap'

These vets who don't seek or qualify for care by the Department of Veterans Affairs are also not eligible for Medicaid coverage, especially in states that did not expand the program. Meanwhile, news outlets report about the ongoing challenges at the VA.

NBC News: 600,000 Veterans May Go Without Health Insurance Over Medicaid Stand: Report
More than 600,000 veterans will go without health insurance next year unless 19 states stop holding out against expanding Medicaid, researchers said Wednesday. A new report from the Urban Institute finds that 604,000 veterans fall into the so-called "Medicaid gap" — they are not poor enough to qualify for Medicaid, but they make too much money to qualify for federal subsidies to buy health insurance on the Obamacare exchanges. (Fox, 9/29)

The Associated Press: After Subpoena, VA Turns Over Documents On Costly Hospital
The Veterans Affairs Department turned over documents to Congress on Wednesday in response to a subpoena demanding information about how the cost of a Denver-area VA hospital soared more than $1 billion over budget. VA spokeswoman Linda West said the department gave the House Veterans Affairs Committee some of the documents that lawmakers wanted and that more were on the way. (Elliott, 9/28)

Center for Investigative Reporting: Veterans Choice Is Flawed, But Congress Is Stymied On A Solution 
The VA for years has bought private care for veterans at its own discretion. But the Veterans Access, Choice, and Accountability Act made getting that care a right for a significant number of veterans. And, after a slow start, top VA officials last year told local health care systems that they had to use it. That wreaked havoc on local VA facilities that already were relying heavily on the private sector to treat veterans – without the complications of going through a middleman. (Romney, 9/28)


Medicare Advocates Press Congress To Help Beneficiaries Facing Steep Premium Hike

The Medicare Trustees have estimated that the deductible for Medicare Part B would grow from $166 to $204 next year for all enrollees and the premiums would grow 22 percent next year for about 30 percent of beneficiaries.

Morning Consult: Some Medicare Beneficiaries Could Face Premium Increases, Again
Congress will likely need to take action for the second year in a row to keep out-of-pocket health care costs from significantly rising in 2017 for some seniors. A group of 75 health care and employer groups on Tuesday sent congressional leaders a letter urging them to prevent this from happening. It won’t be clear whether Congress has to do anything until next month, but the advocates are preparing anyway. It’s looking likely that a congressional fix will be needed. The Medicare Trustees report, released in June, estimated that premiums for Medicare’s doctor benefit, or Part B, would increase by 22 percent next year for a select group of seniors. The trustees also estimated that the Part B deductible would rise from $166 to $204 next year for all enrollees. (Owens, 9/27)

Modern Healthcare: Why CMS Wants Surgeons To Code Every 10 Minutes
The comments flooded in after the CMS proposed in July that surgeons collect data on every 10 minutes of perioperative activity. “Undue burden,” the American Medical Association called the suggested requirement. The American Association of Neurological Surgeons and Congress of Neurological Surgeons warned the approach “is onerous and will result in underreporting of data.” To stop and code how they spend every 10 minutes of their time would be a tall order to ask of anyone, much less busy doctors and surgeons. So why did the CMS do it? (Whitman, 9/28)

The Associated Press: Hospital Chain Settles Medicare Suit For $32.7 Million
A national hospital chain headquartered in central Pennsylvania has agreed to pay $32.7 million to resolve allegations that it billed Medicare for medically unnecessary services. The Department of Justice alleged that between 2006 and 2013, Mechanicsburg, Pennsylvania-based Vibra Healthcare admitted patients to five long-term health care hospitals and an inpatient rehabilitation facility although their symptoms didn’t qualify them for admission. (9/28)

Miami Herald: Bascom Doctor Accuses UM, Colleague Of Medicare ‘Malfeasance’ 
A four-year-old lawsuit between a pair of star doctors who had a falling out at the nation’s No. 1 ranked eye institute, Miami-based Bascom Palmer, was finally unsealed on Wednesday — revealing allegations of “false claims” for procedures billed to Medicare based on “fabricated” patient evaluations. Dr. Philip Rosenfeld, a retinal specialist, accused his one-time colleague, Dr. Timothy Murray, an oncology eye surgeon, along with Bascom’s corporate parent, the University of Miami, of committing fraud in a whistle-blower action. (Weaver, 9/28)


Federal Employees' Share Of Health Premiums To Increase 6.2 Percent Next Year

Federal officials attributed the rise largely to increasing prescription drug costs, which make up about a quarter of the total costs in the program, general inflation and the aging of the covered population, The Washington Post reports. Meanwhile, Bloomberg examines how the U.S. health care system compares to other countries.

The Washington Post: Federal Employee Health Premiums To Rise 6.2 Percent On Average
The enrollee share of premiums in the health-care program for federal employees and retirees will rise 6.2 percent on average in 2017, an increase about in line with the general trend for employer-sponsored health insurance, the government announced Wednesday. The announcement of premium rates in the Federal Employees Health Benefits Program comes in advance of an annual open season, which this year will run Nov. 14-Dec. 12, during which enrollees may change plans or change types of enrollment for the following year. Also, employees who are not currently enrolled may join the program, although retirees generally may not newly join. (Yoder, 9/28)

Bloomberg: U.S. Health-Care System Ranks As One Of The Least-Efficient
The U.S. health-care system remains among the least-efficient in the world. America was 50th out of 55 countries in 2014, according to a Bloomberg index that assesses life expectancy, health-care spending per capita and relative spending as a share of gross domestic product. Expenditures averaged $9,403 per person, about 17.1 percent of GDP, that year — the most recent for which data are available — and life expectancy was 78.9. Only Jordan, Colombia, Azerbaijan, Brazil and Russia ranked lower. (Du and Lu, 9/28)

Health IT

New Email Scam Involves Fake Health Law Tax Bill

In other health information technology news, researchers work on flexible bone grafts using a 3D printer.

The Wall Street Journal: The New IRS Email Scam Coming To Your Inbox
Americans, beware: the Internal Revenue Service isn’t emailing you. Just recently, a new scam has started involving fake tax bills tied to the Affordable Care Act. In one sure sign the notices are fake, many are arriving by email—and the IRS doesn’t initiate taxpayer contact by email. Even so, some of the fakes are paper notices sent by regular mail and taxpayers should watch out. (Saunders, 9/29)

Public Health And Education

27 Overdoses In 24 Hours: Opioid Crisis Grips An Ohio City

The wave of overdoses overwhelmed first responders in Columbus. Police officers are scrambling to determine the source of the heroin.

Columbus Dispatch: Democrat Lawmakers Urge Kasich To Declare Heroin Emergency 
As Ohio continues to endure unprecedented waves of heroin overdoses, including 27 in Columbus in a 24-hour period this week, legislative Democrats again urged Gov. John Kasich to declare a state of emergency on Tuesday. ... Democrats want the governor to declare a state of emergency on the heroin epidemic, allowing for the release of at least $300 million from the state’s $2 billion-plus rainy day fund to help communities deal with the crisis. (Siegel, 9/28)

And in Pennsylvania and Florida —

The Philadelphia Inquirer: For Wolf, Opioid Crisis Offers Chance To Flex Political Muscle
Gov. Wolf has called it a public health crisis and an epidemic, crisscrossing Pennsylvania for more than a year to participate in roundtables and work sessions on how to combat prescription drug and heroin addiction. On Wednesday, he used his office's bully pulpit to address a joint session of the legislature and urge lawmakers to swiftly pass bills aimed at fighting the problem - his boldest public move yet to focus attention on opioid abuse. (Couloumbis, 9/29)

Health News Florida: Bondi Announces Ban On Synthetic Drug 
Florida Attorney General Pam Bondi on Tuesday announced an emergency rule to ban a type of synthetic drug that she said has caused multiple deaths in Florida. The rule targets a drug known as U-47700, which Bondi's office said is usually found in powder or granular form but also can be made into a pill that appears like a prescription drug. It also can be found in liquid form and as a nasal spray. (9/28)

Despite Tremendous Progress, America Still Lags Behind On Teen Birth Rates

For the seventh straight year, U.S. teen birth rates drop. But other industrialized countries are far ahead of America. In other public health news, high blood pressure could affect children's cognitive skills, biological age trumps actual age when it comes to lifespan and a study finds a link between contraception use and depression in women.

WBUR: Could Your DNA Serve As Clock To Gauge How You Age And When You'll Die?
UCLA geneticist Steve Horvath led a team of 65 scientists in seven countries to record age-related changes to human DNA, calculate biological age and estimate a person’s lifespan. A higher biological age — regardless of chronological age — consistently predicted an earlier death. The findings are published in today’s edition of the journal Aging. (Goldberg, 9/28)

Kaiser Health News: Large Danish Study Links Contraceptive Use To Risk Of Depression
Aside from pesky side effects like nausea and headaches, hormonal contraceptives are generally considered quite safe and effective. But researchers Wednesday identified a heightened risk of an unintended consequence: depression. A study published in JAMA Psychiatry found women using hormonal contraception faced a higher rate of developing depression and using antidepressants than women who did not use the drugs. Oral contraceptives that combine two key hormones, a type widely used by Americans, increased women’s rate of taking antidepressants by 23 percent. Among teens using these contraceptives, the rate nearly doubled. (Heredia Rodriguez, 9/28)

Immunotherapy Is The Hottest Trend In Cancer Treatment -- So What Exactly Is It?

The Washington Post offers a look at the basics of the treatment that has everyone from patients to investors to pharmaceutical companies paying attention.

The Washington Post: Cancer Immunotherapy Is Moving Fast. Here’s What You Need To Know.
The idea of using the body's immune system to fight cancer has been around for a century, but only in the past half a dozen years have dramatic breakthroughs begun rocking the medical world. "That's when the tsunami came," says Drew Pardoll, director of the Bloomberg-Kimmel Institute for Cancer Immunology at Johns Hopkins University, and those advances are spawning hundreds of clinical trials nationwide, plus generating intense interest from patients, physicians and investors. (McGinley, 9/28)

In other news, sometimes, when it comes to the technology to diagnose cancer, cheaper is actually better —

The Washington Post: Ask A MacArthur Genius: Just How Cheap Can Cancer Diagnosis Get?
What’s the best way to bring cutting-edge healthcare to the world’s poorest places? It can be tempting to export money and equipment to solve the problem. But when bioengineer Rebecca Richards-Kortum visits hospitals in places such as Malawi and El Salvador, she sees the unintended consequence of that charitable impulse. “Ironically, if you walk down the hall or into the basement of a hospital, there’s always a big room that is just for broken, donated equipment,” she says. (Blakemore, 9/28)

State Watch

State Highlights: Vt. Makes Progress Toward All-Payer Reimbursement System; Exploring The Reasons Behind Texas' Pregnancy-Related Death Rates

Outlets report on health news from Vermont, Texas, California, Indiana, Ohio, Illinois, Washington, Wisconsin, Maine and Florida.

Modern Healthcare: Vermont Gets Preliminary OK To Move Toward All-Payer System
Vermont has received tentative approval from the Obama administration to establish an all-payer reimbursement system for healthcare providers in the state starting in January. Maryland long has had an all-payer system, but it covers only hospitals. Vermont plans to use an accountable care organization-type structure that would cover all providers. (Dickson, 9/28)

The Associated Press: US Soda-Tax Battle Bubbles Up In San Francisco Bay Area
The national fight over sugary soda is bubbling up in the San Francisco Bay Area, where voters in November will consider a tax on the drinks that many health experts say contribute to diabetes, obesity and tooth decay. Backers of the campaign say a penny-per-ounce tax is needed in San Francisco, Oakland and tiny Albany to curb consumption of sweetened cola, sports drinks and canned teas that people gulp without thinking, adding empty calories. (9/28)

Reuters: Special Report: Flawed CDC Report Left Indiana Children Vulnerable To Lead Poisoning
In this industrial northwest Indiana city, hundreds of families who live in a gated public housing community with prim lawns and a new elementary school next door are searching for new homes. Their own places have been marked for demolition.The school, temporarily closed, has been taken over by the Environmental Protection Agency and health officials who offer free blood tests to check residents for lead poisoning. (Schneyer, Pell 9/28)

The Chicago Sun Times: Rauner, Legislative Panel Have $2.4-Billion Deficit Disagreement
Gov. Bruce Rauner’s administration said on Wednesday that the state’s deficit is $2.4 billion less than what a bipartisan legislative commission projected in a July report.The Commission on Government Forecasting and Accountability — the Illinois General Assembly’s independent budget analysts – estimated total state spending for the 2017 fiscal year that began on July 1 at $39.5 billion, compared with revenues of $31.8 billion — leaving nearly a $7.8 billion deficit. ... Illinois Budget Director Tim Nuding said the commission didn’t factor in several key levels of revenue, including federal reimbursements to the state for Medicaid spending. The commission used Medicaid spending numbers from February, $8.2 billion, which Nuding called outdated. (Sfondeles, 9/28)

San Francisco Chronicle: Judge Hints At Support In Suit Over Sex-Reassignment Surgery 
A Bay Area federal judge is suggesting she intends to rule that a transgender employee can sue his employer under sex-discrimination law for denying insurance coverage for sex-reassignment surgery. “This is a sex-based procedure. It couldn’t be more sex-based,” U.S. District Judge Yvonne Gonzalez Rogers of Oakland said Tuesday to a lawyer defending the refusal of Dignity Health of San Francisco and one of its out-of-state hospitals to cover the employee’s operation. The lawyer, Barry Landsberg, replied that the hospital’s policy was gender-neutral because “it applies equally to men and women.” Federal law, he argued, prohibits discrimination against males or females, “but there is not a third sex.” (Egelko, 9/28)

The Seattle Times: ‘This Was Preventable:’ Heart-Transplant Patient To Sue UWMC Over Legionnaires’ Disease
A 32-year-old Vancouver, Wash., woman who struggled with heart failure for more than a decade received a lifesaving transplant this summer — only to contract Legionnaires’ disease during a deadly outbreak at the University of Washington Medical Center (UWMC). Victoria Martin planned to file a claim Tuesday notifying UW Medicine that she intends to sue the hospital for failing to prevent the infection that also has sickened four other people, including two who died. (Aleccia, 9/27)

USA Today/Milwaukee Journal Sentinel: Integrated Health Network Scales Back
Integrated Health Network of Wisconsin gave itself the ambitious goal of clinically integrating eight health systems throughout the state to prepare for the expected changes in the way hospitals and doctors are paid. The network would require the health systems to work toward lessening the variation in how care was provided. It would track their performance on an array of quality and cost measures. And it would build the complex computer systems to collect and analyze information from medical claims and electronic health records. Its plans may have proven too ambitious. (Boulton, 9/28)

WBUR: California Eliminates Statute Of Limitations On Rape Cases
California Gov. Jerry Brown has signed a bill that ends a statute of limitations on prosecuting rape cases. The bill is widely believed to be inspired by allegations against comedian Bill Cosby, after some of his accusers came forward long after the alleged sexual assaults took place. (Kennedy, 9/28)

The New York Times: Maine’s ‘Clean’ Medical Marijuana: ‘Organic’ In Disguise
Maine is one of 25 states, plus the District of Columbia, that permit the use of marijuana for medical purposes. It is a competitive market with thousands of growers, known as caregivers under state law. But Ms. Haywood now claims a distinction that sets her apart. She is among the first five farmers whose weed is labeled Certified Clean Cannabis by the Maine Organic Farmers and Gardeners Association. Branded MC3, the marijuana is grown following organic standards, but it cannot be labeled “organic” under federal guidelines. (Carpenter, 9/28)

Orlando Sentinel: Seniors Testing Whether 'Park Prescriptions' Are Good Medicine  
South Florida seniors may help prove that a walk in the park is just what the doctor ordered. Patients at Humana's MetCare clinic in Plantation are testing a new initiative aimed at encouraging older adults to exercise outdoors.Called Park Rx, the program is part of the growing nationwide "park prescription" movement. Its mission: to harness nature's potential medical and mental health benefits by steering people of all ages to public parks and green spaces for their exercise. (Lade, 9/28)

Weekend Reading

Longer Looks: A Molecule That Could Heal Aging Brain; A $1 Microscope

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

Stat: Curious Molecule That Makes Mice Smart Sets Off A Whirlwind
The mice were decidedly smart. Normal mice put inside a watery maze took more than a minute to locate the submerged platform that would let them escape. But these mice — which had been injected with a curious new molecule — found it in an average of just 16 seconds. That news startled Peter Walter. A 61-year-old biochemist, he’d spent his life, and built a sterling reputation, uncovering the workings of a critical quality control mechanism in cells. (Usha Lee McFarling, 9/28)

Vox: How To Change The World With A $1 Microscope
When Manu Prakash was growing up in India, he was obsessed with skeletons. Upon finding a dead rabbit, he would clean and painstakingly reassemble its 200-plus bones. "It physically told me how intricate every object actually is," Prakash tells me. "The more you see, the more you want to see." (Brian Resnick, 9/28)

The Atlantic: Remedy Offers Help Fighting Medical Bills
If you’re the special kind of person who’s interested in medical billing, I’ve had an exciting past few months. One day this spring, I was frantically chopping carrots after work when I noticed that my left hand was covered in lukewarm blood. When I washed it off, I saw my skin splaying open to reveal my pale-blue thumb joint. That necessitated not one, but two trips to an urgent-care center, a strange hybrid of an emergency room and doctor’s office where payment can be similarly muddled. (Olga Khazan, 9/28)

Stat: Analysis Identifies Anthrax Used As A Soviet Bioweapon
On the first Monday in April 1979, a wind blew south through a Siberian city called Sverdlovsk. A few days later, people and sheep began to die.Government officials said the victims had eaten meat contaminated with anthrax or come into contact with animals sickened by the deadly bacteria. Or perhaps, officials hinted, it was a plot by the American government. (Karen Weintraub, 9/27)

Slate Magazine: Top Peer Reviewers Are Motivated By Their Dedication To Science.
The goal of peer review is to ensure that only the most scientifically sound research papers make it into scientific journals—a tall order for a system that operates almost entirely on scientists’ goodwill and dedication. By Publons’ count, the average reviewer referees just 4.4 papers per year—though even that number might be high, as it only includes the people enthusiastic enough to register for the account that helps them track this work. So what motivates the super peer reviewers to do it? (Shannon Palus, 9/23)

The Atlantic: Most Of The World Doesn't Have Access To X-Rays
Irene Githinji, a radiologist in Nairobi, Kenya, didn’t know if the 5-year-old boy had a deadly lesion in his brain. She needed a CT scan to be sure, but her hospital didn’t have one. Kenya’s private facilities have them for $60 to $200, but Mbagathi Hospital, where Githinji treats families, sits at the edge of the Kibera slum, the largest in Africa. “I don't know what happened to the patient after that,” she says, “but I doubt that they ever did the CT scan.” (Jason Silverstein, 9/27)

The Economist: The Other Global Drugs Problem
All around the world, drug-resistant infections are on the rise. They now kill more than 700,000 people a year. In 2014 nearly 60% of samples of Escherichia coli, a common gut bacterium, collected from patients in hospital were strains that could not be treated with penicillins. About 25% were resistant to one or both of two other commonly used sorts of antibiotics. (9/24)

Editorials And Opinions

Viewpoints: Clinton's View Of Health; The Return Of The Public Option; Reducing EpiPen Costs

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

The New England Journal of Medicine: My Vision for Universal, Quality, Affordable Health Care
Because of the Affordable Care Act (ACA), 20 million more Americans have health insurance and more than 8 million kids receive health coverage each year as a result of the Children’s Health Insurance Program. ... What’s more, expanded consumer protections and access to free preventive services — like vaccinations and cancer screenings — mean all Americans now have stronger, better health coverage. Despite this progress, we still have real challenges ahead. Americans face rising out-of-pocket costs and a health care system that is too fragmented. We need to make health coverage affordable so people can access the care they need. We need to do more to break down barriers and achieve health equity across our communities. We need to expand Medicaid in every state so that everyone has access to care, regardless of their income and where they reside. And we need to devote more resources to the necessary scientific research into the diseases of our time. (Hillary Clinton, 9/28)

The New York Times: The Health Care ‘Public Option’ Is Back. Can It Help Obamacare?
On the campaign trail and in the halls of policy wonks, the health care term of the moment is “the public option.” The idea is to create a government-run health care plan that would be an alternative to the private insurance plans offered under the Affordable Care Act, or provide a fallback in markets where insurers have been pulling out. In an article in The New England Journal of Medicine published on Wednesday, Hillary Clinton reiterated her support for such a measure. (Reed Abelson and Margot Sanger-Katz, 9/29)

The Fiscal Times: To Save Obamacare Exchanges, Drive Competition From The Bottom Up 
While Clinton has yet to release any specifics, her 2008 healthcare platform, the American Health Choices Plan, gives us a glimpse. The AHCP stipulated a public option “which could be modeled on the traditional Medicare program, but would cover the same benefits as guaranteed in private plan options … [to] compete on a level playing field with traditional private insurance plans … [and] provide a more affordable option. That assumes insurers are price gouging by not offering affordable options. But the problem isn’t that there’s too much profit being made on the exchanges, it’s that there’s too little. (Paul Howard and Stephen Parente, 9/28)

JAMA Forum: Health And Taxes
Health care shows up on the political agenda in 2 very different ways, as a social issue and a budget issue. These 2 views prompt very different sets of questions and also shape how the 2 major political parties focus their respective efforts in the health care arena. (David Cutler, 9/28)

Stat: Hillary Clinton's Proposed Ban On Pay-For-Delay Deals Would Do Little To Lower Drug Prices
Banning “pay-for-delay” deals that postpone the production of less-expensive generic drugs is a key action point in Hillary Clinton’s comprehensive plan to lower prescription drug costs. Eliminating these deals, she says, could save Americans billions of dollars on medications. But an even more productive strategy would be to stop drug makers from producing so-called authorized generics. (Farasat Bokhari, 9/28)

Forbes: A Modest Proposal To Reduce The Price Of EpiPens
Devon Herrick of the National Center for Policy Analysis recommends EpiPens be made available over-the counter (OTC). Herrick explains that about one billion dollars’ worth of EpiPens are thrown out unused in the United States, because they need to be immediately at hand but expire after about a year.  Pharmacies have evolved into very consumer-friendly retail environments – almost more like supermarkets or department stores than old-chemists’ shops. If patients knew they could walk in and pick up EpiPens from the pharmacy, they would not need to stockpile as many injectors as they do when they have to go to a physician for a prescription. (John Graham, 9/28)

Stat: EpiPen Pricing Controversy Reflects Larger Issues In Pharma Industry
Why is this controversy erupting now? Certainly the size and timing of the price hikes played a role. But less discussed is a change in how insurance covers access to prescription medications. In less than a decade, average health care deductibles have risen from approximately $300 to more than $1,000, with some families now facing annual deductibles of almost $5,000. In that same time period, the percentage of individuals enrolled in high-deductible insurance plans has gone from less than 5 percent to potentially approaching 40 percent in the coming year. This means that a family whose fixed copay a few years ago was $25 or $50 per prescription for their twin pack of EpiPens could get the recommended multiple sets for school, home, and to carry around for about $75 to $150. Today, many are now required to pay list price — upwards of $600 — for each set, or almost $2,000 to satisfy their deductibles. (James R. Baker Jr., 9/28)

Bloomberg View: Health-Care Costs Ate Your Pay Raises
Real, or inflation-adjusted, compensation has risen 61 percent since 1970; wages, on the other hand, have increased less than 3 percent in real terms in that period. This is a tale that has gotten short shrift in this political season. Much of the narrative of the 2016 election is about middle-class anger over the lack of economic progress in an era of increasing financial inequality. Residual frustration with the financial crisis and bank bailouts isn't making voters feel any better either. (Barry Ritholtz, 9/28)

JAMA: Medicare’s Bundled Payment Program For Joint Replacement: Promise And Peril?
The United States is in the midst of a bold experiment. Medicare is moving rapidly away from traditional fee-for-service payment. Various alternative payment models (APMs) intended to improve quality and reduce costs are being implemented or tested. The stakes are high. If an evaluation finds that a new model meets the statutory requirements for expansion, the US Secretary of Health and Human Services is authorized to expand the models across the country. Whether these new programs work and how effectively they are evaluated should matter to physicians, patients, and taxpayers. (Elliott S. Fisher, 9/27)

Modern Healthcare: Invest In New Hospitals? Really?
Healthcare wasn't entirely absent from last night's debate. When asked about the economy, both Republican candidate Donald Trump and Democratic candidate Hillary Clinton called for more infrastructure spending. But in his reply, Trump said: “We have a country that needs new roads, new tunnels, new bridges, new airports, new schools, new hospitals,” he said. (Merrill Goozner, 9/27)

The Washington Post: Cyberattacks On Personal Health Records Growing ‘Exponentially’
This year marks the 20th anniversary of the Health Insurance Portability and Accountability Act, better known as HIPAA. Since it took effect, doctors’ offices, hospitals and other health-care providers have been very careful about releasing information. Sometimes frustratingly so. I’ve had providers refuse to send my information to me by email, because that form of communication is considered less secure than the now-ancient practice of faxing. (Joe Davidson, 9/28)

Stat: Medical Students Need To Learn The Potent Medicine Of Empathy
A few years ago at a large teaching hospital in Texas, a medical resident asked a nurse how to order an autopsy for a patient they were currently treating. It was a reasonable request. Autopsies help further the understanding of disease. There was just one problem: their patient, who was very much alive, was lying nearby. He’d overhead the request, and that’s how he found out he was soon going to die. (Wolfgang Gilliar, 9/29)

USA Today: Docs Need Help To Ease Opioid Epidemic
In an unprecedented move, Surgeon General Vivek Murthy sent a letter to every doctor in America last month. It did not congratulate us on a job well done; instead, it said we need an urgent change in how we manage pain and opioids. The gesture, launching the TurnTheTideRx campaign, was praiseworthy but unfortunately misses point. (Robert Bonakdar, 9/26)

Louisville Courier-Journal: Curbing Opioid Abuse - Shared Work
You don’t have to flip through many TV channels or pick up many magazines before seeing news related to the opioid epidemic in our country. The focus of these stories is often on heroin, but that’s only part of the picture. Prescription drug abuse and misuse is the other part. (Deb Moessner, 9/28)

Los Angeles Times: Heavy-Handed Proposition 60 Would Deputize Every Californian As A Condom Cop
Ideally, adult film performers would use condoms when they engage in on-screen intercourse. It’s the most reliable way to keep them safe from contracting or spreading sexually transmitted diseases, including HIV. But the adult film industry has doggedly refused to adopt this simple protective measure, even though state labor code requires workers be protected from blood-borne pathogens. ... however ... we part philosophical company with Proposition 60, a heavy-handed measure on the Nov. 8 ballot backed by the AIDS Healthcare Foundation and its president, Michael Weinstein. The proposition would, in effect, make every Californian a potential condom cop by both mandating condom use and creating a private right of action so that any resident who spots a violation in a pornographic film shot in the state could sue and collect cash from the producers and purveyors if they prevail in court. (9/28)

Concord Monitor: My Turn: The Truth Behind New Hampshire Hospital
The critical mental health needs of those in treatment at New Hampshire Hospital and the hopes of those who love them should be a priority for our state, regardless of party or political persuasion. Real progress has been made at the hospital in the aftermath of a federal lawsuit, but more needs to happen and I am optimistic it will. (John T. Broderick, Jr., 9/29)

The Denver Post: Hope For Changes After Abuses Of Colorado's Developmentally Disabled
When it comes to dealing with abuses of the most developmentally disabled adults in Colorado, a population that is unable to speak for itself, it’s critical that state officials who work with them be as transparent as possible. For the better half of a year in 2014 and 2015, residents at the Pueblo Regional Center suffered abuse and neglect. ... Now a federal report has been released detailing and documenting the horrors. In addition to rehashing past abuses that the Department of Human Services (DHS) made public in April 2015, the report called for additional safeguards that we hope the state makes serious a commitment to following. (9/28)