KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: 'Nothing To Sneeze At?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Nothing To Sneeze At?'" by Gary Varvel, The Indianapolis Star.

Here's today's health policy haiku:

PROPOSED REG AIMS TO PROMOTE HEALTH CARE EQUALITY

Long-awaited rule
expands protections based on
gender in health law.

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Health Law Issues And Implementation

Administration Unveils Protections For Transgender Patients’ Health Services

The new guarantees are part of a wide-ranging proposed rule that would bar discrimination based on gender in insurance coverage, treatments and access.

The New York Times: Health Care Rules Proposed To Shield Transgender Patients From Bias
The Obama administration proposed a rule Thursday that would forbid most health insurers and medical providers to discriminate against transgender patients, including by prohibiting insurers from categorically denying coverage of care related to gender transition. The proposal clarifies a civil rights provision of the Affordable Care Act that bans “any health program or activity” that receives federal funds from discriminating based on race, national origin, sex, age or disability. The proposed regulation expands on that broad language, specifying that the administration considers discrimination on the basis of gender identity a form of sex discrimination. (Goodnough and Sanger-Katz, 9/4)

The Washington Post: U.S. Moves To Protect Women, Transgender People In Health Care
The ACA already bars discrimination based on sex and other factors, but the long-delayed proposed regulation issued Thursday explains how the protections will be applied to insurers and health-care providers, such as hospitals and doctors who receive Medicare and Medicaid payments, and it clarifies the standards federal officials would use in implementing the law. The proposed regulation comes as social attitudes about sexuality and gender are undergoing major shifts. (Sun and Bernstein, 9/3)

The Wall Street Journal: Obama Administration Proposes Antidiscrimination Rules Under Health Law
Federal officials have been wrestling for years about how to handle the Affordable Care Act’s provision that requires health insurers and providers to ensure they treat patients equally, including on the basis of their sex and race. The requirement has been in effect since 2010, the year the law was passed, but the administration is still fleshing out its details. The thorniest issue has been whether federal officials also can use the provision to bar bias based on sexual orientation. (Radnofsky, 9/3)

CQ Healthbeat: Health Protections For Transgender People Pushed In HHS Rule
Doctors and hospitals that treat Medicaid patients and insurance companies participating in health law marketplaces would be banned from discriminating against transgender people under rules proposed Thursday by the Health and Human Services Department. Health plans would be prohibited from issuing a blanket denial of services to help a person transition to another gender, although the insurers still could refuse to cover surgery or other care on a case-by-case basis if the decisions are based on a legitimate rationale. (Attias, 9/3)

Politico Pro: HHS Finally Proposes Anti-Discrimination Health Care Rule
The Obama administration on Thursday issued a long-awaited proposed rule explaining how it will enforce a wide-ranging ban on health care discrimination. With that release, HHS is seeking to cement one of Obamacare’s key promises — equal access to health care regardless of a person’s race, color, nationality or disability. The rule would also ban health care discrimination on the basis of sex for the first time. (Millman, 9/3)

Kaiser Health News: HHS Unveils Civil Rights Protections For Transgender Patients’ Health Services
The Obama administration issued a sweeping proposal Thursday to bolster civil rights protections in health care, barring medical providers and insurers from discriminating based on gender, whether in treatments or access to facilities or services. The long-awaited rules from the Office of Civil Rights in the Department of Health and Human Services further define protections included in the Affordable Care Act, particularly broadening those for transgender Americans. The proposal also includes provisions requiring medical providers to bolster their communication efforts for people with disabilities or limited English proficiency. (Appleby, 9/3)

Bloomberg: Insurers Can't Deny Gender Transition Treatment Under U.S. Plan
Transgender individuals would gain new health-care protections in rules proposed today by U.S. regulators. Under the rules, discrimination against transgender people would be a form of sex discrimination. That would block insurers from categorically denying coverage for treatments that help people transition to another gender, according to a fact sheet released today by the Department of Health and Human Services. Some exclusions for transition treatments will be evaluated case-by-case, the agency said. (Tracer, 9/3)

The Associated Press: Plan Targets Health Care Bias Against Transgender People
Mirroring a shift in society, the Obama administration proposed Thursday to ban discrimination against transgender people throughout the health care system. Once the proposed regulations are final, they should expand insurance coverage for gender transition and prohibit health care facilities from denying transgender people access to restrooms that match their individual gender identity. (Alonso-Zaldivar, 9/3)

Reuters: U.S. Government To Extend Healthcare Nondiscrimination Law To Transgender People
The Affordable Care Act, also known as Obamacare, was passed in 2010 and included anti-discrimination provisions to prevent insurers from charging customers more or denying coverage based on age or sex. That law left some areas open to interpretation and thousands of consumers complain each year about being discriminated against, the U.S. Department of Health and Human Services said on Thursday. (9/3)

The Huffington Post: New Rules Bar Transgender Discrimination In Health Care
The Obama administration is making a major push for transgender rights by prohibiting health insurance companies and medical providers from discriminating against patients because of their gender identities. Under a proposed regulation issued by the Department of Health and Human Services Thursday, transgender people would be entitled to equal treatment in health care and would gain the legal right to make civil rights claims against insurers, doctors, hospitals and others who deny them coverage or necessary care because they are transgender. That includes forbidding health insurers from categorically excluding treatments related to gender transitions. (Young, 9/3)

Financial Losses Prompt Highmark To Cut Health Plan Offerings On Obamacare Exchanges

In other news on state insurance plans, the California Association of Health Plans opposes legislation that would tax health plan participants while California Healthline reports on the success of the state's takeover of a local health plan.

The Wall Street Journal: Highmark Is Latest To Trim Offerings Under Health Law
Highmark Health said it would reduce its range of offerings on the Affordable Care Act marketplaces, becoming the latest insurer to retrench amid steep financial losses. The big Pittsburgh-based nonprofit company said it would continue to sell plans related to the federal health overhaul in all of the areas it currently serves, which span Pennsylvania, Delaware and West Virginia. But “we will have less products in the market overall,” said David L. Holmberg, the company’s chief executive, who said Highmark had lost $318 million on its individual health-law plans in the first six months of 2015, after rolling out a very broad array of options that had attracted many consumers with chronic conditions who required costly care. (Wilde Mathews, 9/3)

The Sacramento Bee: Health Plans Come Out Against Tax Bills
California’s largest health plan group this week declared its opposition to both of the healthcare special session bills that would impose new taxes on managed-care organizations, the latest sign that a replacement for a soon-to-expire health plan tax is unlikely to emerge before lawmakers adjourn next week. (Miller, 9/3)

And, as enrollment season approaches, KHN writes on the benefits of COBRA vs. health law plans and North Carolina's Navigator Consortium gets a grant to help sign up consumers -

Kaiser Health News: Consumers With COBRA Coverage Should Weigh Moving To Health Law Plans
As the open enrollment season for employer-sponsored health insurance gets underway this fall, experts say there’s one group that should definitely consider changing plans: people who have coverage through their former employer under the federal law known as COBRA. ... Before the health law passed, people who lost their jobs may not have had other options. Plans on the individual market could turn people down because of their health, and the coverage was often skimpy and expensive in any case. Times have changed. (Andrews, 9/4)

The Associated Press: Consortium Receives $2.6 Grant For Health Care Navigation
A group of 14 health care, social service and legal aid organizations has received more than $2.6 million in federal funding to help North Carolina residents sign up for health insurance through the Affordable Care Act. Officials with the Centers for Medicare and Medicaid Services said Wednesday that the N.C. Navigator Consortium will receive the grant to help consumers sign up during the open enrollment period for 2015-2016. (9/3)

Women’s Health

Abortion Providers File Supreme Court Appeal Of Texas Law That Has Shuttered Clinics

In June, justices granted an emergency appeal to put a temporary hold on Texas' new clinic regulations that would leave the state with only 10 abortion providers. If the court hears the case, it would result in the first major abortion ruling since 2007.

The Dallas Morning News: Texas Abortion Clinics Think U.S. Supreme Court Will Hear Appeal
Texas abortion providers say they expect the U.S. Supreme Court to take up their appeal asking the court to review a 2013 law that would force half of the state’s remaining abortion clinics to close if it is allowed to go into effect in full. The Supreme Court signaled in June that it would probably take up the case when justices voted 5-4 to put a lower appeals court decision to uphold the law on hold. If the case moves forward, it will be the most significant challenge to abortion law in over 20 years. (Martin, 9/3)

CQ Healthbeat: Texas Abortion Challenge Lands At Supreme Court
Calling it a pivotal moment for abortion rights in the United States, women’s health care providers on Thursday asked the Supreme Court to hear a challenge to Texas’ controversial anti-abortion law. The providers want the justices to strike down two Republican-backed provisions from Texas’ 2013 law that they say would reduce by 75 percent the number of abortion clinics in the nation’s second largest state, to as few as 10 — a tiny number compared to the 500 clinics in California and 250 in New York. (Ruger, 9/3)

The Austin American-Statesman: Abortion Rights Advocates Ask Supreme Court To ‘Shut Down’ Texas Law
Abortion care providers filed a petition this week to the U.S. Supreme Court asking the court to review their case against Texas’ far-reaching restrictions that have already shuttered more than two dozen clinics. The Supreme Court suspended the enforcement of strict standards on abortion clinics in Texas in late June following a lower court ruling that upheld most of the 2013 abortion law, known as House Bill 2. (McSwayne, 9/3)

Reuters: Clinics Seek U.S. Supreme Court Review Of Texas Abortion Law
Texas abortion providers asked the U.S. Supreme Court on Thursday to hear their challenge to the state's Republican-backed restrictions on abortions that they contend are aimed more at shutting clinics than protecting women's health. If the Supreme Court hears the appeal, it would be one of the most anticipated cases of the court's next term, which starts in October. The nine justices are likely to decide by the end of the year whether to hear the case, meaning oral arguments could come in early 2016 with a ruling by the end of June. (Garza, 9/3)

Capitol Hill Watch

N.Y. Lawmakers Urge Congress To Extend Law Covering 9/11 Responders' Health Problems

The law is slated to expire in October 2016. Also on Capitol Hill, the Senate Finance Committee chairman suggests that Congress might repeal the health law's device tax through a special budgetary rule, and Democrats are calling for investigations of the antiabortion activists who released secretly recorded videos about Planned Parenthood.

The Wall Street Journal: Lawmakers Seek Extension To 9/11 Health-Care Act
At Thursday’s news conference, U.S. Reps. Carolyn Maloney and Jerrold Nadler, both New York City Democrats, and Peter King, a Long Island Republican, called on their colleagues to make the Zadroga Act permanent. The legislation, signed into law in 2011 after extensive lobbying by survivors, provides for the monitoring and treatment of people suffering from illness and injuries caused by the terrorist attacks. Many 9/11 first responders developed ailments including asthma, lung disease and cancer. (MacMillan, 9/3)

CQ Healthbeat: Hatch Sees Reconciliation As Avenue For Device Tax Repeal
With a shortage of other viable legislative vehicles, Senate Finance Chairman Orrin G. Hatch has his eye on using a potential reconciliation bill later this year or early in 2016 to repeal parts of the health care overhaul, including the 2.3 percent excise tax on medical devices. The top tax writer has been hunting for a home for a device tax repeal (S 149) he authored that has 39 co-sponsors. The House passed a similar plan (HR 160), 280-140, in June. The Utah Republican also is weighing other health-related add-ons for reconciliation, including incentives for manufacturing so-called orphan drugs that combat rare diseases. (Ota, 9/3)

The Washington Post: House Democrats: Congress Should Investigate Anti-Planned Parenthood Activists, Too
Two high-ranking House Democrats are calling on their Republican counterparts to end their congressional investigations of Planned Parenthood -- or at least expand them to encompass alleged misdeed by antiabortion activists who put the group's fetal tissue practices in the spotlight. Rep. John Conyers (Mich.), top Democrat on the House Judiciary Committee, and Rep. Elijah Cummings (Md.), top Democrat on the House Oversight and Government Reform Committee, said in a letter to the Republican chairmen of those committees that the undercover videos that sparked the investigations are unreliable and may have been obtained by illegal means, calling on them to "halt these one-sided investigations immediately." (DeBonis, 9/3)

In other congressional news -

CQ Healthbeat: Lifting Congress' Needle Exchange Ban Said To Save $45 Million
Congress’ 2007 decision to lift a ban on the District of Columbia’s ability to tap local funds for needle exchange programs averted an estimated 120 cases of HIV over two years and saved almost $45 million, according to a study released Thursday that could expand support for other policy changes. The findings by researchers at the George Washington University’s Milken Institute School of Public Health comes as Congress has shown more openness to providing states with leeway to use federal funds to support needle exchanges in some circumstances, by modifying the ban implemented annually through the appropriations process. (Attias, 9/3)

Marketplace

Cheaper? First New Biosimilar Drug Still Expensive -- For Now

The price of Zarxio, made by Novartis, will likely be 15 percent lower eventually than Amgen's Neupogen -- but The Washington Post says that the actual spending on the drugs in the short term will be much closer. Pharmaceutical companies are bracing for a barrage of biosimilar drugs that could cut into their profits. Elsewhere, more seniors find themselves in the Medicare Part D "doughnut hole," and a hedge-fund manager vows to keep challenging drug patents.

The Washington Post's Wonkblog: The First In A New Generation Of Cheaper Drugs Isn’t Much Cheaper
The first in a long-awaited category of drugs that have been projected to save tens of billions of dollars over the next decade became available today. But its price tag highlights a question economists and industry watchers have been wrestling with for the past few months: how much will these new drugs actually bring down prices? The new drug, Zarxio, is the first American "biosimilar" -- a copycat version of a complex biologic drug. (Johnson, 9/3)

Reuters: Novartis Launches First U.S. 'Biosimilar' Drug At 15 Percent Discount
Novartis kicked off a new era in U.S. medicine on Thursday with the launch of the first "biosimilar" copy of a biotechnology drug approved in the United States, at a discount of 15 percent to the original. The Swiss drugmaker's generics unit Sandoz said Zarxio, its form of Amgen's white blood cell-boosting product Neupogen, would increase access to an important treatment by offering a "high-quality, more affordable version". (Hirschler and Shields, 9/3)

The Wall Street Journal: Big Pharma: The Moment of Dread Is Here
The initial stakes are low for the imminent launch of the first U.S. biosimilar drug. Pharmaceutical companies that develop branded drugs shouldn’t expect them to stay that way. ... Beyond Zarxio’s launch, the stakes will get higher as discounts get larger. Likewise, competition will intensify. In aggregate, drugs with biosimilar competition on the way—such as AbbVie’s Humira or Johnson & Johnson’s Remicade—totaled more than $25 billion in U.S. sales in 2014. (Grant, 9/3)

Pittsburgh Post-Gazette: Rising Drug Costs Send More Medicare Recipients Into The "Donut Hole"
Milly Scott first fell into the Medicare Part D coverage gap a year ago. A seven-year beneficiary of the government prescription coverage program for seniors, Mrs. Scott saw her co-payment for the anti-depressant Pristiq hold steady the last two years at $285 for a 90-day supply. But, between that and her other medications, she fell the program’s “donut hole” of reduced coverage for the first time in October. This year, she landed in the gap even earlier — in July. ... While the federal Affordable Care Act will eventually eliminate the gap, rising drug costs until then are sending more seniors into the hole. (Twedt, 9/4)

The Wall Street Journal: Hayman Capital’s Kyle Bass Vows To Continue Drug-Patent Challenges
Hedge-fund manager Kyle Bass says he’ll persist in his campaign to invalidate what he calls weak pharmaceutical patents, despite being handed two early setbacks in recent weeks. ... On Wednesday, a panel of judges employed by the U.S. Patent and Trademark Office declined to review Mr. Bass’s challenge to Biogen Inc.’s multiple sclerosis pill Tecfidera patent. The ruling, which came ahead of schedule, followed a denial in August of Mr. Bass’s challenges to Acorda Therapeutics Inc.’s drug Ampyra. (Walker, 9/3)

Mass. Hospitals Considering Merger In Effort To Combat Rising Health Costs

The negotiations between Beth Israel Deaconess and Lahey Health follow a number of high-profile mergers in recent months. In other health care business news, autoworker contract talks continue to look at a health-care co-op across the industry, a hospice chain in the South settles a whistleblower suit and Oscar, an insurance start-up, is profiled.

The Boston Globe: Rising Costs, Changing Payments Driving Hospital Mergers
In the ever-changing world of health care, at least this remains constant: Hospitals want to get bigger. The ongoing merger talks between Beth Israel Deaconess Medical Center of Boston and Lahey Health of Burlington are just the latest example of the bigger-is-better strategy health care executives are pursuing. ... The backdrop for these merger discussions is health care costs that are accelerating, according to data released by state agencies over the past week. ... These trends are contributing to the motivation to merge as federal and state laws pressure health care providers to bring costs under control, and new payment systems reward providers for sticking to budgets while improving care. These developments have only added to hospitals’ urgency to find efficiencies through mergers, analysts said. (Dayal McCluskey, 9/3)

Reuters: Detroit Three Show Interest In UAW Health Care Co-Op Idea
The Detroit Three automakers are showing increased interest in the United Auto Workers union's proposal that they pool their healthcare systems, a sign that contract talks between the union and manufacturers are down to the big money issues. The UAW and bargainers for General Motors Co, Ford Motor Co and Fiat Chrysler Automobiles face a Sept. 14 deadline to negotiate new labor agreements for 142,000 U.S. workers. Rising healthcare costs have emerged as a stumbling block in the way of raises for blue collar workers. (Woodall, 9/3)

The Associated Press: Hospice Chain Settles Whistleblower Suit For $5.9M
A chain of hospices in four states has agreed to settle a whistleblower lawsuit concerning overbilling for $5.9 million. The settlement between the federal government and the St. Joseph Hospice chain, based in Baton Rouge, Louisiana, was announced Thursday in Jackson. Federal prosecutors alleged that St. Joseph was driving up Medicare payments by billing for continuous care to patients who weren't eligible under federal rules. (Amy, 9/4)

Bloomberg: For Health Insurance Startup Oscar, Cute Ads Only Go So Far
Health insurance hasn’t attracted much money from Silicon Valley investors. The industry is highly regulated and fiercely competitive, and turning a profit depends on signing up healthy customers and getting favorable prices from hospitals and doctors. Still, investors, including some Facebook backers, put hundreds of millions of dollars into health insurance startup Oscar. “Insurance is a confusing system, confusing as hell,” says Mario Schlosser, a computer scientist and former McKinsey consultant, who is Oscar’s chief executive officer. He co-founded the company two years ago with fellow business school alums Joshua Kushner of venture capital firm Thrive Capital, and Kevin Nazemi, a veteran of Microsoft’s health-care division. They hope to capitalize on the young, tech-savvy customers buying health insurance through the new markets created by the Affordable Care Act. Oscar operates in New York and New Jersey and will start selling coverage in California and Texas in November. (Racer and Satariano, 9/3)

And in news about several other companies -

The Associated Press: Molina To Spend $200 Million On Behavioral, Mental Health Services
Insurer Molina Healthcare will spend about $200 million to expand the behavioral and mental health services it provides with its coverage. The Long Beach-based insurer said Thursday it will buy two subsidiaries of the Providence Service Corp. They are Providence Human Services and Providence Community Services. Molina said the subsidiaries will complement its health plans. (9/3)

Reuters: Medtronic Sales Surge As Rise In U.S. Surgeries Drives Demand
Medtronic Plc, the world's largest standalone medical device maker, reported a 70 percent rise in quarterly revenue, helped by higher sales across its business lines, in part due to the acquisition of surgical products provider Covidien Plc. Medtronic said it is well positioned to benefit from the Medicare bundle payment program, which aims to link payments for multiple services during an episode of care rather than pay providers separately for each service. (Grover, 9/3)

Campaign 2016

Puerto Rico's Health Care Crisis, Fiscal Collapse Becomes Prominent Issue On The Stump

Meanwhile, Hillary Clinton will kick off a push on women's issues, Ben Carson appeals to evangelicals with positions on abortion and health care while a presidential run by Vice President Joe Biden, still grieving his son, will be influenced by his "emotional energy."

The Associated Press: Puerto Rican Voters Prized By Democrats, Republicans
[Marco] Rubio is coming Friday for a fundraiser in San Juan and a rally in Santurce. [Hillary] Clinton plans an event the same day in San Juan about reversing what her campaign calls the U.S. territory’s economic decline and its health care crisis. ... The parade of presidential hopefuls to the territory speaks to the growing power of Puerto Rican voters on the mainland, especially in Florida, the top destination for those fleeing the island’s 12 percent unemployment rate and nine-year economic slump. (Bustos, 9/4)

USA Today: Hillary Clinton To Take Women's Issues Out Of Silo
Hillary Clinton plans to launch a new initiative this weekend as she seeks to weave women’s issues into every facet of her campaign instead of using them in a separate silo as she did in her unsuccessful 2008 presidential bid. ... Unlike previous presidential campaigns, officials say, Clinton will take women’s issues out of their own silo. For instance, Clinton will make expanding paid leave for new mothers part of her economic platform by emphasizing its cost to families. (Przybyla, 9/4)

NPR: Ben Carson, The Other Republican Outsider On The Rise
Donald Trump isn't the only political outsider who's been having a good summer. Retired neurosurgeon Ben Carson is gaining in several polls — especially in the first-in-the-nation caucus state of Iowa, where evangelical voters play a big role. ... On the stump, Carson often talks about his belief in God and his opposition to abortion. He has compared it to slavery and accused Planned Parenthood of targeting African-Americans. (McCammon, 9/3)

USA Today: Biden Says He'll Run If He Has The 'Emotional Energy'
Vice President Joe Biden said Thursday that the biggest factor in his decision on whether to run for president is whether he and his family “have the emotional energy to run.” “The honest-to-God answer is, I just don’t know,” he said. That deeply conflicted response was the first public articulation of a thought process he’s discussed until now only privately with top Democrats and close advisers. He gave no timetable for a decision. (Korte, 94/)

Public Health And Education

'Improper Diagnosis' May Account For Part Of ADHD Rate Jump, Report Says

In other children's health news, thousands of landlords have not properly filed their rental units with Maryland's lead registry, and a new study examines why some kids get allergies and others don't.

The Washington Post: One In Five Kids With ADHD Diagnosed By Doctors Improperly
All sorts of theories have been proposed to explain the alarming rise -- 6.4 million in 2011, a 42 percent jump from 2004 -- in schoolchildren being diagnosed with Attention-Deficit/Hyperactivity Disorder, or ADHD, requiring therapy, medicine or both to make it through their day. ... Now a new report from the Centers for Disease Control and Prevention brings up another possibility: improper diagnosis. (Cha, 9/3)

The Washington Post: More Evidence That The Key To Allergy-Free Kids Is Giving Them Plenty Of Dirt — And Cows
People who grow up on farms -- especially dairy farms -- have way fewer allergy and asthma problems than the rest of us. Now one research team thinks they've brought science closer to understanding why. In a study published Thursday in Science, researchers report that they were able to pinpoint one possible mechanism for the allergy protection in mice they studied. Surprisingly, the protein that they fingered as the likely allergy-preventer doesn't actually affect the immune system -- it affects the structural cells that make up the lining of the lung. (Feltman, 9/3)

Truvada Highly Effective At Preventing HIV Transmission, Insurer Study Finds

The daily prescription medication has had mixed reception from medical professionals and gay communities, with some calling it an "end to the HIV epidemic" while others see it as a "party drug."

Newsweek: Truvada For HIV Prevention Proves Highly Effective
Truvada (emtricitabine and tenofovir) was originally developed as an antiviral drug for managing HIV, but in 2012 the U.S. Food and Drug Administration (FDA) approved it as a daily prophylactic pill for patient populations at highest risk for HIV, such as gay men with multiple sexual partners. But many have questioned whether the drug was effective enough and also whether the prophylactic treatment might encourage risky behavior and a rise in other sexually transmitted—and highly treatable—infections. ... This week, the private insurance company Kaiser Permanente released the largest population study to date that shows the drug is highly effective for preventing HIV transmission. (Firger, 9/3)

Vox: Critics Worried An HIV Prevention Pill Would Encourage Risky Sex. So Far, It Hasn't
When a new pill to prevent HIV hit the US market in 2012, it sharply divided the health community. Some experts hailed it as a major breakthrough in the fight against AIDS. Others worried it would turn back years of advocacy around condom use and encourage risky sex. ... But some public health researchers and AIDS activists had concerns about how this drug might be used in the real world. They feared that people might take Truvada (the brand name for PrEP) and then abandon condoms altogether — leading to a rise in other types of sexually transmitted infections. Others worried about what might happen if people didn't take the pill every day, as directed. Would it still work? (Belluz, 9/3)

Be On Guard Against Medicare Schemes

With an uptick in Medicare fraud, The Los Angeles Times offers tips to seniors for avoiding becoming a victim, while Reuters reports on how health care costs should factor into your retirement planning.

Los Angeles Times: How To Avoid Becoming A Victim Of Medicare Fraud
Medicare fraud in all its forms is rampant. Though exact numbers aren't known, the government estimates that $60 billion to $90 billion is lost each year to Medicare fraud and abuse. In California, as many as 20% of fraud allegations investigated each year by the Senior Medicare Patrol involve durable medical equipment. Experts offer these tips to avoid becoming a victim of Medicare fraud. (Zamosky, 9/4)

Reuters: Why Planning To Work In Retirement Is A Risky Business Due To Health
Half of all retirees leave the workforce earlier than planned due to a health problem or job loss. The index does not measure the risk of early retirement due to job loss or other factors, such as the need to care for a family member. Instead, it looks at cognitive, psychomotor, physical and sensory abilities required to do various jobs. The key finding: highly educated professionals can be as susceptible to early retirement risk as a steelworker or truck driver. (Miller, 9/3)

Veterans' Health Care

Veterans Face Transportation Barriers When Seeking VA Health Care

Meanwhile, an inspector general report finds “serious” problems with enrollment data among the wider Department of Veterans Affairs issues delaying care.

WMFE: Time-Consuming Trip To And From New VA Hospital
Floridians depend on cars to get just about anywhere. And getting to the doctor without one can be tough. Orlando resident David Williams knows this reality well, especially since the brand new Orlando VA Medical Center moved from the downtown core to the suburbs. (Aboraya, 9/3)

Fox News: IG Report: 300,000 Vets Died While Waiting For Health Care At VA
More than 300,000 American military veterans likely died while waiting for health care -- and nearly twice as many are still waiting -- according to a new Department of Veterans Affairs inspector general report. The IG report says “serious” problems with enrollment data are making it impossible to determine exactly how many veterans are actively seeking health care from the VA, and how many were. For example, “data limitations” prevent investigators from determining how many now-deceased veterans applied for health care benefits or when. (9/3)

State Watch

Calif. Prison Outbreak Of Legionnaires' Contained While Inmates In Other States Reported Ill

New York City finds contaminated water at a facility where four contracted Legionnaires' disease and the prisoner death toll rises to eight in Illinois. Meanwhile a mystery gastrointestinal illness strikes 220 at an Arizona jail.

NPR: Legionnaires' Outbreak Contained At Calif. Prison; New Cases In Illinois
The number of confirmed cases of Legionnaires' disease at California's San Quentin prison is holding steady at six, one of three outbreaks of Legionnaires' around the country that have sickened dozens and killed 20. Another 95 San Quentin inmates are under observation because of respiratory illness, state officials said, but they have not been diagnosed with Legionnaires' disease. The inmates are being treated at San Quentin's medical unit. ... In New York City, health officials announced Wednesday that they had detected Legionnaires' bacteria in the water in one building in the Melroses Houses complex in the South Bronx, where four people have fallen ill. Other buildings there are being tested. ... And in Quincy, Ill., the death toll from a Legionnaires' outbreak has risen to eight, health state officials reported Wednesday. (Aliferis, 9/3)

The Associated Press: Arizona Corrections: 220 Inmates Ill At Prison’s 2 Units
Hundreds of inmates at a state prison in northern Arizona have gotten ill in the past 48 hours, and the state Department of Corrections says it’s working with health officials to identify the cause. The department says lab samples are being sent out to determine why 220 inmates in the Winslow prison complex’s Kaibab and Coronado units have had gastrointestinal illness. (9/3)

In California, three officers are charged with the murder of a man in jail while waiting for a bed at a treatment program -

State Highlights: Medi-Cal's Pharmacy 'Clawback'; Mass. Health Spending Jumps; Clock Ticking For Colo. Teen Birth Control Program

Health care stories are reported from California, Massachusetts, Colorado, Florida, Kansas, Ohio, Texas and New York.

Kaiser Health News: Health Care Spending In Massachusetts Rises Faster Than State’s Goal
For years, Massachusetts has been out in front of other states, trying ideas to change the health system. It passed a state law extending health insurance coverage to almost all citizens four years ahead of the federal health law, and then the commonwealth tried to tackle rising health costs. But the latest numbers are disappointing: Massachusetts spent $632 million more on health care last year than it aimed to, according to a report from the state’s Center for Health Information and Analysis. (Bebinger, 9/4)

NPR: Colorado's Long-Lasting Birth Control Program For Teens May Not Last Long
Six years ago, Children's Hospital outside Denver and dozens of clinics around the state began focusing on long-acting forms of contraception, such as IUDs and hormonal implants. Research shows they're much more reliable at preventing pregnancy than the pill or condoms. Liz Romer, who runs the clinic at Children's, where teenagers and young women can get free and confidential birth control, said that's in part because they're less subject to human error. (Horsley, 9/3)

The News Service Of Florida: Supreme Court Ponders Medical Malpractice In Patient Suicide
In a medical-malpractice lawsuit stemming from the death of a woman who hanged herself, the Florida Supreme Court on Wednesday weighed whether her doctor could be found negligent in the suicide. The case, brought by the husband of Sarasota County woman Jacqueline Granicz after her 2008 death, raises issues about physician Joseph Chirillo's "duty" of care. The 2nd District Court of Appeal ruled last year that the lawsuit against Chirillo could move forward, overturning a circuit judge's ruling in the doctor's favor. (Saunders, 9/3)

Health News Florida: State Seeks To Clear Way For Doctor-Patient Gun Law
Attorney General Pam Bondi's office argued this week that a potential challenge at the U.S. Supreme Court should not prevent the state from carrying out a law aimed at restricting doctors from asking questions about patients' gun ownership. A three-judge panel of the 11th U.S. Circuit Court of Appeals in July upheld the controversial law --- dubbed the "docs vs. glocks" law. Opponents last month asked the full appeals court to hear the case. If that request is rejected, the opponents indicated they will take the issue to the U.S. Supreme Court. (9/3)

Kaiser Health News: For California, Last Year’s West Nile Season Was Most Severe Ever
West Nile virus hit California harder than ever last year, with a record 561 cases of neuroinvasive disease–the most serious types of the illness–reported from the mosquito-borne virus, according to federal health data released Thursday. The number of these serious California cases was 83 percent higher than the previous record number reported in the state in 2005, according to the U.S. Centers for Disease Control and Prevention. (Feder Ostrov, 9/4)

The Kansas Health Institute News Service: Mental Health An Emerging Issue For Kansas Tribes
Members of the four American Indian tribes with northeast Kansas reservations recently gathered to talk about health. They discussed continuing the fight against diseases, such as diabetes, that have plagued Indians for generations. But the talk didn’t stop there. “Native Americans are the most at risk for having diabetes. It’s just predispositioned that way. And so, because of that, I knew that that was going to be one of the most important things,” said Tiffany Buffalo, who heads the diabetes program for the Sac and Fox Tribe. (Thompson, 9/3)

Health News Florida: Heroin Popular, Deadly In Manatee County
In July 2015, emergency responders in Manatee County handled more than 200 heroin overdose calls. And the repeat overdose calls alone are nearly three times what the overall total was for July 2014. Chief Stephen Krivjanik with Manatee County Public Safety Department’s EMS Division called July 2015’s numbers “overwhelming.” (Watts, 9/3)

The Columbus Post-Dispatch: Advocate Takes Own Life A Year After Testifying For Expanded Mental Health Treatment
In fact, the woman from Beavercreek in suburban Dayton not only testified twice publicly for Senate Bill 43 — a law allowing judges to order out-patient treatment for the mentally ill — but also attended a bill-signing ceremony in Gov. John Kasich’s office on June 17, 2014. A photo shows Kasich with his left arm around Baker’s shoulder in the center of a group of lawmakers and advocates. How did things go so wrong? (Johnson, 9/4)

The Kansas Health Institute News Service: Health Advocates Push To Add E-Cigarettes To State Smoking Ban
Erica Anderson, a health promotion specialist for the Lawrence-Douglas County Health Department, likes to tell a story about a woman who came to one of her workshops eager to talk about electronic cigarettes. The woman, who was pregnant, said she was in a restaurant when a man at the table next to her started puffing on an e-cigarette, which delivers nicotine to users in a vapor. As the white cloud of vapor wafted over to her, she got up and asked the restaurant owner to tell the man to stop. (Marso, 9/3)

The Texas Tribune: Workers Comp Insurer Fined $250,000
For years, Crystal Davis battled an insurance company for workers' compensation benefits after her husband, Wayne, was killed on the job in 2012. As a result of her struggles, the Texas Department of Insurance has slapped that insurer with what is believed to be the highest fine ever issued for workers' compensation violations in the state — $250,000. None of the money goes to Davis — a stay-at-home mom from Tyler with two children — but the state is requiring that a large chunk of it be used to help children of injured or killed workers. (Satija, 9/3)

Health Policy Research

Research Roundup: PTSD And Vietnam Vets; Kids' Use Of Antipsychotic Drugs; Calif.'s Elder Poor

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

JAMA Psychiatry: Course Of Posttraumatic Stress Disorder 40 Years After The Vietnam War
The long-term course of readjustment problems in military personnel has not been evaluated in a nationally representative sample. The National Vietnam Veterans Longitudinal Study (NVVLS) is a congressionally mandated assessment of Vietnam veterans who underwent previous assessment in the National Vietnam Veterans Readjustment Study (NVVRS). ... Approximately 271 000 Vietnam theater veterans have current full PTSD plus subthreshold war-zone PTSD, one-third of whom have current major depressive disorder, 40 or more years after the war. These findings underscore the need for mental health services for many decades for veterans with PTSD symptoms. (Marmar et al., Sept., 2015)

JAMA Psychiatry: Treatment Of Young People With Antipsychotic Medications In The United States
[Researchers sought to] describe antipsychotic prescription patterns among young people in the United States, focusing on age and sex .... The percentages of young people using antipsychotics in 2006 and 2010, respectively, were 0.14% and 0.11% for younger children, 0.85% and 0.80% for older children, 1.10% and 1.19% for adolescents, and 0.69% and 0.84% for young adults. In 2010, males were more likely than females to use antipsychotics, especially during childhood and adolescence .... Antipsychotic use increased from 2006 to 2010 for adolescents and young adults but not for children aged 12 years or younger. Peak antipsychotic use in adolescence, especially among boys, and clinical diagnosis patterns are consistent with management of developmentally limited impulsive and aggressive behaviors rather than psychotic symptoms. (Olfson, King and Schoenbaum, 9/3)

UCLA Center for Health Policy Research: More Than Three-Quarters Of A Million Older Californians Are “Unofficially” Poor
More than three-quarters of a million (772,000) older Californians are among the “hidden poor” – older adults with incomes above the federal poverty line (FPL) but below a minimally decent standard of living as determined by the Elder Economic Security Standard Index (Elder Index) in 2011. ... This study finds that the FPL significantly underestimates the number of economically insecure older adults who are unable to make ends meet. Yet, because many public assistance programs are aligned with the FPL, potentially hundreds of thousands of economically insecure older Californians are denied aid. The highest rates of the hidden poor among older adults are found among renters, Latinos, women, those who are raising grandchildren, and people in the oldest age groups. (Padilla-Frausto and Wallace, 8/31)

The Kaiser Family Foundation/Rockefeller Institute of Government: Economic And Fiscal Trends In Expansion And Non-Expansion States: What We Know Leading Up To 2014
The effects of the Medicaid expansion on state budgets and economies have been key issues for policy makers. This brief ... is designed to provide some insight into the underlying economic and fiscal conditions in [Medicaid] expansion and non-expansion states leading up to 2014. ... Key findings include: The typical expansion state was in a better position across the factors analyzed leading up to the ACA Medicaid expansion in 2014. Median poverty and uninsured rates were higher in non-expansion states. ... Median tax collections per capita have historically been higher in expansion states. ... The typical expansion state spent more per capita on Medicaid and K-12 education prior to the major ACA coverage expansions. (Synder et al., 9/1)

Rand Corp.: Behavioral Health And Service Use Among Civilian Wives Of Service Members And Veterans
[R]esearchers analyzed the National Study of Drug Use and Health to examine utilization of behavioral health care among current or former wives of service members and veterans who are covered by either TRICARE or CHAMP-VA. Three findings of interest emerged .... First, relative to the comparison group, military wives were more likely to receive behavioral health services, but this pattern was exclusively due to use of prescription psychiatric medications. No difference was found for specialty behavioral health treatment. Second, residing in rural areas was negatively associated with behavioral health care service use for both groups. Third, contrary to expectations, military wives who live more than 30 minutes from a military treatment facility were more likely than military wives who lived closer to receive prescription psychiatric medications but not other types of behavioral health services. (Breslau and Brown, 8/24)

Commonwealth Fund: How Strong Is The Primary Care Safety Net? Assessing The Ability Of Federally Qualified Health Centers To Serve As Patient-Centered Medical Homes
[T]he Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), which provide an important source of care in low-income communities. A pair of Commonwealth Fund surveys asked health center leaders about their ability to function as medical homes. Survey findings show that between 2009 and 2013, the percentage of centers exhibiting medium or high levels of medical home capability almost doubled, from 32 percent to 62 percent. The greatest improvement was reported in patient tracking and care management. Despite this increased capability, health centers reported diminished ability to coordinate care with providers outside of the practice, particularly specialists. (Ryan et al., 9/3)

Health and Human Services Office of the Inspector General: HHS Oversight of Grantees Could Be Improved Through Better Information Sharing
The Department of Health and Human Services (HHS) is the largest grantmaking agency in the Federal Government. In fiscal year 2014, HHS awarded nearly $402 billion in grants. ... Awarding agencies' grant officials use various sources of information and communication to mitigate grantee risks; however, grant officials noted limitations in some instances. For example, information available in databases assists staff from awarding agencies in managing grantee risks, but lack of integration poses challenges. NEARC memorandums contain important information about grantee risks, but not all awarding agencies receive them. Awarding agencies lack a systematic method of sharing information about grantee risks, and sharing occurs infrequently. (Murrin, 9/2)

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

Reuters: Religion Rarely Part Of ICU Conversation
In less than 20 percent of family meetings in the intensive care unit do doctors and other health care providers discuss religion or spirituality a new study finds. For many patients and families, religion and spirituality are important near the end of life, and understanding these beliefs may be “important to delivering care that is respectful of the patient as an individual,” said senior author Dr. Douglas B. White of the University of Pittsburgh School of Medicine, in email to Reuters Health. (Doyle, 8/31)

Medscape: Ryan White-Funded HIV Programs Offer More Complete Services
Low-income patients with HIV who received care at a facility funded by the Ryan White HIV/AIDS Program (RWHAP) were more likely to achieve viral suppression than those at non-RWHAP-funded facilities, according to a new study. RWHAP-funded facilities were also more likely than others to provide services such as case management and mental health and addiction services. John Weiser, MD, MPH, from the Division of HIV/AIDS Prevention of the Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues report their findings online August 31 in JAMA Internal Medicine. (Frellick, 9/2)

The Associated Press: A Racial Gap In Kidney Transplants Closes But Work Remains
A racial gap in kidney transplants appears to have closed, a 13-year study found. Rates of such transplants among white patients used to far surpass those in blacks, but U.S. data on nearly 200,000 end-stage kidney disease patients shows that disparity had disappeared by 2010. Rates remained stable in 2011 and that trend likely has continued, said Dr. Jesse Sammon, the senior author and a urologist-researcher at the Henry Ford Health System in Detroit. (Tanner, 8/31)

Reuters: Kidney Recipients, Donors Want Info About Each Other’s Health
Living kidney donors and their recipients would like to share more health information before the transplant surgery, a new survey indicates. Currently, patients must be informed if they’re at risk for acquiring hepatitis or HIV from a donor organ, researchers write in the Clinical Journal of the American Society of Nephrology. Beyond that, transplant professionals cannot share information without the permission of both parties, senior author Dr. Lainie Friedman Ross of the MacLean Center for Clinical Medical Ethics at the University of Chicago told Reuters Health by email. (Doyle, 9/2)

CNN: Survey: Mental Health Stigmas Are Shifting
Mental health has a long-standing public perception problem, but the stigma appears to be shifting, at least in the United States, a new survey reveals. Results from a national online survey on mental health, anxiety and suicide indicate that 90% of Americans value mental and physical health equally. (Ansari, 9/1)

Reuters: Activity Trackers Vary In Accuracy
Wrist-worn activity trackers, increasingly popular among consumers and in healthcare research, can vary considerably in their accuracy, a study from Iowa State University suggests. Researchers pitted consumer devices against a gold-standard metabolic monitor and found the wristbands are more accurate for calories burned while resting or jogging, but have higher error rates for activities like weight lifting and crunches. (Kennedy, 9/1)

MedPage Today: AAP: Screen Children For Binge Drinking Early And Often
With rates of binge drinking increasing, the American Academy of Pediatrics recommends that physicians screen children as young as 9 years of age for alcohol abuse, according to the most recent clinical report on the subject. Lorena Siqueira, MD, of the AAP Committee on Substance Abuse, and colleagues cited survey results that indicate children start to think positively about alcohol between ages 9 and 13. They also found that almost 15% of children 14 to 20 years old, including almost 5% (4.5%) of 14- and 15-year-olds reported binge drinking (defined as ≥3 to ≥5 drinks on one occasion, depending on age and sex). (Walker, 9/1)

Reuters: New Guidelines For Cancer Doctors Aim To Make Sense Of Gene Tests
The American Society of Clinical Oncology (ASCO) has issued guidelines on how cancer doctors should approach the use of new genetic tests that screen for multiple cancer genes at the same time, including counseling patients about genes whose contribution to cancer is still poorly understood. The guidelines aim to educate doctors about the risks and benefits of new genetic tests, argue for regulation to assure quality and call for more equitable reimbursement of the cost of the tests from private and public insurers. (Steenhuysen, 8/31)

Editorials And Opinions

Viewpoints: GOP Efforts Would Raise Deficits; Abortion And Down Syndrome

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

The Washington Post: The GOP’s Self-Defeating Budget Flaw
If you’ve heard anything about the upcoming budget battle, it’s probably that Republicans want to dramatically slash spending. Yay, fiscal conservatism! What you may not know is that many of their desired funding cuts would increase deficits in the long run. Here’s why. You know how you’re supposed to go to the doctor for preventive care so you don’t get really sick later on? Some government spending programs serve a similar purpose. (Catherine Rampell, 9/3)

The New York Times: Does Down Syndrome Justify Abortion?
A week earlier, my pregnant wife, Jennifer, had undergone a routine prenatal ultrasound that revealed “soft markers” suggestive of genetic abnormalities. Now we were in the consultation room awaiting the results of the amniocentesis, which would conclusively determine whether our daughter would be born with Down syndrome. ... Hammering home the momentous difficulties that would await us as parents was clearly a tactical move by the doctor to push us toward an abortion. That abortion is not the exception, but rather the expectation in cases of Down syndrome, is not limited to medical professionals. Though precise numbers are unavailable, at least two-thirds and as many as 90 percent of fetuses found to have Down syndrome in utero are aborted. (Mark Lawrence Schrad, 9/4)

The New York Times: Cheeseburger, Hold the Salmonella
Americans eat more than 50 pounds of beef per person each year. That’s a lot of beef. It’s also a lot of risk, because about half — or more than two billion pounds — is ground beef, which can too easily harbor dangerous bacteria. ... But as a new report points out, there is more the Department of Agriculture and the Food and Drug Administration can do to keep Americans safe and some simple things consumers could do themselves. (9/4)

Los Angeles Times: Making The Most Of A Cigarette Tax Hike
A bill that would more than triple the California cigarette tax was gaining little traction in the Legislature until it received a push forward from Gov. Jerry Brown's special legislative session on funding healthcare for the poor. The additional $2-per-pack tax imposed by the bill would initially raise $1.5 billion a year. A well-crafted cigarette tax is a thing of beauty. Not only does it raise revenue, but it helps reduce smoking rates and deters teenagers from developing a cigarette habit, preventing many premature deaths. California, whose cigarette taxes are in the bottom third nationwide, is overdue for an increase. But more than six months after the bill's earliest hearings, the "well-crafted" part is still missing. (9/3)

Health Affairs: Physician Payment Reform In A Post-SGR World: Challenges Remain
On April 16, 2015 President Barack Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) which, among other things, finally repeals the Sustainable Growth Rate (SGR) mechanism of updating fees to the Physician Fee Schedule (PFS). The SGR had been blamed for causing instability and uncertainty among physicians for over a decade and led to 17 overrides of scheduled fee cuts, at a cost well in excess of $150 billion. The passage of MACRA, however, raises new questions about where the U.S. health care system is headed in the post-SGR world of payment and delivery reform. (John O'Shea, 9/3)

The New England Journal of Medicine: Scoring No Goal — Further Adventures In Transparency
One Monday morning, rounding on a patient who needed relatively urgent coronary-artery bypass surgery, a newly appointed cardiologist in New York asked the team to call a surgical consult .... “We can't call today,” the cardiology fellow explained patiently. “Dr. X. is taking consults. He wouldn't touch our patient with a 10-foot pole.” The fellow scrutinized the call schedule. “The only surgeon who might take him isn't on until Wednesday.” In New York, one of a handful of states where outcomes of cardiac surgery and percutaneous coronary intervention (PCI) have been publicly reported for some years, such situations are not uncommon. Although the aim of report cards was to motivate proceduralists to improve quality, they seem instead to have motivated avoidance of the sickest patients. (Lisa Rosenbaum, 9/2)