KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: 'Played Out?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Played Out?'" by Steve Kelley and Jeff Parker, from 'Dustin'.

Here's today's health policy haiku:


Governor Brown signs
Right-to-die bill, reflecting
On what he would want.

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Campaign 2016

Clinton's Health Plan Takes On Issues Of Obamacare Affordability

Meanwhile, the Los Angeles Times looks at how a new phase in the health care debate could impact the 2016 elections while NPR reports on an algorithm that could help campaigns identify politically persuasive language, like "pre-existing" and "mandate," that strike a chord with voters.

The New York Times: Hillary Clinton’s Health Care Proposals, Focused On Cost, Go Well Beyond Obama’s
Hillary Rodham Clinton, as she offered up a sheaf of new health care proposals, said she was “building on the Affordable Care Act.” But lurking in those proposals was a veiled criticism of President Obama’s signature domestic achievement: For many families, the Affordable Care Act has not made health care affordable. Mr. Obama has spent five years minimizing cost issues still confronting many health care consumers. Mrs. Clinton is taking those on without apologies. She would go beyond the president’s 2010 law, capping a patient’s share of the bill for doctor visits and prescription drugs. She would repeal the law’s planned tax on high-cost employer-sponsored insurance — a tax the White House says is needed to constrain the growth of health spending. (Pear, 10/6)

Los Angeles Times: How The Debate Over Healthcare Is Changing - Just In Time For The 2016 Election
With the first primaries of the 2016 presidential campaign just months away, the national healthcare debate is poised to enter a new phase, more focused on consumers’ pocketbooks than on re-litigating the 5-year-old Affordable Care Act. Hillary Rodham Clinton, who is campaigning on a detailed program to crack down on rising drug prices and runaway medical bills, is making a play for the hearts of voters increasingly irritated about what they have to pay for healthcare. In the process, Clinton, the front-runner for the Democratic presidential nomination, has issued an implicit challenge to her Republican rivals, who continue to campaign with broadsides against Obamacare but few details about how they would address consumers’ basic healthcare worries. (Levey, 10/7)

NPR: Inside The Message Machine That Could Make Politicians More Persuasive
It sounds like a politician's dream: a machine that can tell you exactly what to say to change a voter's mind. Well, that's what a political scientist has come up with — at least, a first tentative step in that direction. Using text from a pro-Obamacare website and testing different combinations of sentences on volunteers, an algorithm created by Northeastern University assistant professor Nick Beauchamp was able to identify optimally persuasive terms that make people more inclined to support the landmark health care law. Sentences including words like "pre-existing," "condition," "coverage" tended to leave study volunteers feeling more positive about the law. "States," "federal" and "government" were among the topics that turned people off Obamacare. (Detrow, 10/6)

Meanwhile, in the New Hampshire Senate race -

The Associated Press: Hassan's Political Philosophy Shaped By Advocacy For Son
A dozen years before running for governor in New Hampshire, Maggie Hassan got her start in public service at the invitation of then-Gov. Jeanne Shaheen, the woman she now hopes to serve alongside in the U.S. Senate. A lawyer at the time, Hassan caught Shaheen's eye for her advocacy work on behalf of children with disabilities, including her son Ben. Now 27, Ben was born with cerebral palsy and cannot walk or speak. Hassan believed he and children like him should have the same access as any child to a good education — and she fought for it. ... Now in her second, two-year term, Hassan's aiming higher: On Monday, she announced she'll challenge Republican U.S. Sen. Kelly Ayotte in what is likely to be one of country's most expensive and closely watched contests as the two parties vie for control of the Senate. (Ronayne, 10/6)

Health Law Issues And Implementation

HHS Is Upgrading's Window Shopping Option For Insurance

The ability to quickly browse plans is popular with consumers and needed some repair, The Associated Press reports. At the same time, Politico Pro looks at Republican lawmakers' strategy on the Cadillac tax.

The Associated Press: Gov't Health Insurance Website Getting Upgrades
Consumers shopping on the government's health insurance website should find it easier this year to get basic questions answered about their doctors, medications and costs, according to an internal government document. A slide presentation dated Sept. 29 says's window-shopping feature is getting a major upgrade. Window shopping is a popular part of the website that allows consumers to browse for taxpayer-subsidized health insurance plans. (Alonso-Zaldivar, 10/7)

Politico Pro: Republicans Are In No Rush To Kill The Cadillac Tax
Seemingly everyone hates the Affordable Care Act's "Cadillac tax" on health benefits — which is precisely why efforts to repeal it are likely to go nowhere fast. Republicans say they won't simply let Democrats off the hook for creating what's proving to be a wildly unpopular tax. They want Democrats to give them something big in exchange for killing it, such as agreeing to scrap other parts of the health care law. (Faler, 10/6)

In other insurance news -

The Washington Post: Want To Get Your Partner’s Child Insured? Put A Ring On It, Federal Employees Told.
The Obama administration reversed a policy Monday that had allowed unmarried federal employees and retirees in same-sex domestic partnerships to obtain insurance coverage for children of their partners under certain conditions. The change, applying to the separate insurance programs for health care and for vision and dental care, is a fallout of the June U.S. Supreme Court decision requiring all states to allow and recognize same-sex marriage. It overturns a policy that itself was a result of a ruling by the high court two years earlier and could be a harbinger of other changes in eligibility for federal employee benefits. (Yoder, 10/6)

Reactions Mixed On Utah's Medicaid Expansion Plan At First Public Hearing

Meanwhile in Kansas, a local hospital renews debate over Medicaid expansion.

The Associated Press: Medicaid Plan Gets First Public Hearing But No Vote Yet
State lawmakers held the first public hearing Tuesday evening on a new plan to help thousands of Utah's poor get health insurance by expanding Medicaid. They didn't take any action on the plan, however, after hearing hours of testimony from doctors, advocates for the poor and more. The proposal would help poor residents get health insurance mostly through private insurance plans. Doctors, hospitals and others would help pay the state's cost through higher taxes and fees. (Price, 10/6)

Elsewhere, insurance marketplace and data privacy news comes from Massachusetts, Connecticut and New Jersey -

The Connecticut Mirror: Auditors Question Access Health’s Information Security
State auditors have raised concerns about the ability of Connecticut’s health insurance exchange to ensure that information about its customers is secure. In a report released Tuesday, the auditors cited concerns raised by a security expert who reviewed the exchange following a 2014 security breach and suggested that the quasi-public agency should develop a system for responding to reported security deficiencies. (Levin Becker, 10/6)

The Philadelphia Inquirer: N.J. Health Insurer Defends Plan As Lawmakers Object
New Jersey's largest health insurer on Monday defended a new alliance it has struck with some of the state's hospital systems that's intended to lower costs for consumers, even as lawmakers questioned the criteria it used to choose its partners. Horizon Blue Cross Blue Shield of New Jersey last month announced it had formed the Omnia Health Alliance with six of the state's 20 hospital systems and a physicians group. The only South Jersey hospital system included in the alliance is Inspira. (Seidman, 10/6)


Key Pharmacy Benefits Manager Will Offer Two Expensive Cholesterol Drugs To Some Patients

Express Scripts says it will add both of the new cholesterol-lowering drugs to its list of covered drugs, but it will closely adhere to federal guidelines about who should get the medicines.

The Wall Street Journal: Express Scripts To Cover Both New Cholesterol Drugs
The first major showdown between two new effective but expensive cholesterol-lowering drugs resulted in a draw. Express Scripts Holding Co., the big pharmacy-benefits manager, said it would include both drugs—Praluent from Regeneron Inc. and Sanofi SA and Repatha from Amgen Inc., on its national list of covered medicines. ... Insurance coverage for the two agents, known as PCSK9 inhibitors, has been an unanswered question since the drugs were approved this summer. The list price for Praluent is about $14,600 a year while Repatha is priced at $14,000. (Winslow, 10/6)

The Associated Press: Express Scripts To Cover Pricey New Cholesterol Treatments
The decision comes as soaring drug prices draw criticism from patients, doctors and politicians, as well as insurers and employers that generally pay most of the prescription bill. Praluent and Repatha both stirred worry, in particular, because of their potential to be used by millions of patients. The biologically-engineered drugs are considered the first major advance in managing cholesterol since the introduction of statin drugs more than 20 years ago. They aim to lower bad, or LDL, cholesterol, and analysts expect them to generate billions in sales. (Murphy, 10/6)

Kaiser Health News: Express Scripts To Cover Pricey New Cholesterol Drugs
The nation’s largest pharmacy benefit manager said Tuesday it’s not going to try to bring down costs by forcing the makers of two pricey new cholesterol drugs to compete against each other, as it successfully did this year with expensive hepatitis C treatments. Instead, Express Scripts said it will control spending by aggressively managing which patients get the injectable medications. The firm also said it won some discounts from the treatments’ estimated $14,000 annual list price. (Appleby, 10/7)

Los Angeles Times: Prescription Firm Agrees To Cover Pricey New Cholesterol Drugs -- For Some
But in addition to their promise, the drugs carried a suggested price of more than $14,000 a year — 140 times more expensive than statins, the most common cholesterol-fighting medication. The pricing had drawn widespread criticism, with one study concluding the true value of the drugs is a fraction of their sticker price. The new drugs hit the market amid a fierce debate between insurers and pharmaceutical companies about the appropriate pricing of specialty drugs, which treat smaller patient populations but can come with price tags significantly higher than older medications. (Pfeifer, 10/6)

The New York Times: Express Scripts Says It Will Cover 2 New Cholesterol Drugs
Express Scripts created a stir late last year when it decided to pay for AbbVie’s new drug to treat hepatitis C, Viekira Pak, and not for Harvoni, a competing product from Gilead Sciences. Some other health plans followed suit in choosing only one of the two drugs, forcing Gilead and AbbVie to offer bigger discounts to retain sales. Investors and cardiologists have been waiting to see whether health plans would try to force the same winner-take-all bargaining from the makers of the two new cholesterol drugs. Express Scripts, at least, will not, saying Tuesday that it had received sufficient discounts to offer both products. However, it did not indicate what it would pay for the drugs or what consumers would pay, which depends on their health plan. (Pollack, 10/6)

Study Finds Dramatic Differences In Prices For Health Care Services

The differentials extend across the country and within metropolitan areas, researchers reported.

Kaiser Health News: Buyer Beware: A Mammogram’s Price Can Vary By Nearly $1,000, Study Finds
Thinking about getting a mammogram in the Dallas-Fort Worth area? You might check carefully because the cost can vary from $50 to as much as $1,045. How about an initial routine gynecological exam? Around Phoenix, those prices can range from $72 to $388. According to an analysis released Wednesday, it can pay to shop around for women’s health care, with mammograms and other routine services often costing far more in one office than in another. Researchers at Castlight Health, a company that helps businesses analyze health care prices, looked at 179 metropolitan areas and found that mammogram prices varied four-fold or more in Atlanta, Houston, Los Angeles, Miami, Philadelphia and Seattle, among others. (Rau, 10/7)

The Charlotte Observer: Charlotte Area Among Highest For Some Medical Costs, Survey Shows
Charlotte ranks in the top four of 30 U.S. cities for the price consumers pay for four common medical procedures, according to the 2015 Castlight Health Costliest Cities Index. For the second year, Castlight, a health care management organization based in San Francisco, produced the index based on private insurance claims and public data showing what employers and consumers actually pay for common procedures in 30 U.S. cities, including Charlotte and Raleigh. (Garloch, 10/5)

Health Care Stocks Weigh Down U.S. Markets

Among the shares dropping are those in the biotech sector, which may be headed for its worst loss since 2011. Investors are worried over drug prices as disappointing earnings news also affects the stocks' value.

The Wall Street Journal: Health-Stock Selloff Saps Market’s Momentum
A sharp selloff in health-care shares snapped the S&P 500’s five-day winning streak on Tuesday. ... Investors continued to hammer health-care stocks, particularly the biotechnology sector, taking profits from a yearslong rally as concerns rise over the scrutiny of pricing during the presidential campaign, said Bill Nichols, head of U.S. equity trading at Cantor Fitzgerald LP. Investors are concerned about the chances that “all of a sudden, the gold at the end of the rainbow is lessened,” he said. (Josephs, 10/6)

Reuters: Biotechs Extend Selloff As Pricing Concerns Intensify
U.S. biotech shares extended their recent downward spiral on Tuesday as concerns about drug pricing continued to plague the sector while disappointing news from Illumina and other companies added to selling pressure. The Nasdaq Biotechnology index, down 4 percent, has now fallen about 17 percent since just before Hillary Clinton, front-runner to be the Democratic nominee in next year's U.S. presidential election, vowed on Sept. 21 to take steps to curb high drug prices. (Valetkevitch and Berkrot, 10/6)

Bloomberg: Biotech Rout Back As Profits Become Latest Investor Concern
Biotechnology stocks plunged Tuesday, with an index tracking the industry at one point heading for its worst loss since August 2011, after earnings warnings from companies that sell technology to drug firms and concern about pharmaceutical pricing reignited selling that began three weeks ago. (Renick and Garber, 10/6)

Bloomberg: Cures-For-Dollars Model Comes Undone As Biotech Stocks Sink
For the last five years, biotechnology and pharmaceutical stocks have surged on an assumption about the companies that invent and sell drugs for American patients: Invent amazing treatments that save lives and cure the sick, and you can charge pretty much what you want. That thesis is under more pressure than any time in recent history, in part because of increasing scrutiny of how some drugmakers price their medicine. In the last month, media reports about price increases for therapies that have been on the market for years have caused Democratic presidential candidates to call for regulating the sector’s business practices, including what companies spend on research and how much they can charge. (Armstrong and Coons, 10/6)

Bloomberg: Glenview Fund Said To Lose 12% Last Month On Healthcare
Glenview Capital Management, the hedge fund firm led by Larry Robbins, lost 12.4 percent in its main fund in September as bets on health-care companies suffered. The performance leaves the fund down 12.9 percent in 2015 through last month, according to a person with knowledge of the returns who asked not to be named because the information is private. Taylor Ingraham, a spokesman for the New York-based Glenview at ASC Advisors, declined to comment on the losses. (Foxman, 10/6)

Public Health And Education

Opponents Of Calif.'s Assisted Suicide Law Seek Referendum To Overturn It

The groups are launching a campaign to get a referendum, but it could be an uphill battle. Also, news outlets examine how the California law will impact other states considering similar legislation and seek to answer consumer questions about how this would work.

Los Angeles Times: Referendum Papers Filed On Assisted Suicide Law
A day after Gov. Jerry Brown signed a bill allowing assisted suicides for the terminally ill in California, opponents filed papers to seek a referendum to overturn the measure on the November 2016 ballot. A group called Seniors Against Suicide filed papers with the state attorney general’s office to get an official title and summary for the referendum, the first step toward collecting signatures. The group would have 90 days, or until Jan. 3, to collect the signatures of 365,880 registered voters, a difficult task as those behind a failed referendum on the state’s new vaccine law recently found out. (McGreevy, 10/6)

The Associated Press: Right-To-Die Backers Say California Helps Fight Elsewhere
It will soon be legal for the terminally ill to end their own lives in the nation's most populous state, and right-to-die advocates expect other states to follow California's example. ... California marks a turning point, and its legislation includes more safeguards than the other four states where the practice is legal, the law's supporters say. They are now focusing on New Jersey, where the state Senate is slated to debate a similar bill this fall, and Massachusetts, where a legislative hearing on the issue is set for this month. (Watson, 10/6)

The Washington Post: Right-To-Die Advocates Hope To Mimic California Victory In D.C., Maryland
National right-to-die advocates are hoping their recent success in California will boost their efforts to allow terminally ill patients to legally end their lives in Maryland and the District. ... Maryland on Tuesday held a workshop on an assisted-suicide bill introduced by Del. Shane E. Pendergrass (D-Howard) where lawmakers heard from officials in Vermont and Oregon about the implementation of similar laws. Pendergrass started the hearing by reading Brown’s letter in signing California’s law, highlighting that the governor said he would not take options from others facing excruciating death despite his Catholic background. (Nirappil, 10/6)

NPR: California Gov. Jerry Brown Signs End Of Life Option Act
Yesterday California's Governor Jerry Brown signed into law the End of Life Option Act. The law allows terminally ill people to be prescribed the drugs that will end their lives. The main opponents of the bill included some doctors, disability rights groups and religious organizations. One group called it, quote, "a dark day for California." On the other side of the debate, there is Christy O'Donnell. She's 47 years old and a former LAPD detective. After she was diagnosed with stage four lung cancer last year, she became an advocate for this law. (McEvers, 10/6)

The San Jose Mercury News: How To Talk To Your Doctor About Life-Ending Drugs
When faced with a life-threatening diagnosis, it is difficult to talk to a doctor about hastening death. So some patients wait until it is too late to discuss the topic with their doctor, said George Eighmey, the Oregon state legislator who in 1997 was instrumental in getting that state's Death With Dignity law passed and then went on to lead the state's chapter of the organization Compassion & Choices. (Krieger, 10/6)

Planned Parenthood Wants Class-Action Status In Fight Against Arkansas' Defunding Efforts

The reproductive health organization asked a federal judge to expand a ruling that temporarily blocks Arkansas from stopping payments to three women to cover a larger group of potential plaintiffs. In related legal news, a judge rules that anti-abortion activists can turn over their Planned Parenthood video tapes to Congress, and Arkansas urges the Supreme Court to overturn Roe v. Wade.

The Associated Press: Planned Parenthood Asks Judge To Expand Arkansas Case
Planned Parenthood has asked a federal judge to expand a ruling that temporarily blocked Arkansas from cutting off Medicaid payments for three patients after the state canceled the organization’s contract amid controversy over videos secretly recorded by an anti-abortion group. The organization filed a request late Monday seeking class-action status for its lawsuit challenging Gov. Asa Hutchinson’s termination of its contract, saying the lawsuit should cover current and future Medicaid patients who seek treatment at Planned Parenthood. (Bleed, 10/6)

Reuters: Planned Parenthood Seeks Class Action Status After Arkansas Cuts Payments
Planned Parenthood has sought class action status for its Medicaid patients in Arkansas after a U.S. judge ordered the state to continue payments to three women who challenged Arkansas' move to halt payments to the organization. The filing in federal court in Arkansas on Monday could reverse the state's decision to cut off funding for Planned Parenthood programs in the state, lawyers for the group said on Tuesday. (Barnes, 10/6)

Politico: Judge Rules That Anti-Planned Parenthood Activists Can Give Congress Undercover Videos
Heading off a potential constitutional clash, a federal judge ruled Tuesday that anti-abortion activists can hand over unreleased undercover sting videos and outtakes subpoenaed by a House committee even though a court order remains in place barring those activists from releasing the materials publicly. U.S. District Court Judge William Orrick said Tuesday that he would not prevent activist David Daleiden and the Center for Medical Progress from complying with the subpoena issued last month by House Oversight and Government Affairs Committee Chairman Jason Chaffetz. (Gerstein, 10/6)

Politico: Arkansas To U.S. Supreme Court: Overturn Roe V. Wade
Arkansas has asked the Supreme Court to revisit its long-standing ruling that a woman can terminate a pregnancy until the fetus is viable outside of the womb. Arkansas on Tuesday asked the justices to overturn a lower court decision that found that the state’s ban on abortion at 12 weeks of pregnancy and when a heartbeat is detected is unconstitutional. (Haberkorn, 10/6)

Are Dietary Guidelines Discouraging Whole Milk Wrong? Researchers Evaluate Health Benefits

Meanwhile, schools struggle to get students to eat healthier food, and lobbying is underway to influence the next round of U.S. dietary recommendations.

The Washington Post's Wonkblog: For Decades, The Government Steered Millions Away From Whole Milk. Was That Wrong?
U.S. dietary guidelines have long recommended that people steer clear of whole milk, and for decades, Americans have obeyed. Whole milk sales shrunk. It was banned from school lunch programs. Purchases of low-fat dairy climbed. ... Whether this massive shift in eating habits has made anyone healthier is an open question among scientists, however. In fact, some recent evidence indicates that just the opposite might be true: millions might have been better off had they stuck with whole milk. Scientists who tallied diet and health records for several thousand patients over ten years found, for example, that contrary to the government advice, people who consumed more milk fat had lower incidence of heart disease. ... This year, as the “Dietary Guidelines for Americans” undergoes one of its periodic updates, the federal bureaucrats writing them must confront what may be the most controversial and weighty question in all of nutrition: does the consumption of so-called saturated fats - the ones characteristic of meat and dairy products - contribute to heart disease? (Whoriskey, 10/6)

The New York Times: Schools Report Varying Results In Their Efforts To Comply With Nutrition Guidelines
As students lined up for lunch at the Washington Technology Magnet School cafeteria [in St. Paul, Minn.] on a recent late morning, taco pizza was available along with the fresh fruits and vegetables. Angie Gaszak, a school system nutritionist, said the school tries to offer a mix. “We want to make sure they eat healthy, but we also want to serve things that they will eat,” Ms. Gaszak said. It is a balance that is hard to achieve as school systems try to comply with legislation signed in 2010 by President Obama that required schools to update their nutritional standards to cut back on sugar and sodium in foods and add more fruit and vegetables for the 30 million children they serve. (Nixon, 10/6)

Politico Pro: The Money Behind The Fight Over Healthy Eating
Updated every five years, the proposed dietary guidelines update for 2015 has been unusually contentious. They urge Americans to consume a diet rich in fruit and vegetables, whole grains, seafood, legumes and nuts and to eat less red and processed meats, sugar and processed foods. They also recommend emphasizing plant-based foods because they are better for the environment– sacrilege to food and agriculture industry groups, which unleashed a lobbying bonanza on the Hill. (Purdy and Bottemiller Evich, 10/6)

C-Section Rates Vary Widely Among States And Individual Hospitals, Study Shows

In Florida, a health safety group is warning that South Florida hospitals perform too many C-sections, with some area hospitals reporting that the procedure is used for more than half of all deliveries. In other reproductive health news, another study finds that more women are being offered IUDs right after delivery.

Miami Herald: Health Safety Group: South Florida Hospitals Perform Too Many C-Sections
The average rate of cesarean section surgeries for Florida hospitals was among the highest in the nation — about 32 for every 100 deliveries — according to a study released Wednesday by The Leapfrog Group, a nonprofit that surveys hospitals for quality and safety measures. The numbers, which were self-reported by Florida hospitals and included only first-time, low-risk mothers with single babies, exceeded the recommended target of about 24 for every 100 deliveries. (Chang, 10/6)

NPR: Hospitals Still Don't Give Moms Enough Support For Breast-Feeding
Most hospitals around the country aren't doing a good job of helping new moms who want to breast-feed, researchers report Tuesday in the journal Morbidity and Mortality Weekly Report. Several common practices at the institutions may actually prevent moms from sticking with breast-feeding for six months — the duration thought to be most healthful for babies. (Doucleef, 10/6)

Reuters: More U.S. Women May Get IUDs Right After Giving Birth
For new mothers in the U.S. who receive government-sponsored health insurance, it’s becoming easier to get intrauterine devices (IUDs) implanted immediately after giving birth, a study found. “Immediate insertion is associated with more women who want an IUD implant actually getting it, higher use at three months postpartum, and lower rates of unplanned rapid repeat pregnancies within 12 to 24 months of delivery,” said lead study author Dr. Michelle Moniz of the University of Michigan in Ann Arbor, in email to Reuters Health. “Furthermore, multiple analyses suggest that this strategy is cost-effective.” (Rapaport, 10/6)

CBS News: More Women Have Option For IUD Right After Giving Birth
Inserting an intrauterine device (IUD) or long-term contraceptive implant immediately after a woman delivers a baby may seem like an oddly-timed procedure. But more states are offering this option through their Medicaid programs, according to a new study published today in the journal Contraception. (Welch, 10/6)

Using Hip-Hop To Grab Teens' Attention: FDA Launches New Anti-Smoking Campaign

The agency says it's critical to find creative ways to target young people, especially in minority groups who traditionally have been at higher risk of becoming addicted to cigarettes.

The Washington Post: How The FDA Is Trying To Keep ‘Hip-Hop’ Teens From Smoking
Can the federal government do hip-hop? That's the goal of a new ad campaign from the Food and Drug Administration, which aims to embrace the attitude and style of "hip-hop culture" in an effort to dissuade young African Americans, Hispanics and other minority teenagers from smoking. The $128 million "Fresh Empire" campaign, funded by fees on the tobacco industry, will include television ads, local outreach efforts and events featuring DJs and musicians -- all intended to curb smoking among minority teenagers. (Dennis, 10/6)

The Associated Press: FDA's New Anti-Smoking Campaign Uses Hip-Hop To Target Youth
Government health officials are betting they can adapt the sounds, style and swagger of hip-hop culture to discourage young African Americans, Hispanics and other minority youths from using tobacco. ... FDA officials say research shows young people who identify with hip-hop are more likely to use cigarettes and other tobacco products than their peers. To be sure, hip-hop's origins as an anti-establishment, urban movement seem to clash with the federal government's buttoned-down image. But FDA officials predict they can convincingly pitch their message to hip-hop fans, based on focus group testing. (Perrone, 10/6)


Seniors Switch To Traditional Medicare Plans When More Serious Conditions Hit, Study Shows

In other Medicare news, the Pennsylvania Supreme Court hears the University of Pittsburgh Medical Center's appeal regarding in-network rates. Also, open enrollment begins Oct. 15, the GAO wants tougher Medicare Advantage oversight and beneficiaries face hurdles to getting hearing aids.

NPR: Seniors Tend To Quit Medicare Advantage When Health Declines
Senior citizens are switching from privately run insurance plans to traditional Medicare when they face serious, long-term health conditions, a study shows. Researchers at Brown University found that 17 percent of Medicare Advantage patients who entered nursing homes for long-term care chose to switch to traditional Medicare the following year. Only 3 percent of similar patients in Medicare made the decision to go to a private Medicare Advantage plan. (Kodjak, 10/6)

The Associated Press: Supreme Court Hears UPMC's Appeal Of Medicare Ruling
The University of Pittsburgh Medical Center asked the Pennsylvania Supreme Court on Tuesday to vacate a lower court's order forcing UPMC to maintain cheaper, in-network rates for Highmark Inc.'s 182,000 Medicare Advantage customers. Commonwealth Court Judge Dan Pellegrini ordered UPMC in May to maintain the cheaper rates through 2019 for Medicare Advantage subscribers who use UPMC's doctors and hospitals. His ruling came after UPMC tried to cancel its in-network contract with Highmark's Medicare Advantage plan. (Mandak, 10/6)

St. Louis Public Radio: Medicare Enrollment Starts This Month. Here's What You Need To Know
Open enrollment for Medicare starts this month, on Oct. 15, and closes Dec. 7. It is the only time of the year that plan beneficiaries have the ability to change their Medicare health and drug plans. Plan costs and coverage benefits seem to change almost as soon as they are enacted. Around 1700 people in the St. Louis area alone will be impacted by their Medicare Advantage plan not renewing their contract with Medicare, making open enrollment an important part of the year to pay attention to. (Moffitt, 10/6)

Connecticut Health I-Team: Medicare Advantage Plans Need Tougher Oversight, GAO Says
Federal investigators have found that Medicare officials rarely enforce rules for private insurance plans intended to make sure beneficiaries will be able to see a doctor when they need care. ... The report by the Government Accountability Office, the investigative arm of Congress, said that Medicare did not check provider networks to ensure that doctors were available to beneficiaries and cited Connecticut as a “case study” in what can go wrong. (Jaffe, 10/5)

The New York Times: The Hurdles To Getting Hearing Aids
But perhaps the more important reason people fail to get hearing aids when they are needed is the cost, which is rarely covered by insurance and not at all by Medicare, unless the device is for a child. Properly fitted, up-to-date digital aids for both ears, like those Dr. Hammel wears, cost thousands of dollars. (His were $5,600, which is fairly typical.) Many people, especially older people living on fixed incomes, can’t afford them and can’t understand why such a basic health need is overlooked by private and government insurance. (The same lack of insurance coverage is often true for eyeglasses, incidentally.) (Brody, 10/6)

Meanwhile, rules protecting home health care workers can go forward -

The Associated Press: Chief Justice Won't Delay Wage Rules For Home Care Workers
Supreme Court Chief Justice John Roberts won't hold up new Obama administration regulations that give overtime and minimum wage protections to nearly 2 million home health care workers. Roberts on Tuesday denied an emergency request from three home care industry trade groups that said the rules set to take effect Oct. 13 threaten irreparable harm to businesses that provide in-home care for the elderly and disabled. (10/6)

State Watch

State Highlights: Nev. Settles Case About Patient Dumping; Pa. Mandates Improved Mammograms

News outlets report on health issues in California, the District of Columbia, Florida, Kansas, Nevada, Ohio and Pennsylvania.

Reuters: Nevada Agrees To Pay San Francisco $400,000 Over Patient Dumping
Nevada has agreed to pay the city of San Francisco $400,000 to settle a lawsuit claiming that the state bused patients, many of them poor and mentally ill, from a Las Vegas hospital to the Bay Area without plans for their care, Governor Brian Sandoval's office said on Tuesday. The settlement, which must still be approved by the San Francisco Board of Supervisors and the Nevada Board of Examiners, includes attorneys' fees and a plan for better management and transfer of patients. (Skinner, 10/6)

The Philadelphia Inquirer: Pa. Mandates 3-D Mammogram Coverage
Women in Pennsylvania who undergo breast cancer screening with the latest advance, three-dimensional mammography, will not be charged extra for it. Gov. Wolf's office announced a new policy Monday under which insurers must cover all screening mammograms, including the 3-D versions, at no out-of-pocket cost to consumers. (McCullough, 10/6)

The Washington Post: Paid Family-Leave Proposal Arrives With Force Before D.C. Council
Dozens of supporters of a controversial proposal for the nation’s most generous family-leave law, including parents, small-business owners and union members, urged city lawmakers Tuesday to pass the measure supported by a majority of the D.C. Council. ... Seven of the council’s 13 members co-introduced the proposed law Tuesday that would give every D.C. resident as much as 16 weeks of paid family leave. (Davis, 10/6)

Kaiser Health News: Whistleblower Doctor Warns About Hospitals Hiring Physicians
There is a good chance that your once-independent doctor is now employed by a hospital. Dr. Michael Reilly, a Fort Lauderdale, Fla., orthopedic surgeon, does not believe this is good for physicians, patients or society. For years he watched Broward Health, a nonprofit Florida hospital system, hire community doctors, pay them millions and minutely track the revenue they generated from admissions, procedures and tests. ... Last month Broward Health agreed to pay $70 million to settle allegations that it engaged in 'improper financial relationships' with doctors under laws prohibiting kickbacks in return for patient referrals. (Hancock, 10/7)

The Associated Press: Inmates Help Other Prisoners Face Death In Hospice Program
[Scott] Abram is a counselor trained in a national ministry program who sees his volunteer work as part of his own growth. Behind bars [in Ohio] since the early 1990s for murder, he has gotten used to spending time with male prison friends as they die in rooms 205 or 206 on the second floor of the state's prison for chronically ill inmates. ... He is one of 15 male and female inmates trained in the program at Franklin Medical Center, a small prison just south of downtown Columbus that houses some of the state's sickest inmates, many of whom die there. (Welsh-Huggins, 10/6)

KQED: How U.S. Supreme Court Just Made It Tougher To Challenge California Vaccine Law
The U.S. Supreme Court will not hear a challenge to a requirement in New York state that all children be vaccinated before they can attend public school. The justices on Monday let stand lower court rulings that the policy does not violate the constitution. This decision matters in California, where a new law passed this summer requires virtually all schoolchildren to be vaccinated against a range of diseases in order to attend school. (Aliferis, 10/6)

The Kansas Health Institute News Service: State Delays Integration Of Medicaid Services
State officials announced Tuesday they will delay for six months a plan to consolidate Medicaid support services for Kansans with various disabilities. The leaders of the Kansas Department of Health and Environment and Kansas Department for Aging and Disability Services said they want to use the time to gather more information from people who would be affected by the changes. (Marso, 10/6)

The Milwaukee Journal-Sentinel: Sister's Death Fuels Man's Crusade Against Medical Malpractice
It has been 12 years since the death of his sister and Wade Ayer can't let go of the pain and frustration. Julie Ayer Rubenzer, 38, died in a Brookfield nursing home on Dec. 26, 2003, three months after she stopped breathing while undergoing breast implant surgery at a doctor's office in Florida. Records showed that Rubenzer received excessive amounts of the anesthetic propofol during surgery. The surgeon lost his medical license. ... Ayer said he believes he is on a mission to make medicine safer. (Glauber, 10/6)

The Columbus Post-Dispatch: Columbus Board Approves Plan To Add Health Clinics To Schools
Thousands of Columbus students on the South and Near East sides will have access to mini-clinics at their schools by this winter, allowing them to skip doctors’-office visits for treatment of a variety of common illnesses. The clinic plan was approved in an agreement between the school district and Nationwide Children’s Hospital at the school board meeting on Tuesday evening. (Bush, 10/7)

Editorials And Opinions

Viewpoints: Make Mental Health Issues A Public Health Mission; GOP And Planned Parenthood

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

Los Angeles Times: The Issue Isn't Mental Illness, It's Too-Easy Access To Firearms
The Centers for Disease Control and Prevention stands as one of the federal government's premier agencies for studying public health and the behaviors that affect it, such as the links between distracted driving (texting) and fatal motor vehicle accidents. So it stands to reason that the CDC would also research the public health issues surrounding gun violence. But it doesn't, under a de facto 20-year ban that the National Rifle Assn. got Congress to impose on taxpayer funding for such research. Yes, the organization that represents gun manufacturers and gun owners continues to convince lawmakers that the CDC should not study the effects of guns on public health. That's despite the fact that gun-related deaths — homicides, suicides and accidental shootings — exceed 30,000 a year, on par with those killed in motor vehicle accidents. (10/6)

USA Today: After Roseburg, Face Up To Mental Illness, Addiction
Nearly 10 years ago, I crashed my car into a barrier at the U.S. Capitol at 3 in the morning. The very next day, I began the process of trying to have a conversation about what it’s like to suffer from mental illness and addiction. Not everyone was in favor of me being open about all of this. Even my father, Sen. Ted Kennedy, didn’t really get it — at least not when it came to our own family, which shows that even the most committed, informed leaders on health care can still have old-school, unprocessed ideas about diseases of the brain. (Patrick J. Kennedy, 10/6)

The Washington Post: The War On Planned Parenthood
We got a taste of the GOP’s latest assault on women’s health when House Republicans hauled Planned Parenthood President Cecile Richards in front of a mostly-male hearing last week. Republican committee members compared Richards to a criminal. They expressed astonishment over her salary (which is comparable to those of other chief executives of large nonprofits). Rep. Jason Chaffetz (R-Utah) brandished a highly misleading chart from Americans United for Life that appeared to indicate — falsely — that Planned Parenthood performs more abortions than cancer screenings. ... What really demands attention are the lives currently hanging in the balance. Since 2011, states have enacted an astonishing 287 new restrictions on abortion access. One-and-a-half abortion clinics are closing every week. Last Wednesday, a Planned Parenthood clinic near Los Angeles was deliberately set on fire. These setbacks seriously hinder access to desperately-needed health services, especially for those without other options. (Katrina vanden Heuvel, 10/6)

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

The New York Times: Jerry Brown’s Personal Message On Assisted Suicide
Gov. Jerry Brown of California gave a deeply personal explanation on Monday for his decision to sign legislation allowing terminally ill patients to obtain a lethal dose of painkillers from a doctor to hasten their death. ... Governor Brown, a Democrat, said that he had carefully read the opposition materials presented by a number of doctors, religious leaders and champions of disability rights and had considered religious arguments that shortening one’s life is sinful. He also consulted with a Catholic bishop, two of his own doctors, and former classmates and friends, who took a variety of positions. In the end, he reflected on what he would want in the face of his own death. “I do not know what I would do if I were dying in prolonged and excruciating pain,” he wrote. “I am certain, however, that it would be a comfort to consider the options afforded by this bill. And I wouldn’t deny that right to others.” (Philip M. Boffey, 10/6)

The Wall Street Journal: The Tax-Smart Way To Use Health Savings Accounts
As open-enrollment season approaches, it’s time to consider how your health-insurance plan can help with not just your medical expenses, but your taxes as well. ... For tax year 2015, an HSA allows you to contribute up to $3,350 a year for individual coverage or $6,650 a year for family coverage to your account tax free. ... By contributing to your account over time, you are building a fund that you can use to pay your future medical expenses. You may not be able to continue contributing once you move to a different type of health insurance or qualify for Medicare, but the money you contributed up to that point will still be there ready for you to use. Any interest, dividends, or capital gains earned also remain tax-free as long as they stay in the account and are used for health-care expenses. (George Papadopoulos, 10/6)

The Winston-Salem Journal/Charlotte Observer: Aldona Wos Fallout Drags On At DHHS
It’s unfortunately not surprising to hear that a federal criminal grand jury is investigating expensive contracts for high-ranking employees at the state Department of Health and Human Services. It remains to be seen whether the spending spree during former DHHS Secretary Aldona Wos’ tenure was illegal. But it was definitely wasteful and wrong. The News & Observer reported last week that U.S. attorneys served subpoenas in July, demanding that DHHS turn over records related to employees including Wos, who resigned several days after the subpoenas were served; Les Merritt, a former state auditor who was hired to be the chief financial officer for DHHS’s mental-health division; Thomas L. Adams, who briefly served as chief of staff to Wos; Joe Hauck, who was a senior adviser to Wos; and Angeline Sligh, a former DHHS manager. (10/6)