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Here's today's health policy haiku:


Health plans … on or off
The marketplaces … there are
Big differences.

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Summaries Of The News:

Health Law Issues And Implementation

Dwindling Choices In Health Law Marketplace May Be Trickier Issue Than Spiking Premiums

Subsidies provide a safety net for most customers, but there's not a backup plan if insurers completely pulling out of the marketplace. Meanwhile, President Barack Obama paints a sunny picture of his signature law in the face of negative news about the premiums.

The Associated Press: Lack Of Choice In Health Insurance Markets A Growing Problem
Americans in the health insurance markets created by President Barack Obama's law will have less choice next year than any time since the program started, a new county-level analysis for The Associated Press has found. The analysis by AP and consulting firm Avalere Health found that about one-third of U.S. counties will have only one health marketplace insurer next year. That's more than 1,000 counties in 26 states — roughly double the number of counties in 2014, the first year of coverage through the program. (10/28)

The Hill: Obama: Most Will Be ‘Pleasantly Surprised’ By Health Plan Costs
President Obama said Thursday that most people will be “pleasantly surprised” by the cost of their health insurance plans this year despite the deluge of negative headlines about rising premiums. In a national call with healthcare groups and activists, the president painted a sunny outlook of ObamaCare as he sought to combat the tide of negative attention on his healthcare law this week. “The bottom line is most people are going to be pleasantly surprised by just how affordable their options are, if we can just get them to see for themselves,” Obama said, adding the vast majority of people would find plans that cost less than $75 per month with the help of tax credits. (Ferris, 10/27)

The Hill: White House Plans ObamaCare Push In Red States 
The White House is planning a major ObamaCare enrollment push in 11 states this fall, nearly all of which are led by GOP leaders who remain firmly opposed to the law. The administration is pouring resources into 15 cities in 11 states, including Texas, Florida, North Carolina and Georgia, it announced Thursday. All but two of the states — Missouri and Pennsylvania — are led by Republican governors. In both of those states, however, Republicans are in control of both legislative chambers, which can constrain a governor’s office from actively promoting this year’s sign-up period. (Ferris, 10/27)

The Associated Press: Obama Says Health Consumers Need To Shop Around
President Barack Obama is telling workers and volunteers signing up customers for health insurance coverage that the enrollment season comes at a critical time in the Affordable Care Act's history. In a conference call, Obama is challenging workers to ensure the insurance program is in a position of strength when the next president comes into office. (10/27)

Reuters: Obama Rallies Obamacare Troops At 'Critical Time' For Program
President Barack Obama on Thursday urged more than 25,000 volunteers and advocates who dialed in to a White House conference call to pull out the stops to boost the number of people signing up for Obamacare health insurance plans. Obama warned it will be challenging to overcome the skepticism about the plans given an onslaught of headlines about surging premium prices, but he said the stakes are high. (Rampton, 10/27)

Meanwhile, an analysis looks at the difference between plans sold on and off the health law exchanges —

Governor Suggests Rebate Plan As Minn.'s Exchange Crisis Fans Political Tensions

Minnesota Gov. Mark Dayton proposes a state-funded rebate to help offset the spiking premiums facing the state's residents. Media outlets also report on developments in Maryland, Connecticut and California.

Pioneer Press: Dayton Offers Rebate Plan For MN Health Insurance Costs
Just one day after Republican House Speaker Kurt Daudt said Dayton was “literally playing politics” over health care, Dayton said Republicans “are now trying to maximize their political advantages” by attacking the Affordable Care Act. The battle matters given the current divided control of the Legislature. Even if one party takes both chambers in the Nov. 8 election, the current body of lawmakers will remain in office for the remainder of the year — and all sides agree a solution can’t wait until January. (Montgomery, 10/27)

Politico Pro: Minnesota Governor Proposes 25 Percent Rebate To Cushion Rate Hikes 
Minnesota Gov. Mark Dayton is proposing that the state fund a 25 percent rebate to blunt rate hikes for Obamacare customers who don't qualify for federal premium subsidies. Roughly 123,000 Minnesotans who are expected to purchase individual market coverage next year would qualify for the state assistance, according to a new fact sheet outlining the governor’s proposal. The rebate program would reduce average rate increases in Minnesota from 55 percent to 16 percent, Dayton's office said. (Pradhan, 10/27)

The Associated Press: Maryland Among Fairly Robust States In Health Reform Choices
Maryland consumers next year will have more choices than consumers in many other states in health insurance markets created by President Barack Obama’s 2014 health care overhaul, an analysis for The Associated Press shows. The county-by-county analysis by Avalere Health, a consulting and data-crunching company that has tracked the Affordable Care Act commonly known as Obamacare since its start, finds Maryland among nine states that will have three or more participating insurers in its counties. (Witte, 10/28)

The CT Mirror: As ACA Faces New Challenges, Fixes Not Assured
The Affordable Care Act is facing more challenges than at any time since its glitch-riddled initial enrollment period in 2013, and political prospects for returning it to better health are cloudy. Open enrollment will begin on Nov. 1, but many of those signing up will face higher premiums and fewer choices of plans and insurers. Those problems have re-energized GOP opposition to the ACA, creating a politically fraught climate in which to address the health care law’s challenges. In Connecticut, premium rate hikes for people buying insurance on the ACA’s exchange, Access Health CT, will rise nearly 25 percent on average. (Radelat, 10/28)

The Hour: As Open Enrollment Arrives For Health Insurance, Connecticut Rates All Over The Map 
As open enrollment season arrives for the large majority of Connecticut residents, many — though not all — will be presented with a menu of unappealing choices from their employers or health insurance carriers, in the form of escalating rates and deductibles or dwindling choices for health services. How large those changes will be depends to a large degree on the individual and they plan in which they are enrolled. As of Thursday, the Connecticut Insurance Department has approved health premium rate increases averaging out at 24.8 percent for individual plans and 12 percent for small group plans. (Soule, 10/27)

California Healthline: Reduce Your Obamacare Sticker Shock
The past few weeks have been scary ones for consumers with Obamacare health plans. As if open enrollment weren’t stressful enough, they’ve also been bombarded with headlines about 2017 rate hikes of 25 percent, 50 percent or even more. But there’s some hope for Californians. Our rate increases, while high by our standards, are generally lower than in other states. And if you’re willing to be flexible, most of you can limit your premium increases to no more than 5 percent. (Bazar, 10/28)

Meanwhile, a new report looks at the number of uninsured children under the health law —

Texas Tribune: Texas Continues To Struggle With Large Number Of Uninsured Children
Even as the share of children in Texas without health insurance continues to decline, the state still has nearly twice the national average, according to a new study. A Georgetown University Center for Children and Families report released Thursday found that Texas still ranks second-worst in the nation for uninsured children, even though the rate of Texas kids without insurance decreased from 16.6 percent in 2009 to 9.5 percent in 2015. The national average was 4.8 percent in 2015. Researchers, working from U.S. Census data, found almost one in five uninsured children in the United States live in Texas — 682,000 as of 2014. Only Alaska ranked worse. (Evans, 10/28)

Columbus Dispatch: Medicaid Expansion Credited For Getting A Record Number Of Kids Insurance In Ohio 
More than 95 percent of Ohio children have health coverage as the uninsured rate fell to historic lows in the wake of Obamacare. A new report from the Georgetown University Center for Children and Families credits Medicaid expansion under the Affordable Care Act for the decline in uninsured children. In Ohio, 26,000 children gained coverage between 2013 and 2015, the analysis showed, leaving an estimated 115,000 younger than 19 without health insurance. The state’s rate of uninsured children during that time fell to 4.4 percent, down from 5.3 percent, and just under the national average. (Candisky, 10/28)

Campaign 2016

Clinton Promises To Fix Obamacare If She Wins, But Her Proposals Face Long Odds In Congress

The candidate's suggestions to improve the health law are anathema to congressional Republicans.

Bloomberg: Democrats Face Difficult Obamacare Fight In 2017, Even If Clinton Wins 
After news broke Monday that premiums for the Affordable Care Act will rise an average of 22 percent next year, Democratic presidential nominee Hillary Clinton spent the week defending the healthcare law, saying its problems are fixable. She called for lowering the Medicare buy-in age and again advocated for a so called public option — a government-run competitor to private insurers. While polls show her leading Republican Donald Trump with just 10 days to go before the election, a Clinton administration likely would find itself caught between liberal lawmakers wedded to the politically unviable public option and Republicans who want to scrap the law entirely. (John, 10/28)

The Hill: Clinton Faces New Challenges On ObamaCare 
Responding to the uproar over ObamaCare premium hikes, Hillary Clinton on Tuesday promised: “We’re going to make changes to fix problems like that.” The question is: What changes could actually get through Congress? Both parties agree that ObamaCare has problems. Premiums are rising sharply, and the pool of enrollees is smaller and sicker than expected. (Sullivan, 10/27)

In other 2016 election news —

The Washington Post Fact Checker: Trump’s Claim That He Predicted That Obamacare ‘Can’t Work’
After the fact, Trump often likes to claim he had great foresight. But then it turns out there is slim evidence to back up his assertions. ... So this made us wonder when Trump started to claim that he warned against the structure of the Affordable Care Act when it was passed in 2010. As he put it, he claimed that “the concept is no good” and that “it’s going to be a disaster” and that he knew the premiums were going to soar. Is that remotely true? (Kessler, 10/28)

The Hill: Poll: Top Healthcare Priority Is Drug Prices, Not ObamaCare 
High drug prices, not ObamaCare, are the public’s top healthcare priority, according to a new poll released Thursday. The poll from The Henry J. Kaiser Family Foundation finds that 74 percent of the public lists making sure high-cost drugs are affordable as a healthcare priority for the next President and Congress. (Sullivan, 10/27)


Pentagon Paid Millions More Buying EpiPens At Retail Prices

The Defense Department gets a discount on EpiPens dispensed at military treatment facilities and by mail order, but nearly half of its spending was at retail pharmacies where it most recently paid an average of $509 for EpiPen and $528 for EpiPen Jr two-packs. In total, the Pentagon paid about $54 million more than it should have from 2009 to 2016.

Reuters: EpiPen Price Hikes Add Millions To Pentagon Costs
Mylan NV's price hikes on EpiPens have added millions to U.S. Department of Defense spending since 2008 as the agency covered more prescriptions for the lifesaving allergy shot at near retail prices, government data provided to Reuters shows. Pentagon spending rose to $57 million over the past year from $9 million in 2008 - an increase driven both by volume and by price hikes that had a bigger bite on prescriptions filled at retail pharmacies, according to the previously unreported data. (10/28)

Reuters: Mylan EpiPen: One Piece Of A Complicated U.S. Pricing System
The complex U.S. system for drug pricing creates wide variation in what people pay for the same prescription medications, such as Mylan NV's EpiPen. A Reuters review of government data found that Mylan's price hikes on the lifesaving allergy shot have increased spending for the U.S. Defense Department, based on its arrangements for covering drug costs. Here's how drug pricing works for different constituencies. (10/28)

In other news about the EpiPen-maker —

Stat: FTC Seeks Review Of A Court Ruling On Generic Drug Competition
A four-year-old case is now lodged in a federal appeals court in Philadelphia where Mylan Pharmaceuticals — and the agency — are urging a review of an example of product hopping. The term is used to describe modest reformulations that are made to a medicine, but without offering any substantive therapeutic advantages. Generic companies say such moves are a subterfuge designed to extend patents. Brand-name drug makers maintain such improvements are legitimate. In this instance, Warner-Chilcott, which is now owned by Allergan, added a line, or “score,” to its Doryx acne tablets. The company has contended that scoring served a useful consumer purpose by allowing patients to more easily divide their pills. (Silverman, 10/27)

Pepsi Joins Effort to Make TB Medication Sweeter And Easier To Swallow For Kids

In other pharma news: what would a big election win for Democrats mean for the biotech industry; a Cuban lung-cancer vaccine gets its first U.S. clinical trial; and AstraZeneca halts enrollment into two trials for a head and neck-cancer treatment while it investigates bleeding in some patients.

The New York Times: Can A Spoonful From Pepsi Help The Medicine Go Down?
PepsiCo is using its expertise to help make medication more palatable for children. The giant food and beverage company, whose original soda was concocted by a pharmacist using sugar, lemon oil and nutmeg, is returning to its roots by deploying its vast research and development operation to improve the taste of tuberculosis drugs. (Strom, 10/27)

Boston Globe: Biotech Stocks Down On Worries That A Sweep By Democrats Would Bring More Regulation 
Political jitters have fueled a sell-off in biotechnology shares in recent weeks as investors weigh the growing prospects of a Democratic sweep in the coming election that could bring heavier regulation for the industry, including restrictions on prescription drug prices. In a note to investors this week, biotech analyst Geoffrey C. Porges estimated that escalating market fears over the prospect of Democrats controlling Congress and the White House has shaved about $50 billion off the value of biotech companies since Oct. 7. That’s when a video was made public that showed Republican presidential candidate Donald J. Trump in 2005 using graphic language to boast about groping women. (Weisman, 10/27)

The Washington Post: In A First, U.S. Trial To Test Cuban Lung-Cancer Vaccine
The Food and Drug Administration has approved the first clinical trial to test a Cuban drug in the United States — a lung-cancer vaccine developed in Havana. The decision on the early-stage trial was announced Wednesday by New York Gov. Andrew Cuomo (D) and officials at the Roswell Park Cancer Institute, based in Buffalo. The trial could start as soon as next month and will enroll 60 to 90 patients. It is likely to take three years to complete. (McGinley, 10/27)

Capitol Hill Watch

Call To Address High Drug Prices Threatens Passage Of Cures Bill

“There is no justification for moving forward with legislation that provides substantial benefits to the drug industry without asking for something in return," liberal groups wrote to the House Energy and Commerce Committee. It's unlikely, though, that Republicans would agree to such additions.

The Hill: Cures Bill In Jeopardy Amid Drug Pricing Push
A medical cures bill is in jeopardy following congressional Democrats’ push for it to address high drug prices. A coalition of liberal groups has come out against passage of the measure this year, further putting its future in doubt.  A spokesperson for Democrats on the House Energy and Commerce Committee released a statement Thursday saying the bill, known as 21st Century Cures, “must include” policies to address high drug prices, raising questions about whether Republicans would agree to such additions and help pass the bill this year. (Sullivan, 10/27)

Morning Consult: House Democrats Still Working Toward Agreement On Cures
House Democrats aren’t ruling out advancing medical innovation legislation before the end of the year after about a dozen left-learning groups this week urged them to delay the bill. “We continue to work closely with our Republican and Senate counterparts to find a way to proceed with a final Cures bill that Democrats can support,” a Democratic spokesman for the Energy and Commerce Committee said. “Any final bill must include policies that facilitate access to affordable drugs and do not exacerbate rising drug prices in this country while also allowing for innovation to help treat diseases.” “The final bill also must include Democratic funding priorities like the Vice President’s Cancer Moonshot program,” the spokesman added. (McIntire, 10/27)


Senators Release Bipartisan Plan To Revamp Medicare Coverage For Chronic Diseases

Treating chronic diseases accounts for 86 percent of the nation's health care spending so the senators' efforts to make Medicare policy more efficient could help both the patient and the budget. Also, federal officials are temporarily blocking more insurers from automatically switching customers to Medicare.

The Hill: Senators Unveil Bipartisan Medicare Reforms
A bipartisan group of senators on Thursday released a draft of legislation aimed at making Medicare more efficient and saving money in the long run. The proposal is the product of months of work by Senate Finance Committee Chairman Orrin Hatch (R-Utah) and the panel’s top Democrat, Sen. Ron Wyden (Ore.), as well as Sens. Mark Warner (D-Va.) and Johnny Isakson (R-Ga.). The bill, referred to as the Chronic Care Act, would expand or create a range of Medicare programs to make treatment of chronic conditions such as heart disease and diabetes more coordinated and cost-efficient. (Sullivan, 10/27)

Morning Consult: Senate’s Chronic Care Working Group Circulates Draft Bill
The discussion draft released Thursday focuses on increasing access to high-quality home care for patients with chronic conditions, advancing team-based care, expanding the use of technology in caring for these patients, improving identification of such patients, and empowering patients and caregivers to better coordinate care. (McIntire, 10/27)

Kaiser Health News: Medicare Bars New ‘Seamless Conversion’ Efforts For Some Seniors
The federal government is temporarily blocking more health insurance companies from automatically moving customers who become eligible for Medicare into Medicare Advantage plans while officials review the controversial practice. They also will issue rules soon for plans that already have permission to make these switches, known as “seamless conversion,” according to a memo from Michael Crochunis, acting director of the Medicare Enrollment and Appeals Group at the Centers for Medicare & Medicaid Services. (Jaffe, 10/28)


Aetna Reports Revenue Up As Medicare, Medicaid Plans Perform Well

But the insurer lowered its forecast because of membership declines in commercial policies and losses from its business on the health law marketplaces.

The Wall Street Journal: Aetna Revenue And Profit Rise
Aetna Inc. said revenue and profit rose in its latest quarter, but the insurer is still struggling with pressure in the Affordable Care Act business, which it will largely exit next year. Revenue grew in Aetna’s government business managing Medicare and Medicaid plans, which was partially offset by membership declines in commercial products. Profit rose on higher fees and other revenue in Aetna’s core health-insurance business and lower general and administrative costs. (Wilde Mathews and Hufford, 10/27)

The Associated Press: Aetna Tops Street 3Q Expectations, Narrows 2016 Forecast
Aetna's third-quarter earnings rose nearly 8 percent to top Wall Street forecasts, as growing government business and cost cutting countered higher costs from the health insurer's Affordable Care Act coverage. But the nation's third-largest insurer narrowed its 2016 forecast just below analyst expectations heading into the year's final months. (Murphy, 10/27)

Modern Healthcare: Aetna Profits Bolstered By Medicare, Medicaid. Insurer Confident Merger With Humana Will Close.
Membership gains in Medicare and Medicaid bolstered Aetna's third-quarter earnings, despite pressures stemming from its public exchange business. Aetna also stressed Thursday that it remains confident its multibillion-dollar merger with rival insurer Humana will close in 2017. Hartford, Conn.-based Aetna's third-quarter net income jumped 7.8% to $603.9 million compared with the same period in 2015, and revenue was up by 5.5% year over year, totaling $15.78 billion. (Livingston, 10/27)

And on another proposed insurance merger —

St. Louis Post Dispatch: Missouri Insurance Regulator Calls Public Hearing On Anthem-Cigna Merger
Missouri's top insurance regulator has scheduled a public hearing to review another mega-insurance tie-up, this time between Anthem Inc. and Cigna Corp. The public will have an opportunity to listen to officials with the Missouri Department of Insurance explain the reasoning behind the merger. And it will give the department the opportunity to question the insurance representatives and opponents about the merger and its effects. (Liss, 10/27)

Public Health And Education

Why Opioid Users Overdosing In Cars Is 'New Norm': They're More Likely To Survive

It's another day and there's another photo going viral of a woman who overdosed with her child in the backseat. Cops and other experts say it's a common scene because an overdose is more likely to be fatal at home where there's a chance no one would find them for days.

In other news on the epidemic —

New Hampshire Union Leader: Situated Between Two Major Cities, Merrimack Copes With Drug Overdoses
As communities throughout the Granite State continue to struggle with an unprecedented number of drug overdoses, Merrimack is no exception. Situated between two of the state’s largest cities — Manchester and Nashua — the problem is difficult to escape, said officer Christopher Dowling of the Merrimack Police Department. “As a police officer, I see the end result of addiction,” Dowling told members of the Greater Manchester and Nashua Board of Realtors, who gathered at the Merrimack Public Library this week to receive an update on the war against heroin. In 2015, there were 439 drug deaths reported in New Hampshire, which included 397 deaths associated with heroin and opioids, according to Dowling. (Houghton, 10/27)

He Had A Financial Plan For Retirement -- Then He Was Diagnosed With Alzheimer's

Not only can a diagnosis of dementia rock patients' financial security by forcing them out of the workforce early, but a common symptom is money problems -- such as not paying bills on time and giving away funds needed for living expenses.

The Washington Post: Facing Financial Reality When Early Dementia Is Diagnosed
Chuck McClatchey had a sound retirement plan. Already retired with pensions from two jobs — one as a U.S. Air Force master sergeant (E-7) and the other as an electrical operations superintendent for 20 years with the Arizona Department of Transportation — he landed another job with the state of Texas working on traffic signals and traffic intel systems. He moved to Fort Worth at age 61 with his partner Bobbie Duncan, and they spent $25,000 in savings on a fixer-upper house. His plan was to work until he was 70. (Hamilton, 10/27)

In other news on aging —

The Philadelphia Inquirer/ Why Are Urinary Tract Infections Such A Big Deal For The Elderly?
For many young women, urinary tract infections are an occasional annoyance. They cause a few painful hours and many trips to the bathroom, but are soon dispatched with medication. Why are urinary tract infections such a big deal for the elderly? But they are something else again for the elderly. They send millions of women - and men - to the hospital every year and can kill if infection spreads to the kidneys or blood. (Burling, 10/28)

Related News: For more KHN stories related to aging & improving care of older adults, check out our resource page.

If A Patient Knows It's A Placebo Will The Benefits Still Work?

Placebos have been shown to help ease pain and other symptoms, but doctors can't ethically prescribe them to patients. Some scientists want to rescue placebos from the "garbage pail" of clinical practice.

NPR: Placebos Can Work Even If You Know They're Placebos
Placebos can't cure diseases, but research suggests that they seem to bring some people relief from subjective symptoms, such as pain, nausea, anxiety and fatigue. But there's a reason your doctor isn't giving you a sugar pill and telling you it's a new wonder drug. The thinking has been that you need to actually believe that you're taking a real drug in order to see any benefits. And a doctor intentionally deceiving a patient is an ethical no-no. (Hobson, 10/27)

The New York Times: Sugar Pill Beats Two Drugs In Migraine Trial For Children
Neither of the two drugs used most frequently to prevent migraines in children is more effective than a sugar pill, according to a study published on Thursday in The New England Journal of Medicine. Researchers stopped the large trial early, saying the evidence was clear even though the drugs — the antidepressant amitriptyline and the epilepsy drug topiramate — had been shown to prevent migraines in adults. (Saint Louis, 10/27)

Her Daughter Was Scared Of Needles, So She Didn't Push For Flu Shot. It Was A Fatal Mistake.

One woman is trying to get the message out about the importance of flu shots after her child died, not wanting others to make the same mistake as she did. Meanwhile threats to public health often flourish in a bad economy.

The Washington Post: She Didn’t Think A Flu Shot Was Necessary — Until Her Daughter Died
Piper Lowery had a fever that soared to 105 degrees. It hurt for her to walk, and she was breathing heavily, her mother said. She was also bleeding from her nose and vomiting blood. On Jan. 16, just four days after she got sick, Piper collapsed in the parking lot of a children's hospital in Tacoma, Wash. By then, the H1N1 flu had already attacked her kidneys.Piper died shortly before 12:30 p.m. that day. She was 12 years old. (Guerra, 10/27)

Stat: Mosquitoes — And Diseases Like Zika — Flourish When Economies Tank
The news out of Puerto Rico is grim: Not only has the Zika virus infected nearly 25,000 people so far, including almost 1,700 pregnant women, but the US government has appointed a Financial Control Board to oversee the territory’s government spending as it tries to cope with a nosediving economy and crippling debt. With few job prospects, Puerto Ricans are leaving the island in droves, often abandoning their homes. A failing economy, empty homes, and the outbreak of Zika: The three are related. (Liebman, 10/28)

In other public health news —

Bloomberg: Americans Are Dying Faster. Millennials, Too 
The latest, best guesses for U.S. lifespans come from a study (PDF) released this month by the Society of Actuaries: The average 65-year-old American man should die a few months short of his 86th birthday, while the average 65-year-old woman gets an additional two years, barely missing age 88. This new data turns out to be a disappointment. Over the past several years, the health of Americans has deteriorated—particularly that of middle-aged non-Hispanic whites. Among the culprits are drug overdoses, suicide, alcohol poisoning, and liver disease, according to a Princeton University study issued in December. (Steverman, 10/28)

Stat: Smoking Machine Helps Researchers Study Lung Disease
It’s pretty hard to smoke at Harvard University unless you are a small rubber block full of lung cells at the Wyss Institute. Then, it’s totally OK, because it’s in the name of science. This block, called a lung-airway-on-a-chip, is connected to a respirator that mimics how humans smoke. It’s part of new technology created by Wyss researchers to study the effects of tobacco smoke and electronic cigarettes on lung cells. (Empinado, 10/27)

The Mercury News: How Does THC Make You High?
How does THC make you “high”? Here is an explanation from the National Institute on Drug Abuse: THC and other cannabinoid chemicals in marijuana are similar to chemicals that naturally occur in the body. These natural cannabinoids, such as “anandamide,” function as neurotransmitters because they send chemical messages between nerve cells throughout the nervous system. They affect brain areas that influence pleasure, memory, thinking, concentration, movement, coordination, and sensory and time perception.Because of this similarity, THC is able to attach to molecules called cannabinoid receptors on neurons in these brain areas and activate them, changing various mental and physical functions. (Krieger, 10/27)

Why Spending The Zika Money Isn't As Easy As It Seems

Marketplace looks at why allocating and spending the funds to fight the Zika virus is more complex than it would seem.

Health News Florida: Surgeon General Wants To Know How Miami-Dade Is Spending Zika Funds 
Florida’s Surgeon General wants to know how Miami-Dade County is spending state funds in combating the Zika virus. In a letter sent Wednesday to Miami-Dade officials, Dr. Celeste Phililp says the state has sent $12 million to the county to combat Zika and she wants to make sure the mosquito-control strategies have been effective. Philip requests a comprehensive report that details how effective efforts have been to kill mosquitoes that spread the virus. (Ochoa, 10/27)

Marketplace: The Complexities Of Funding The Fight Against The Zika Virus
The Zika virus spread through Brazil and other parts of South America, now it's in Puerto Rico and Florida. Congress took eight months to approve allocating $1.1 billion to help fight the outbreak. The head of the Centers for Disease Control asked for a pot of money to fight health emergencies just as FEMA has for natural disasters and terrorist attacks. But the situation is more complex than it seems. (Uhler, 10/27)

Health News Florida: Florida Reports 14 More Zika Cases 
With Miami-Dade County continuing to be hit hard, Florida health officials said Wednesday the state has added 14 cases of the mosquito-borne Zika virus. Nine of the additional cases involved the virus being transmitted in Miami-Dade, while four were "travel related," meaning people were infected elsewhere and brought the virus into the state. The Florida Department of Health said it has been unable to determine where exposure occurred in another new case because the person traveled to Miami and to an area out of state that has "widespread Zika transmission." (10/27)

Veterans' Health Care

In Kansas, Program To Give Vets Health Options Drives Up Hospital's Uncompensated Care Costs

In other related news, a one-day, free dental clinic for veterans in Florida filled up quickly.

Kansas Health Institute: Veterans Choice Expands Health Care Options, Creates Billing Confusion 
A program designed to ease access to health care for veterans has led to millions of dollars in uncompensated care for a Topeka hospital and paperwork snarls that have jeopardized the credit records of some Kansas veterans. Representatives of the U.S. Department of Veterans Affairs heard those comments and others during a town hall meeting on the Veterans Choice program Wednesday at the Colmery-O’Neil VA Medical Center in Topeka. The Veterans Choice program was born in 2014 out of a scandal at the Phoenix VA facility, where some veterans died while waiting for care. (Wingerter, 10/27)

Health News Florida: Free Dental Clinic For Veterans Already Full
A one-day, free dental clinic for military veterans will open its doors Friday to provide urgent care from root canals to tooth fillings. And there are no empty chairs. That’s because the second annual “Stars, Stripes and Smiles” event, organized by U.S. Rep. Gus Bilirakis (R-FL) and the West Pasco Dental Association, has already filled its allotted 75 slots. But veterans’ names are still being taken for a waiting list. (O"Brien, 10/27)

State Watch

Michigan Governor Vetoes Bills Designed To Repair Flaws In State's Medicaid Funding

The package of bills would have changed how Michigan raises funds to match federal dollars for Medicaid. Also, a look at how California's Medicaid program can make it difficult for patients with mental health issues to get adequate care.

Detroit News: Snyder Vetoes Health Funding Tax Reforms
Gov. Rick Snyder has vetoed a package of bills Thursday that would have overhauled how health insurers are taxed and shifted how the state’s health care program for low-income individuals is funded. The legislation would have ended a tax on health insurance claims assessments 18 months earlier than the tax’s termination planned under a measure the Legislature passed earlier this year. Snyder said in a statement that helped prompt the veto. (Gerstein, 10/27)

MLive: Gov. Snyder Vetoes Bills On Medicaid Matching Dollars
Gov. Rick Snyder on Thursday vetoed a package of bills that aimed to end the state's Health Insurance Claims Assessment and change how the state funds Medicaid matching dollars. ... Michigan does that now through a mix of the HICA and a Medicaid managed care use tax. But the federal government has signaled that the current Medicaid managed care use tax collects from too narrow of a base and will no longer be acceptable at the end of 2016. If Michigan does nothing, it could see its Medicaid payments reduced. (Lawler, 10/27)

California Healthline: Divided Mental Health Care System Can Strand Medi-Cal Patients In The Middle
For low-income Californians enrolled in the state’s Medi-Cal program, mental health care is divided. Managed care plans are responsible for covering people with mild to moderate conditions, while county mental health departments treat those with more serious illnesses. This means that if people have a serious mental illness and then stabilize, they are expected to switch providers, which doesn’t make sense and is not common practice in other areas of medicine, said Bill Walker, Kern County’s director of mental health. “We don’t do that with diabetes or high blood pressure,” he said. “But we do it with psychiatric issues.” (Gorman, 10/28)

State Highlights: Fla. Appeals Court Rejects Malpractice Damage Caps; Ill.'s Rush Hospital To Get Space-Age Command Center

Outlets report on health news from Florida, Illinois, Maryland, Ohio, District of Columbia, California, Tennessee, Georgia and Wisconsin.

Health News Florida: Appeals Court: Malpractice Damage Caps Unconstitutional 
As the Florida Supreme Court considers the issue in another case, an appeals court Wednesday ruled that limits on "non-economic" damages in medical-malpractice lawsuits are unconstitutional. The ruling by a panel of the 2nd District Court of Appeal in a Charlotte County case cited a 2015 decision by another appeals court in a Broward County case. The Supreme Court in June heard arguments in the Broward County case but has not ruled.Non-economic damages, which are awarded for issues such as pain and suffering, have long been controversial. (10/27)

Chicago Tribune: Rush Hospital Is Enlisting GE To Build A NASA-Style Mission Control 
Rush University Medical Center wanted to run its hospital more efficiently. So it’s taking a cue from NASA. The Chicago hospital is working with GE Healthcare Partners, an advisory firm within GE Healthcare, to build a “command center” that will use predictive analytics and big data to manage how patients come in, move around and leave the hospital. (Graham, 10/28)

The Baltimore Sun: At Local Forum, Health Care Experts Highlight Need For Targeted, Digital Care 
Howard County's local health initiatives must adapt as the national health care model shifts to more digital-friendly care and more patients struggle with chronic illnesses, according to local and state health care leaders and professionals. Nationwide, hospitals are grappling to meet the growing number of patients with chronic illnesses and embrace a health care model that brings care as quickly to patients as possible, said Rick Pollack, president of the American Hospital Association. (Waseem, 10/27)

Cleveland Plain Dealer: 19 Ohio Hospitals Sign On To Screen For Earliest Signs Of Child Abuse In Infants
Doctors and nurses at 19 Ohio hospitals, including four in Northeast Ohio, will soon receive training on how to screen for signs of child abuse in the state's most vulnerable residents — infants six months and younger. About one in 10 child abuse victims in Ohio have a record of an early injury that should have raised red flags and triggered followup care, but less than a third of children receive this care. Those are the findings of a coalition from Ohio's six major children's hospitals who have been studying how to cut down on repeat child abuse with the support of a $1 million grant from Ohio Attorney General Mike DeWine. (Zeltner, 10/27)

Health News Florida: Report: More Children Insured, But Florida Still Lagging Nationally
According to a new report, more children than ever before have health insurance. Florida joins 40 other states that insured more children between 2013 and 2015. The reports says that the positive trend in children’s health insurance coverage started with the expansion of Medicaid to more children, and the creation of the Children’s Health Insurance Program - known as CHIP. (Miller, 10/27)

The Associated Press: Jury Awards More Than $70M To Woman In Baby Powder Lawsuit
A St. Louis jury on Thursday awarded a California woman more than $70 million in her lawsuit alleging that years of using Johnson & Johnson's baby powder caused her cancer, the latest case raising concerns about the health ramifications of extended talcum powder use. The jury ruling ended the trial that began Sept. 26 in the case brought by Deborah Giannecchini of Modesto, California. She was diagnosed with ovarian cancer in 2012. The suit accused Johnson & Johnson of "negligent conduct" in making and marketing its baby powder. (10/27)

Modern Healthcare: CHS Stock Plummets Nearly 50% On Q3 Losses
Investor confidence in Community Health Systems plummeted Thursday as losses in the third quarter previewed by the [hospital chain] after the close of markets Wednesday caused its stock to fall nearly 50%. CHS' stock closed the day at $5.05 per share, down $4.98 per share or 49.65%.In a preview of third-quarter results to be announced next week, Franklin, Tenn.-based CHS on Wednesday reported a loss from continuing operations before income taxes of $83 million compared with income from continuing operations of $121 million in the third quarter of 2015. (Barkholz, 10/27)

Atlanta Journal Constitution: Gwinnett Tech Offers New Healthcare Certificate Program
Starting next spring, Gwinnett Tech's Alpharetta campus will offer a Patient Care Assistant Certificate program, school officials announced earlier this week. The program would last for one semester and provide students an avenue for hands-on healthcare experience through clinical training and in field labs like the Roswell Nursing and Rehabilitation Center, according to the school. Patient care assistants typically work in hospitals or nursing homes to give technical care to the sick and injured. (Cooper, 10/27)

Milwaukee Journal Sentinel: 3rd UW-Madison Student Hospitalized With Meningitis
A third University of Wisconsin-Madison student has been hospitalized with meningococcal disease, the university reported Thursday. The student's case of the disease comes about three weeks after two UW-Madison students were hospitalized with a rare, potentially deadly form of the disease. Those students are expected to make a full recovery, according to the university. (Angst, 10/27)

Health Policy Research

Research Roundup: Medicaid Efforts To Combat Tobacco; Premium Changes; Views On Drugs

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

Preventing Chronic Disease: How Medicaid and Other Public Policies Affect Use of Tobacco Cessation Therapy, United States, 2010–2014
State Medicaid programs can cover tobacco cessation therapies for millions of low-income smokers in the United States, but use of this benefit is low and varies widely by state. ... Medicaid policies that require patients to obtain counseling to get medications reduced the use of cessation medications by approximately one-quarter to one-third; states that cover all types of cessation medications increased usage by approximately one-quarter to one-third. Non-Medicaid policies did not have significant effects on use levels. ... States could increase efforts to quit by developing more comprehensive coverage and reducing barriers to coverage. (Ku et al., 10/27)

Health Affairs: Employer-Sponsored Insurance Offers: Largely Stable In 2014 Following ACA Implementation
Affordable Care Act provisions implemented in 2014 could have influenced employers’ decisions to offer health insurance. Using data for 2014 from the Medical Expenditure Panel Survey–Insurance Component, we found little change in employer-sponsored health insurance offerings: More than 95 percent of employers either continued offering coverage or continued not offering it between 2013 and 2014. Fewer than 3.5 percent of employers dropped coverage, and 1.1 percent added coverage. (Abraham, Royalty and Drake, 10/26)

The Kaiser Family Foundation: 2017 Premium Changes And Insurer Participation In The Affordable Care Act’s Health Insurance Marketplaces
We analyzed 2017 premiums and insurer participation made available through on October 24, 2017, as well as data collected from states that run their own exchange websites. ... In most parts of the country in 2016, a 40-year-old adult making $30,000 per year would pay about $208 per month for the second-lowest-silver plan. If this person is willing to switch to whatever the new second lowest-cost silver plan is in 2017, they will pay a similar amount (the after-tax credit payment for a similar person in 2017 is $207 per month or a change of 0%). ... Marketplace insurer participation in states using in 2017 ranges from 1 company in Alabama, Alaska, Oklahoma, South Carolina, and Wyoming, to 15 companies in Wisconsin. (Cox et al., 10/24)

Kaiser Family Foundation/Health Policy Institute, Georgetown University: Medicare Part D: A First Look At Prescription Drug Plans In 2017
This issue brief provides an overview of the 2017 PDP [Medicare prescription drug plan] marketplace, based on our analysis of data from the Centers for Medicare & Medicaid Services (CMS). Key findings include: The average monthly PDP premium in 2017 will increase by 9 percent from 2016, to $42.17 (weighted by 2016 plan enrollment). ... The average Part D PDP deductible is projected to rise by 7 percent. PDP premiums will continue to vary widely across plans in 2017, as in previous years. Among the ten PDPs with the highest enrollment, average premiums in 2017 will range from a low of $16.81 per month, or $202 annually, for the Humana Walmart Rx PDP to a high of $71.66 per month, or $860 annually, for the AARP Medicare Rx Preferred PDP — an annual premium difference of $658. (Hoadley, Cubanski and Neuman, 10/17)

American Economic Journal: Economic Policy: Financial Incentives, Hospital Care, And Health Outcomes: Evidence From Fair Pricing Laws
State laws that limit how much hospitals are paid by uninsured patients provide a unique opportunity to study how financial incentives of healthcare providers affect the care they deliver. We estimate the laws reduce payments from uninsured patients by 25–30 percent. Even though the uninsured represent a small portion of their business, hospitals respond by decreasing the amount of care delivered to these patients, without measurable effects on a broad set of quality metrics. The results show that hospitals can, and do, target care based on financial considerations, and suggest that altering provider financial incentives can generate more efficient care. (Batty and Ippolito, 10/25)

The New England Journal of Medicine: A Randomized Trial Of Long-Term Oxygen For COPD With Moderate Desaturation
In patients with stable COPD and resting or exercise-induced moderate desaturation, the prescription of long-term supplemental oxygen did not result in a longer time to death or first hospitalization than no long-term supplemental oxygen, nor did it provide sustained benefit with regard to any of the other measured outcomes. (The Long-Term Oxygen Treatment Trial Research Group, 10/27)

SAMSHA National Survey on Drug Use and Health Data Review: Risk And Protective Factors And Estimates Of Substance Use Initiation: Results From The 2015 National Survey On Drug Use And Health
This report presents results from the 2015 National Survey on Drug Use and Health (NSDUH) for people aged 12 or older regarding the perceived harmfulness of using cigarettes, alcohol, and specific illicit drugs and the perceived availability of substances. ... Although more than 3 out of 4 people aged 12 or older in 2015 perceived great risk of harm from weekly use of cocaine, heroin, or lysergic acid diethylamide (LSD), only about one third perceived great risk from weekly marijuana use. An estimated 68.7 percent of people also perceived great risk from having four or five drinks of alcohol nearly every day, and 72.8 percent perceived great risk from smoking one or more packs of cigarettes a day. Perceptions of risk from substance use varied across age groups. (Lipari et al., 10/25)

Urban Institute: Women Of Reproductive Age Lack Knowledge Of Zika Virus Transmission And Effects
Women of reproductive age are at the greatest risk of negative health effects from Zika virus, but current, nationally representative information on women’s knowledge about Zika is limited. This brief uses data from late-summer 2016 to explore women’s Zika awareness and concern, knowledge of Zika transmission modes, symptoms, and health effects, and actions taken to prevent Zika infection. The vast majority of women of reproductive age have knowledge gaps about Zika virus: more than half do not know that Zika can be sexually transmitted and less that one-third are aware that Zika can cause an infection with no symptoms. (Shartzer et al., 10/17)

Editorials And Opinions

Perspectives On Health Care On The Campaign Trail; N.C.'s Medicaid Expansion

Editorial and opinion writers offer views on a range of health care issues.

The New England Journal Of Medicine: Health Care In The 2016 Election — A View Through Voters’ Polarized Lenses
This article examines the potential effect of the 2016 election on the future of health policy in the United States. It brings together results from 14 national public opinion polls from various sources and as recently as September 2016 to address four broad questions: What is the mood of the country about health care issues as we approach the 2016 election? How do voters feel about the major health care policy issues likely to be debated after the election? How different are the health care policy views of Republican likely voters and Democratic likely voters? And what are the implications for future health care policy on the basis of the outcome of the presidential and congressional elections? (Robert J. Blendon, John M. Benson and Logan S. Casey, 10/27)

The Charlotte Observer: Poor Die Without N.C. Medicaid Expansion
Careful studies have long indicated North Carolina’s rejection of Medicaid expansion is extraordinarily costly. Not only does the state forgo tens of billions of federal health care dollars, hundreds of millions of state and local dollars in tax revenue, tens of thousands of jobs, hundreds of millions in savings for uncompensated hospital care, but, more directly, 463,000 low-income Tar Heels are denied health care coverage intended under expansion. (Gene Nichol, 10/27)

The New England Journal Of Medicine: Data Sharing — Is The Juice Worth The Squeeze?
The past few years have seen considerable interest in the sharing of patient-level data from clinical trials. There is a clear and logical “ethical and scientific imperative”for doing so, to permit activities ranging from verification of the original analysis to testing of new hypotheses. This interest has resulted in many publications and meetings, attention from the Institute of Medicine, proposed changes in journals’ policies, and enormous effort from pharmaceutical sponsors and other groups to provide access to patient-level data. It is critical that we learn from these early experiences as we move forward. (Brian L. Strom, Marc E. Buyse, John Hughes and Bartha M. Knoppers, 10/27)

Detroit Free Press: Will We See Action On State Flint Water Crisis Reports?
Where do we go from here? A bipartisan joint select committee on Flint has issued its report, and it's up to Gov. Rick Snyder and the Legislature that impaneled the committee to act. Not a blame-casting document, this report offers a slew of suggestions aimed at ensuring that another man-made crisis like the poisoning of Flint's water supply can't happen again. (10/27)

The New England Journal Of Medicine: Days Spent At Home — A Patient-Centered Goal And Outcome
Most measures of the quality of health care delivery focus on what health care providers do, not what patients want. If “high-value, patient-centered care” is to be more than rhetoric, health care organizations need to measure outcomes that matter to patients. Only when they do so will care be designed and organized in ways that improve those outcomes. (Adam C. Groff, Carrie H. Colla and Thomas H. Lee, 10/27)

Viewpoints: Obamacare Premium Hikes -- A Pothole? A Collapse? And How To Save It?

A selection of opinions and editorials from around the country.

The New York Times: Obamacare Hits A Pothole
For advocates of health reform, the story of the Affordable Care Act, a.k.a. Obamacare, has been a wild roller-coaster ride. First there was the legislative drama, with reform seemingly on the edge of collapse right up to the moment of passage. Then there was the initial mess with the website — followed by incredibly good news on enrollment and costs. Now reform has hit a pothole: After several years of coming in far below predictions, premiums on covered plans have shot up by more than 20 percent. So how bad is the picture? (Paul Krugman, 10/28)

The Washington Post: Higher Health-Insurance Premiums Don’t Mean The Affordable Care Act Is A Disaster
“The Affordable Care Act, known as Obamacare, it is not affordable. Premiums have gone up. Deductibles have gone up. Co-pays have gone up. Prescriptions have gone up.” That is what one questioner stated in the second presidential debate. As if to highlight this complaint, the Obama administration has just announced that premiums in the both federal and state ACA exchanges will increase an average of 22 percent for 2017. So the Affordable Care Act is a disaster, right? No. (Ezekiel Emanuel and Bob Kocher, 10/27)

Chicago Sun Times: The Predictable Obamacare House Of Cards Collapse 
Despite all those awful, pandering ads aimed at millennials in 2013 — you remember the ones, with college kids doing keg stands and shotskis? — people in the all-important 18-to-34 age range accounted for only 28 percent of exchange members in 2014, and that remained the case for 2016. This is well below the 40 percent level needed to create a stable rate market. The idea that young, healthy twentysomethings would purchase something they historically did not, just because Obama really wanted them to, was always going to be the true test of the ACA. And not surprisingly, lack of millennial participation is now the program’s canary in a coal mine. (S.E. Cupp, 10/27)

USA Today: Obamacare's Shocking Premium Hikes
Jill: As usual, bad news is giving conservatives an excuse to use health policy as a weapon of political war and once again call for the electric chair for the 2010 law with two unfortunate names. ... David: I am glad you acknowledge that bad news is the “usual” for Obamacare. Let’s dispense with this 20 million number first. The majority of those who gained health insurance coverage were added to Medicaid. That's not health care “reform;” it is spending. The second largest group, as many as 6 million, are young adults now covered under their parents’ plan until they turn 26. That is just cynically telling young people they are getting something for free when everyone else with insurance is paying for it. (David Mastio and Jill Lawrence, 10/27)

Boston Globe: The Freakout Over The Rise In Obamacare Plan Premiums
On Tuesday, however, the federal government announced that premiums on Obamacare plans will increase next year by 25 percent . . . and the political world lost its collective mind. Here was yet another opportunity for Republicans to bash the law they opposed en masse and have tried for six years to repeal. Media organizations, particularly CNN, were happy to pile on, dredging up old clips of President Obama promising that if you liked your doctor you could keep him and suggesting that the latest bad news story on Obamacare highlights the law’s allegedly abundant failures. Lost in this storm of bad faith attacks were some rather salient facts. (Michael A. Cohen, 10/27)

The New York Times: The Best Way To Save Obamacare
The Affordable Care Act has faced a rocky six months. First, major national insurers scaled back their participation, leaving about one in five people buying coverage through health exchanges with only one plan to choose from. Then this week, the Obama administration announced that exchange plans would post an average premium increase of more than 20 percent (though most enrollees would be insulated from the full increase by subsidies for their coverage). (Jacob S. Hacker, 10/27)

Bloomberg: Clinton To The Rescue Of Obamacare 
The Affordable Care Act isn’t all that affordable, it turns out. Less than two weeks before Election Day, Obamacare’s woes have become a weapon in the hands of Donald Trump and down-ticket Republicans. Hillary Clinton is left saying the problems are real, but fixable. Just tack on a public option, and Obamacare will be good as new. If she is elected and pushes for a public option, in which individuals purchase a Medicare-like plan on state marketplaces, she could face another HillaryCare fiasco -- not just because it won’t fly politically, but because it’s the wrong policy. (Paula Dwyer, 10/27)

The New England Journal Of Medicine: Disentangling The ACA’s Coverage Effects — Lessons For Policymakers
Since the passage of the Affordable Care Act (ACA), an estimated 20 million Americans have gained health insurance, and the country’s uninsured rate has dropped from 16% to 9% since 2010. ... Understanding how the law has achieved these coverage changes is critical to evaluating its progress. The primary ACA tools that took effect in 2014 are by now familiar: the expansion of Medicaid (made optional for states by the Supreme Court in 2012), the availability of tax credits to help consumers purchase coverage on the new health insurance exchanges, and the implementation of an individual requirement to purchase health insurance or pay a tax penalty (the individual mandate). Since 2010, the ACA has also allowed young adults to stay on their parents’ health plan through 26 years of age. ... what is less clear is how these different pieces of the law have fit together to produce these changes. (Molly Frean, Jonathan Gruber and Benjamin D. Sommers, 10/27)

Forbes: Another Obamacare Problem: Mass Insurer Exit Diminishes Consumer Choice
President Obama promised that the Affordable Care Act (ACA) would increase competition and choice in insurance markets. In a 2009 speech to a joint session of Congress, for example, the president said, “Individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers.” This claim, along with many others made by ACA supporters, have proven to be wrong. In fact, Americans have far fewer choices for individual market coverage today than they had before the ACA took effect and there is a rapidly declining number of insurers now offering coverage in the ACA exchanges. (Brian Blase, 10/27)