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Political Cartoon: ‘Spoonful Of Sugar?’

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: ‘Spoonful Of Sugar?’" by Dan Piraro.

Here's today's health policy haiku:

OBAMACARE'S FUTURE

Repeal or replace
Didn’t work. GOP’s new
Plan: malign neglect.

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Summaries Of The News:

Health Law

GOP Says It's Close On Graham-Cassidy Bill, But Those Last Votes Have Always Been A Struggle

The measure from Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) is the party's last-ditch effort to repeal and replace the Affordable Care Act. And while Cassidy says he thinks he has about 48 or 49 votes, that still isn't enough to pass it.

The Wall Street Journal: Republicans Say Push To End Obamacare Gathers Support
A group of Republicans making a final push to topple the Affordable Care Act say they have almost enough votes in the Senate to pass their bill. Sen. Bill Cassidy (R., La.) told reporters Friday that he believes 48 or 49 GOP Senators support the bill. Fewer have publicly committed to the legislation, and it remains unclear if it has the momentum supporters claim. (Armour and Hackman, 9/15)

The Hill: Senator Says He Nearly Has The Votes For ObamaCare Repeal
The problem for Senate Republicans when it comes to ObamaCare repeal has always been getting the final few votes to put them over the top. The repeal legislation that failed in July got 49 votes, but fell short because three GOP senators bucked leadership and voted no. There is an extremely short window to pass the bill before a procedural deadline of Sept. 30. Sen. Rand Paul (R-Ky.) on Friday announced his opposition, saying the bill kept too much of ObamaCare. (Sullivan, 9/15)

Politico: Senate GOP Tries One Last Time To Repeal Obamacare
Right now, support for the bill — which would replace Obamacare’s tax subsidies with block grants, end the law’s individual insurance mandate and scale back its Medicaid expansion — among Republican senators is short of 50 votes. But McConnell and his lieutenants will gauge support this week in private party meetings with help from President Donald Trump, administration and Capitol Hill sources said. “McConnell and his team are engaged and serious about the vote and working with the conference to build support for Graham-Cassidy,” a source familiar with the bill’s prospects said Sunday. The “White House is also operating with all hands on deck.” (Everett and Dawsey, 9/17)

The Hill: Paul, Cassidy Tweet Back And Forth On ObamaCare Repeal Bill 
Sen. Rand Paul (R-Ky.) on Friday shot down an attempt by Sen. Bill Cassidy (R-La.) to win over his support for a last-ditch plan to repeal and replace ObamaCare, arguing that the measure keeps too much of former President Obama's signature health care law. In a brief exchange on Twitter that began with Paul accusing Cassidy's measure of being "Obamacare Lite," Cassidy argued that the bill would repeal the Affordable Care Act's "entire architecture," and offered to go over the legislation with the Kentucky senator. (Greenwood, 9/15)

The Hill: Dems Call For Action Against Cassidy-Graham ObamaCare Repeal 
Democratic senators are reigniting their calls to fight against another Republican healthcare push that aims to repeal and replace ObamaCare after reports surfaced that President Trump and GOP leaders are working to garner support for Cassidy-Graham legislation. Prominent upper chamber lawmakers like Sens. Elizabeth Warren (D-Mass.), Dianne Feinstein (D-Calif.), and Chris Murphy (D-Conn.) are taking to Twitter to make impassioned calls for voters to speak up and demonstrate their opposition to the bill. (Beavers, 9/17)

The Hill: Hospital Group Comes Out Against New ObamaCare Repeal Effort
America’s Essential Hospitals announced its opposition to a new ObamaCare repeal and replace bill, warning of cuts and coverage losses. The group, which represents hospitals that treat a high share of low-income people, said it is opposed to a last-ditch bill to repeal ObamaCare from Sens. Bill Cassidy (R-La.), Lindsey Graham (R-S.C.), Dean Heller (R-Nev.) and Ron Johnson (R-Wis.). (Sullivan, 9/15)

Meanwhile —

Politico: 2 GOP Heavyweights Brawl Over Obamacare Bill
As if Sen. Lamar Alexander didn’t face enough difficulties trying to craft a bipartisan bill to shore up Obamacare, he’s taking hostile fire from one of his most powerful Republican colleagues — the other health care chairman. Alexander is “stealing our jurisdiction,” Senate Finance Chairman Sen. Orrin Hatch told POLITICO, referring to the turf split between his panel and Alexander’s HELP Committee. “It’s pretty hard to get excited about what he’s doing.” (Haberkorn, 9/17)

Stateline: Why The Unpopular Individual Mandate Is Likely To Endure (For Now)
The Affordable Care Act’s requirement that Americans either carry health insurance or pay a fine remains the law’s most unpopular feature. Nevertheless, a bipartisan group of governors is insisting that the so-called individual mandate remain in place — at least for now. In a letter sent late last month, the governors urged federal lawmakers to retain the mandate to help stabilize insurance markets. But the group, which is led by Republican John Kasich of Ohio and Democrat John Hickenlooper of Colorado, also said states should be given the opportunity to devise “a workable alternative” to it, subject to federal approval. (Ollove, 9/15)

Columbus Dispatch: Kasich-Backed Plan To Fix Obamacare Still Stands A Chance
With all the attention this week on the Republicans’ last desperate push to overturn Obamacare and Sen. Bernie Sanders’ new single-payer bill that’s going nowhere, has the bipartisan health-care effort backed by Gov. John Kasich fallen by the wayside? Quite the contrary, several analysts say. (Rowland, 9/15)

Anthem Reverses Course, Will Sell Plans On Individual Marketplace In Virginia

So far efforts to keep any county from being "bare" under the law have been successful. Meanwhile, Affordable Care Act navigators brace for deep budget cuts.

Reuters: Anthem To Sell Obamacare Health Plans In Virginia Counties That Don't Offer Them
U.S. health insurer Anthem Inc said on Friday it plans to sell Obamacare health plans in 68 cities and counties in Virginia next year, covering the only remaining U.S. counties that are currently without insurers offering the plans. Anthem said last month it was exiting the Obamacare market in the state, but reconsidered the move after no other insurer stepped up to cover most of Virginia's counties. (Erman and Humer, 9/15)

The Hill: Insurer Anthem To Cover Bare ObamaCare Counties In Virginia 
"Since learning that 63 counties and cities in Virginia would not have access to Individual health plans, Anthem has been engaged in further evaluation and discussion with regulators to ensure that no bare counties or cities exist in the state," Anthem said in a statement Friday. (Hellmann, 9/15)

Richmond Times-Dispatch: Anthem Steps Back Into Individual Health Insurance Market In 68 Localities: Premiums To Rise 42 To 64 Percent
The monthly premiums for the new plans will increase by 42 to 64 percent, according to the company’s amended rate filing with the Bureau of Insurance. Those increases reflect higher medical costs and consumer use of services, as well as the expected return of a health insurance fee on Jan. 1. Before Anthem withdrew from the market, it had applied for premium increases ranging from 35 to 55 percent. (Martz, 9/15)

The Wall Street Journal: Anthem Reverses Decision To Pull Out Of ACA Exchange In Virginia
The decision is the latest twist in a continuing drama that has played out in states around the country, with state officials repeatedly—and, so far, successfully—scrambling to land insurers for potential bare patches on their ACA exchange maps. In addition to Virginia, states including Nevada, Ohio and Tennessee have managed to woo and cajole insurers to come in, after others decided to pull out, often citing uncertainty at the federal level about key aspects of the law. (Wilde Mathews, 9/15)

Detroit Free Press: Michigan's Obamacare Outreach Groups See Funding Slashed
The Trump administration is slashing funding for two organizations in Michigan that help residents navigate the complexities of signing up for and receiving benefits under the Affordable Care Act less than two months before enrollment begins. U.S. Rep. Sandy Levin, D-Royal Oak, said this morning that Enroll Michigan, which provides funding to more than two dozen groups providing sign-up assistance, has been told its grant will be cut by 90%, from $1.2 million to less than $130,000 this year. (Spangler, 9/15)

Orlando Sentinel: Despite Cuts, Obamacare Navigators Gear Up For Nov. 1
The Trump administration cut the Affordable Care Act’s advertising budget, shortened the enrollment period to six weeks and reduced outreach by cutting the funding for in-person assisters. The U.S. Congressional Budget Office’s latest outlook projects an average 15 percent nationwide increase in premiums next year, although that won’t affect consumers who receive subsidies, which is the majority of enrollees in Florida. (Miller, 9/15)

And in other news —

Pioneer Press: Feds Still Considering Minnesota Proposal To Lower Insurance Rates As Time Running Out
Minnesota’s plan to lower health insurance premiums next year had just one little complication, but it’s threatening to turn into a big complication: It requires approval from the federal government. And with time running out, that approval still isn’t here. The $542 million proposal, called “reinsurance,” would keep premiums around 20 percentage points lower next year on the individual market than they’d otherwise be. That’s where the estimated 4 percent of Minnesotans without employer or government coverage get their insurance. But if the federal government doesn’t approve the plan — or waits too long to do so — many Minnesotans could pay thousands more per year for their coverage. (Montgomery, 9/18)

Nashville Tennessean: What's It Like To Be A Christian Scientist When The Country Is Laser Focused On Health Insurance?
Although they are free to seek medical care, many Christian Scientists do not. Still, the Affordable Care Act affects them. Unlike the Amish and some Mennonites, they are required under Obamacare's individual mandate to either buy health insurance or pay an annual tax penalty. The Boston-based denomination, which includes 1,400 churches worldwide and eight in Tennessee, lobbied for an exemption, but the effort failed.  (Meyer, 9/15)

Quality

Following Tragedy, Nursing Home Vows It Sought Urgent Help Which Contradicts State Officials' Story

One of the executives of the facility where eight residents died in the wake of the hurricane said she repeatedly called a special number given out to nursing homes that needed urgent help, and yet no one came. Meanwhile, Gov. Rick Scott has suspended the home from the state's Medicaid program and announced new safety rules for facilities this weekend.

The Washington Post: ‘Waiting For Help That Never Came’: Fla. Nursing Home Where Eight Died After Irma Defends Actions, Says It Called Governor For Help
The night before Hurricane Irma began roaring over Florida, staffers at the Rehabilitation Center at Hollywood Hills locked the doors, shuttered the windows and turned the temperature down to about 67 degrees — a buffer, administrators thought, to keep the building cool in case the power went out. It wouldn’t last long. About 3 p.m. on Sunday, the lights flickered, nursing-home executives say. The power stayed on, but a janitor soon noticed a problem: The massive chiller used to serve the 152-bed facility was spewing warm, muggy air. (Davis, Zezima and Berman, 9/15)

The Wall Street Journal: Visitors Tell Of Extreme Heat At Florida Nursing Home After Eight Deaths
In the sweltering Florida heat Tuesday afternoon, 84-year-old Betty Hibbard sat on her bed, in a second-floor hallway of the nursing home where she lived, wearing an institutional gown near an air blower. Ms. Hibbard was hot and struggling to breathe, according to her friend Jean Johnson, who visited. Ms. Johnson stayed with her for an hour and gave her friend a cold can of Coca-Cola before she left at about 5:30 p.m. (Kamp, Evans and Campo-Flores, 9/15)

Reuters: Florida Governor Orders Removal Of Nursing Home From Medicaid After Eight Died
Florida's healthcare agency ordered a Miami-area nursing home suspended from the state Medicaid program on Thursday after eight elderly patients there were exposed to sweltering heat in the aftermath of Hurricane Irma and died. More than 140 residents of the Rehabilitation Center at Hollywood Hills were evacuated on Wednesday after fire and rescue crews and medical staff from a nearby hospital found many of the facility's residents suffering from dehydration, heat stress and breathing difficulties. (Dobuzinskis, 9/15)

The Hill: Florida Governor Issues Emergency Rules For Nursing Homes After Hurricane Deaths 
Florida Gov. Rick Scott (R) on Saturday announced that he was directing all nursing homes in the state to purchase generators for use during power outages after eight people died at a nursing home following Hurricane Irma. Scott said that he was "outraged" over the deaths of the nursing home residents during a power outage caused by the hurricane, according to a press statement provided by ABC News. (Bowden, 9/16)

Health News Florida: Nursing Home Deaths Could Bring Legislative Changes
Nursing homes and assisted living facilities that lost power during Hurricane Irma are being evacuated throughout Florida. Governor Rick Scott is asking first responders to check in and make sure that residents are safe after eight patients died at a nursing home facility in Hollywood Hills earlier this week. (Aboraya, 9/15)

Administration News

Anti-Abortion Advocates Pleased By Modest, But Sustained, Gains From Trump Administration

“Even with what’s already been done—add that to what we think will be done—I would say this is the most pro-life presidency in the modern era,” says Marjorie Dannenfelser, president of the Susan B. Anthony List. “We’d be hard-pressed to say any other administration has made more gains.”

The Wall Street Journal: Trump Administration Moves Cheer Abortion Foes
The Trump administration has taken a series of steps to cut funds for abortion providers and promote conservative reproductive policies, moving toward what supporters and opponents say could be the most antiabortion presidential agenda in recent memory. A high-profile push to withhold federal Medicaid funding from Planned Parenthood, which provides abortions as well as an array of other women’s health services, fizzled this summer along with the larger Republican health care effort. But the administration has pursued more modest initiatives—rescinding Obama-era rules, curtailing contracts, making key appointments—that could broadly shape access to abortion and contraception. (Hackman, 9/15)

In other news from the administration —

USA Today: Ben Carson Says Housing Must Be Healthy, Safe And Affordable
Residents of Florida and Houston's mold and toxic air and water concerns after floodwaters receded are the latest example of the nexus between health and housing that is becoming a top priority for the Trump administration's housing chief.  Former neurosurgeon, presidential candidate and now-Housing and Urban Development Secretary Ben Carson is a big believer in looking at housing as a major "social determinant of health." That includes victims of Hurricanes Harvey and Irma. (O'Donnell and Gilyard, 9/17)

Kaiser Health News: Trump’s Deadline On ‘Dreamers’ Reverberates Through Health Industries
Karla Ornelas said she has “always had the idea of being a doctor, I’ve never seen myself doing anything else.” The third-year pre-medical student at the University of California-Davis said she plans to become a family medicine physician and work in California’s Central Valley, where there is a great need for doctors and especially bilingual doctors. (Heredia Rodriguez and Ibarra, 9/18)

Columbus Dispatch: Trump Officials Propose Again Letting Nursing Homes Force Residents, Families Into Arbitration
The pre-dispute agreements waive residents’ right to sue, forcing them and their families to settle issues through a professional arbitrator instead of the court system. The Obama administration moved to ban such agreements late last year, but a change in administrations brought an about-face on the issue. Over the summer, the Trump administration proposed withdrawing the ban before it had even taken effect because of pending court cases. (Widman Neese, 9/18)

Capitol Hill Watch

Unlike The Senate, House Panel Fails To Come To Terms On Plan For Children's Health Insurance

Key Senate leaders agreed on a bipartisan funding bill last week for CHIP, but the House left town without announcing any agreement. The program's funding authority runs out Sept. 30.

The Hill: Clock Ticking Down On Children's Health Funding 
Differences between the House and Senate ahead could threaten funding for a program that provides health care to some 9 million low- and middle-income children. Senators last week announced a bipartisan deal to extend the Children’s Health Insurance Program (CHIP), which is set to expire at the end of the month. ... Meanwhile, the House appears stalled on what to do about CHIP. (Weixel, 9/17)

Politico Pro: Children's Health Funding Remains In Limbo As Deadline Nears
While the Senate Finance Committee has agreed to a legislative proposal estimated to cost roughly $8 billion, the House skipped town on Thursday for a weeklong recess without unveiling a bill. “I think we’re much closer than farther apart,” said Energy and Commerce Chairman Greg Walden (R-Ore.), who anticipates the House will mark up its own CHIP plan after returning on Sept. 25. ... any sense of urgency has been swamped by the bitter debate over repealing Obamacare, which could be revived by a long-shot repeal bill from Republican Sens. Lindsey Graham and Bill Cassidy. (Pradhan, 9/15)

Coverage And Access

Vermont Sets Its Focus On Statewide Model Of Care That Incentivizes Keeping Patients Healthy

After its single-payer efforts collapsed, the state is trying to revolutionize health care in a different way. The model is similar to how Medicare pays for care.

The Washington Post: After Single Payer Failed, Vermont Embarks On A Big Health Care Experiment
Doug Greenwood lifted his shirt to let his doctor probe his belly, scarred from past surgeries, for tender spots. Searing abdominal pain had landed Greenwood in the emergency room a few weeks earlier, and he’d come for a follow-up visit to Cold Hollow Family Practice, a big red barnlike building perched on the edge of town. After the appointment was over and his blood was drawn, Greenwood stayed for an entirely different exam: of his life. Anne-Marie Lajoie, a nurse care coordinator, began to map out Greenwood’s financial resources, responsibilities, transportation options, food resources and social supports on a sheet of paper. (Johnson, 9/17)

Modern Healthcare: Population Health: Providers Still Struggling To Build Community Connections
The slow move away from a fee-for-service payment model toward value-based reimbursement in recent years has for many healthcare providers been a key incentive behind their focus on exploring different ways to improve the health of the communities they serve.  For organizations like New York City-based Montefiore Health System, population health management has been a part of its business model and care delivery strategy for the past two decades. The health system began taking on risk-based contracting for patient care in 1996, and now has more than 20% of its net patient revenue tied to such payment models. (Johnson, 9/16)

Medicaid

Ohio House Speaker Surveys Colleagues About Overriding Kasich's Medicaid Expansion

Last summer, Ohio Gov. John Kasich vetoed the part of the state's budget bill that would have frozen Medicaid expansion enrollment. Republicans in the House threatened to try to override the veto in July but eventually did not take a vote. Also in Medicaid news, Pennsylvania's governor says that a cash shortfall is causing Medicaid payments to insurance companies to go out late.

The Associated Press: Ohio House Considers Overriding Gov. Kasich's Medicaid Expansion Veto
The Ohio House is again weighing an override of Republican Gov. John Kasich's veto protecting Medicaid expansion after scrapping the idea in July. A memo circulating among House Republicans said GOP Speaker Cliff Rosenberger "would just like to see" where his caucus members stand now that efforts to repeal the federal health care law in Washington appear indefinitely stalled. (9/17)

The Philadelphia Inquirer/Philly.com: With Budget Impasse, Gov. Wolf Delays More Than $1B In Medicaid Payments
With the state’s cash running low, Gov. [Tom] Wolf on Friday said he was forced to withhold nearly $1.2 billion in payments to Medicaid program providers. In a short statement, the governor said his administration will be unable for at least a week to make the payments to managed care organizations, the private health insurers that cover many of the state’s neediest children, elderly, and disabled residents. Insurance industry officials said Wolf’s move is unlikely to interrupt services for Medicaid recipients but could affect the business side. (Navratil and Couloumbis, 9/15)

Pharmaceuticals

Under Pressure To Reduce Red Tape, FDA To Hold Hearing On Approval Process

The Food and Drug Administration implemented a more structured approach to how new drugs are approved based on their safety risks as part of the reauthorization of the Prescription Drug User Fee Act in 2010. At the meeting, the agency will likely hear testimony on experiences with this approach.

Modern Healthcare: FDA​ To​ Host​ Hearing​ On​ Assessing​ Risks,​ Benefits​ In​ New​ Drugs 
The Food and Drug Administration this week is holding a public hearing on how risk assessments are conducted on new drugs. The agency is under immense pressure to reduce review and approval times of drugs in order to lower costs but also ensure medications are safe before they go to market. In 2014, the FDA implemented a more structured approach to how new drugs are approved based on their safety risks, the severity of the disease and the availability of other drugs to treat that disease. The effort was part of the reauthorization of the Prescription Drug User Fee Act in 2010. At this week's meeting, the FDA will likely hear testimony on experiences with this approach and ways to better incorporate the patient perspective into the process. (Castellucci, 9/16)

In other pharmaceutical news —

Bloomberg: Walgreens Said To Tweak Rite Aid Deal To Clinch U.S. Approval 
Walgreens Boots Alliance Inc. is poised to revise its agreement to buy individual Rite Aid Corp. stores, a move that may be enough to resolve outstanding antitrust concerns and clinch U.S. approval for a deal the companies have been pursuing in different forms for two years, said people familiar with the matter. Walgreens is in the final stage of negotiations with the Federal Trade Commission about its plan to buy more than 2,000 Rite Aid stores and is set to propose a modified deal that could be announced as soon as Monday, according to three people, who declined to be identified because the talks are confidential. (McLaughlin and Langreth, 9/18)

California Healthline: California Drug Price Bill Sweeping In Scope, Lacking In Muscle
A California bill headed to the governor’s desk may be the most sweeping effort in the nation to shine a light on drug pricing, but it lacks the muscle being applied in other states to directly hold those prices down. The idea behind the law is that if everyone knows when and why prices are rising, political leaders eventually will be more empowered to challenge those increases. (Bartolone, 9/18)

Public Health And Education

Insurers Restricting Access To Less Addictive Medication Because Opioids Are Cheaper

As the opioid crisis rages on, the roles of various members of the health care landscape have been examined to see how they've play a part. But insurers have been largely overlooked so far. In other news, some states are trying to cut down on opioid abuse via pets' medication. Media outlets also report on news from the crisis out of California, New Jersey, Arizona and Ohio.

The Washington Post: Veterinarians Who Prescribe Opioids For Pets Are Being Told By Some States To Check Pet Owners Prescription History
Some states are taking the war on opioids into veterinarians’ offices, aiming to prevent people who are addicted to opioids from using their pets to procure drugs for their own use. Colorado and Maine recently enacted laws that allow or require veterinarians to check the prescription histories of pet owners as well as their pets. And Alaska, Connecticut and Virginia have imposed new limits on the amount of opioids a vet can prescribe. (Mercer, 9/16)

Sacramento Bee: Heroin Injection Site Bill Fails In CA Legislature
A controversial proposal allowing some California communities to experiment with a new way to handle drug addiction has failed this legislative session. ... Assemblywoman Susan Talamantes Eggman, D-Stockton, announced Friday evening that she will try again next year to pass Assembly Bill 186, which would have authorized eight counties with heavy intravenous drug use to create pilot “safe injection sites." (Koseff, 9/15)

The Associated Press: Christie To Spend $200M On New Substance Abuse Initiatives
New Jersey Gov. Chris Christie plans to spend $200 million on new initiatives that he hopes will significantly improve the way the state approaches substance abuse treatment and prevention. Christie told NJ.com the money will target programs for underserved populations — the uninsured, Medicaid recipients, babies born with addiction and their mothers. He said the money will come from the budgets of eight state departments. (9/17)

Arizona Republic: Fentanyl Fears Force Policy Change, Testing Backlog Within Arizona DPS
Citing rising concerns about the extra-potent synthetic opioid, the Arizona Department of Public Safety quietly instituted a blanket protocol change that bars troopers from conducting in-the-field testing on suspected drugs. ... While intended to promote trooper safety, the policy change has also resulted in a backlog of more than 2,000 controlled-substance cases in need of testing. (Pohl, 9/16)

'Nobody Cares About People With Sickle Cell': Opioid Crisis, Lack Of Training Leave Patients Struggling

In hospitals, sickle cell patients are typically treated by generalists who know little about the disease and patients’ desperate need for pain relief. Some patients even delay seeking care because they know how much of a "battle" it will be. In other public health news, mental health after hurricanes, antidepressants, gut bacteria, leprosy, tattoos and more.

Stat: In Excruciating Pain, Sickle Cell Patients Are Shunted Aside
The U.S. health care system is killing adults with sickle cell disease. Racism is a factor — most of the 100,000 U.S. patients with the genetic disorder are African-American – and so is inadequate training of doctors and nurses. And the care is getting worse, sickle cell patients and their doctors said, because the opioid addiction crisis has made ER doctors extremely reluctant to prescribe pain pills. STAT interviewed 12 sickle cell patients who described the care they received and didn’t receive. They were old and young, men and women, scattered from coast to coast, some with jobs or attending school and some too sick to do either. Two who wanted to tell their stories were unexpectedly hospitalized and too weak to talk to a reporter. (Begley, 9/18)

NPR: Years After A Hurricane, Most People Fare Well
Long after the floodwaters recede and the debris is cleared, the mental health impacts of disasters like hurricanes can linger. Psychologist Jean Rhodes of the University of Massachusetts-Boston has spent more than a decade studying what happens to people years after a natural disaster — in this case, Hurricane Katrina. (Chang and Jochem, 9/15)

The Washington Post: Can Antidepressants Given Prophylactically Prevent Depression?
If you were at risk for developing depression, would you take a pill to prevent it? For years, physicians have prescribed antidepressants to treat people grappling with depression. Some people can benefit from taking these medications during an acute episode. Others with a history of recurrent depression may take antidepressants to help prevent relapses. (Morris, 9/17)

NPR: Benefits Can Outweigh Risks For Pregnant Women On Anxiety Drugs Or SSRIs
Earlier this year, when Emily Chodos was about 25 weeks into her pregnancy, she woke up one night feeling horrible. "My hands were tremoring, my heart racing, " recalls Chodos, who lives near New Haven, Conn. She couldn't take a deep breath. "I'd never felt so out of control of my body." She ended up paging her obstetrician's office at 4 a.m., and one of the midwives in the practice, after listening to her symptoms, said, "It sounds like you're having a panic attack." (Aubrey, 9/18)

The New York Times: Gut Bacteria May Be Key To Weight Loss
Whether a diet works might depend on which bacteria are in your gut. Using feces samples, Danish researchers analyzed the ratio of two gut bacteria, Prevotella and Bacteroides, in 62 overweight people. For 26 weeks, they randomly assigned them to a low-fat diet high in fiber, fruits, vegetables and whole grains or a diet comparable to that of the average Dane. (Bakalar, 9/15)

WBUR: Leprosy Is Not Quite Yet A Disease Of The Past
That may be a bit surprising — leprosy seems to be a disease of the past. Indeed, in 2006, the World Health Organization issued a report on "elimination of leprosy as a public health problem," stating that the number of cases had dropped by 90 percent since 1985. (Brink, 9/16)

NPR: Teen Wants A Tattoo? Pediatricians Say Here's How To Do It Safely
Ariana Marciano is adding to her collection of about 75 tattoos at the Body Electric Tattoo and Piercing Studio on trendy Melrose Avenue in Hollywood. "I think they're so cool and I think they're visually really nice to look at," she says. There's a ram's head, an elk, a green-and peach colored praying mantis, a love bug and a moth. Today she's getting a ladybug. "I love bugs," Marciano, 23, says. "I think they're kind of overlooked." In about 20 minutes, with dots on its back and a bit of rusty orange, a small ladybug takes its place on her elbow. (Neighmond, 9/18)

The Washington Post: Children Under Fire
On average, 23 children were shot each day in the United States in 2015, according to a Post review of the most recent data from the Centers for Disease Control and Prevention and the U.S. Consumer Product Safety Commission. That’s at least one bullet striking a growing body every 63 minutes. In total, an estimated 8,400 children were hit, and more died — 1,458 — than in any year since at least 2010. That death toll exceeds the entire number of U.S. military fatalities in Afghanistan this decade. (Cox, 9/15)

Richmond Times-Dispatch: Survive A Shooting On Saturday, Back To School On Monday; 'My Teacher Had To Come Tell Me To Focus'
Experts in childhood trauma warn that the recent rash of violence affects not only those directly involved, but also those growing up in and around neighborhoods seared by gunfire and crisscrossed by yellow crime-scene tape. In Richmond, the number of children whose lives have been interrupted is growing, and they carry the weight of those experiences through the doors of city schools and into their classrooms. (Evans, 9/16)

San Antonio Press-Express: Space Out Births For Health Of Moms And Babies
Appropriate spacing between births in a family will improve the health of mothers and infants. Parents often want to have their children 1.5 to two years apart but the World Health Organization and research studies recommend two years between the delivery of one child and the conception of the next. (Plastino, 9/17)

Boston Globe: After Patients’ Weight Loss Surgery, Her Work Really Begins
As obesity reaches epidemic proportions — more than a third of US adults are obese — more bariatric surgeries are being performed at health care centers like Emerson in Concord. What was once considered a high-risk and last-resort measure is now a common procedure that is touted as relatively safe. (Atoji Keene, 9/15)

LA Tries To Get Ahead Of Highly Contagious Hep A Outbreak That's Sweeping San Diego

Since November, 421 people in San Diego County have been infected with the virus, including the 16 who died. So far Los Angeles has been spared, but they don't want to be caught off-guard.

Los Angeles Times: San Diego Is Struggling With A Huge Hepatitis A Outbreak. Is It Coming To L.A.?
Health officials in San Diego have scrambled for months to contain an outbreak of hepatitis A — vaccinating more than 19,000 people, putting up posters at bus stations and distributing hand sanitizer and cleansing wipes. Despite those efforts, 16 people have died of the highly contagious virus in San Diego County and hundreds have become ill in what officials say is the nation’s second-largest outbreak of hepatitis A in decades.Earlier this month, San Diego officials declared a public health emergency. (Karlamangla, 9/16)

Los Angeles Times: San Diego Opens Downtown Restrooms Amid Hepatitis A Crisis
New portable public restrooms were opened in downtown San Diego over the weekend in an effort to help combat the growing hepatitis outbreak that has killed 16 people and infected more than 400 since last fall, officials said. The dearth of 24-hour public restrooms downtown has long been cited as a shortcoming in the city — an inconvenience for visitors and a more dire problem for the growing homeless population. (Smolens, 9/16)

San Diego Union-Tribune: Diners Warned Of Possible Hepatitis Exposure At San Diego Beach Restaurant
A person at a Pacific Beach restaurant may have exposed an unknown number of customers to hepatitis A on seven different days, according to the San Diego County Health and Human Services Agency. Anyone who may have eaten or had a drink at the World Famous restaurant at 711 Pacific Beach Drive in San Diego at specific times on dates in late August and early September “may have been exposed to a person with the hepatitis A virus,” according to a statement released Friday morning by the county. (Sisson, 9/15)

The San Diego Union-Tribune: Restaurants, Diners Taking Precautions After Latest Hepatitis A Scare 
A day after news that San Diego’s deadly hepatitis A outbreak may have infiltrated the food service industry, more than 200 people lined up for vaccinations, restaurants reinforced their health safety measures and the city opened a new set of portable public restrooms downtown in an effort to gain some control over the disease’s spread. “All eyes are on San Diego,” Steve Zolezzi, president of the Food & Beverage Association of San Diego, said of the outbreak, one of the nation’s largest in decades which prompted county officials to declare a local public health emergency earlier this month. (Nikolewski, 9/16)

State Watch

Hospitals Involved In Safety Problems Rarely Face Serious Repercussions, Investigation Finds

USA Today has been following the probe into MedStar Washington Hospital Center for its sewage leaks. Outlets report on more hospital news from Kansas, Connecticut and Wisconsin as well.

USA Today: Hospital Safety Investigations Seldom Result In Major Penalties
Hospitals that fail to report or address safety problems, including those that increase the risk of infections, rarely face meaningful repercussions by state or federal officials, health care experts say. USA TODAY reported last week that MedStar Washington Hospital Center is under investigation by the D.C. health department for recent sewage leaks, although the problem has been going on for up to two years. The go-to hospital for members of Congress and the White House also suffers from poor quality ratings, particularly on foreign bodies left inside patients and certain infections. (O'Donnell, 9/17)

KCUR: How One Missouri Town Saved Its Hospital From Financial Collapse 
$1.25 million.That’s the size of the bill that could have shuttered the only public hospital in rural Pemiscot County, Missouri in August 2013. $750,000 for payroll.  $500,000 for a bond payment. $1.25 million total. One August day in 2013, the hospital’s CEO Kerry Noble had to face facts: The money just wasn’t there. It took an emergency bailout from a local bank to keep their doors open. For now. (Sable-Smith, 9/18)

State Highlights: Texas Ranked As State With Most Uninsured People; Surge Of Domestic Violence Cases Stuns Sacramento

Media outlets report on news from Texas, California, Connecticut, Massachusetts, New York, Virginia and Ohio.

Houston Chronicle: Texas, And Many Of Its Cities, Have The Most Uninsured People In The U.S. 
Of the 10 highest uninsured cities in the U.S. in 2016, eight of them were in Texas.Those Texas cities include Dallas, Laredo, and Baytown, according to the analysis conducted by WalletHub of health insurance data. WalletHub measured and ranked 547 different cities around the country. Of the 64 largest cities analyzed (these were cities with more than 300,000 people), Dallas (22.2 percent) came in dead last with Houston  right above it. (Alfonoso, 9/15)

Los Angeles Times: UCLA Pharmacy Closed After State Finds It Sent Out Drugs With Expired, Potentially Dangerous Ingredients
A state pharmacy inspector made a surprising discovery last year while conducting a routine records review at a Westside facility that compounded drugs for patients at UCLA medical centers. More than 1,000 IV bags of sterile medications for heart patients and others with serious health issues had been made with expired and potentially dangerous ingredients, according to state Board of Pharmacy records. (Christensen, 9/15)

The CT Mirror: Last Night, The Budget Politics — Today, The Details
Legislators arrived at the State Capitol on Friday with the opportunity for the first time to see the details of a $41.4 billion, two-year budget proposal that the administration of Gov. Dannel P. Malloy and Democratic legislative leaders hoped would end Connecticut’s summer-long budget impasse. (Phaneuf, Pazniokas and Rade Thomas, 9/15)

Richmond Times-Dispatch: VDH Encourages Everyone, Especially Health Care Workers, To Receive Flu Shots
Last week, the Virginia Department of Health held an event at the Richmond City Health District with health care leaders, as well as Richmond Mayor Levar Stoney, in which Stoney and Virginia’s health commissioner, Dr. Marissa Levine, received their flu shots. ... In Virginia, the rate of people receiving their flu shots remained relatively stagnant between 2010 and 2014, VDH data show, with just under 50 percent receiving vaccines. (O'Connor, 9/17)

Columbus Dispatch: Study Says The Developmentally Disabled Receive Poorer Health Care
An author of a study that shows Ohioans with developmental disabilities struggle to get adequate medical care says medical schools should focus more on the issue. The study revealed that people with disabilities fared worse than others when it comes to their health status, the quality of their health care, access to care, unmet health-care needs and number of hospitalizations and emergency department visits. (Viviano, 9/16)

The Desert Sun: Thermal's Flying Doctors, Providing Free Health Care, Sees Fewer Patients. Fear Of Deportation May Play Role
Before the sun rose Saturday, people in need of medical care began lining up outside Desert Mirage High School in Thermal for an opportunity to see physicians, dentists, optometrists and hearing specialists – all for free. From 8 a.m. to about 3 p.m., volunteers with Flying Doctors health fair, organized by Luz Moreno with Clinicas de Salud del Pubelo Inc. in Coachella, brings doctors from all over into the east end of the valley to provide much-needed medical care. The one-day clinic offers everything from basic medical checkups to cancer screenings and everything in between. Volunteers also assist with insurance enrollment for those who qualify. (Barkas, 9/16)

Editorials And Opinions

Perspectives: All About Bernie's 'Medicare-For-All' Plan

Editorial writers offer a variety of opinions on the single-payer health plan proposal advanced by Sen. Bernie Sanders (I-Vt.).

Los Angeles Times: Does Bernie Sanders' Single-Payer Plan Have A Shot?
Sen. Bernie Sanders’ “Medicare for All” plan, unveiled last week, is an ambitious and (to many) enticing idea: a single, government-run health plan with generous benefits for everyone — just like most industrialized countries have enjoyed for decades. If only it were feasible in today’s United States. (Doyle McManus, 9/17)

Chicago Tribune: Bernie Sanders' Medicare For All Is A Delusional Promise
Bernie Sanders has a health care plan he calls Medicare for all. He’s underselling it. His proposal really should be called Medicare for all and a pony. It’s everything you could want and then some. ... It’s not clear that we as a country can afford Medicare as it currently exists. Merely preserving it without significant cuts would eventually require a tax increase that working people would resent. But instead of looking for ways to economize, the Vermont senator wants to expand the program in a way that the term “vast” barely begins to capture. (Steve Chapman, 9/15)

The New York Times: Buried Inside Bernie Sanders’s Bill: A Fallback Plan
The Bernie Sanders “Medicare for All” plan promises rapid, sweeping change to the American health care system, with the elimination of all private insurance and the creation of a costly new government insurance program that will cover everyone and nearly every medical service. But deep in its back pages is a more modest fallback plan. ... During that interim, some younger Americans would be able to buy access to the traditional Medicare program, which is now mainly for those 65 and up. The provisions would also establish an option for Americans to buy access to a Medicare-like government plan that would be sold on the Obamacare exchanges. (Margot Sanger-Katz, 9/15)

WBUR: Bernie Sanders’s Single-Payer Swoon
Bernie Sanders filed his “Medicare for All” bill to erect a single-payer system, plugging his plan from a prime perch on The New York Times op-ed page. ... Normally, this is where we’d cue the pitfalls-of-single payer part. But first, we need to hose down the fevered scaremongers on the right who oppose single payer for dumb reasons, insisting that would turn us into a goose-stepping Amerika. (Rich Barlow, 9/18)

The Washington Post: The Democrats Have Become Socialists
When Bernie Sanders launched his bid for the Democratic nomination, he was often asked whether he, a democratic socialist, would actually become a Democrat. Now, more than a year after he ignited a movement with his unsuccessful bid, that question is moot. The Democrats have become socialists. (Dana Milbank, 9/13)

Different Takes: What To Do With CHIP; Deal With Threats To Obamacare Before Single Payer

News outlets examine a variety of pressing health policy issues, ranging from the reauthorization of the Children's Health Insurance Program to what's next for the Affordable Care Act.

Forbes: Children's Health Insurance Program Demands Quick, Bipartisan Passage
CHIP was a shared vision of Republicans and Democrats alike. It seems like ancient history now, but, in 1997, I joined with members from both sides of the aisle to debate health care policy forcefully but productively. Led by Senators Ted Kennedy (D-MA) and Orrin Hatch (R-UT), we crafted the CHIP language. Bipartisan action, so crucial to the health of the country and the economy, was never more important than when it came to insuring America’s children. Now, two decades later, that progress is in jeopardy. CHIP is set to expire on September 30. (Bill Frist, 9/14)

National Review: Continue To Fund Children’s Health Care, But Coordinate The Programs Better
CHIP, which helps states provide health-care coverage to low-income kids, is better structured than Medicaid to ensure that funds are targeted to those who need assistance most. Now, after the Affordable Care Act has created an entitlement to subsidized coverage through the exchange, CHIP-eligible families are often torn between two programs that fit together poorly. If a few minor flaws in its design are fixed, however, CHIP can fill a gap and enhance the rest of America’s health-care safety net. (Chris Pope, 9/18)

The Washington Post: Before Tackling Single-Payer, Save Obamacare
Before supporters of universal health coverage get all wrapped up debating a single-payer system, they need to focus on a dire threat to the Affordable Care Act likely to come up for a vote in the Senate before the end of the month. The latest repeal bill is an offering from Republican Sens. Lindsey O. Graham (S.C.) and Bill Cassidy (La.) that would tear apart the existing system and replace it with block grants to the states. Block grants — flows of money for broad purposes with few strings attached — are a patented way to evade hard policy choices. All the tough decisions are kicked down to state capitals, usually with too little money to achieve the ends the block grant is supposed to realize. (E.J. Dionne, 9/17)

The New York Times: Complacency Could Kill Health Care
I haven’t yet read Hillary Clinton’s “What Happened,” but it seems pretty clear to me what did, in fact, happen in 2016. These days, America starts from a baseline of extreme tribalism: 47 or 48 percent of the electorate will vote for any Republican, no matter how terrible, and against any Democrat, no matter how good. This means, in turn, that small things — journalists acting like mean kids in high school, ganging up on candidates they consider uncool, events that suggest fresh scandal even when there’s nothing there — can tip the balance in favor of even the worst candidate imaginable. (Paul Krugman, 9/18)

Baltimore Sun: Medicaid Cuts Shift Burdens To States
Thanks to massive grassroots mobilization efforts, our state narrowly averted disaster when Congress failed to pass any version of Affordable Care Act (ACA) repeal that would have restructured Medicaid and left thousands of my constituents without health care coverage. Stopping health care repeal was a huge victory, but the fight is not over yet. Even deeper cuts to Medicaid have been proposed in the 2018 budget resolution, which would slash health care by $1.5 trillion over the next 10 years to pay for billions in tax breaks to the rich and corporations over that same period. (Rep. C.A. “Dutch” Ruppersberger, 9/17)

The New York Times: The Best Health Care System In The World: Which One Would You Pick?
“Medicare for all,” or “single-payer,” is becoming a rallying cry for Democrats. This is often accompanied by calls to match the health care coverage of "the rest of the world." But this overlooks a crucial fact: The “rest of the world” is not all alike. The commonality is universal coverage, but wealthy nations have taken varying approaches to it, some relying heavily on the government (as with single-payer); some relying more on private insurers; others in between. (Aaron E. Carroll and Austin Frakt, 9/18)

The Washington Post: A Century Ago, Women Fought For Access To Contraception. The Trump Administration Threatens To Undo Their Work.
Trump administration officials vow that they are going to take care of the health of moms and babies. But their pledge to cut funding to Planned Parenthood promises to do the opposite. The proposed cuts have focused not just on the procedure of legal abortion (which is, of course, another column), but also on eliminating access to contraceptives. These proposals ignore a fundamental truth: Access to birth control is central to women’s health. In fact, it always has been. (Lauren MacIvor Thompson, 9/15)

Viewpoints: Nursing Home 'Horror'; Time To Talk About Mental Illness, Not Blame The Victim

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

The Washington Post: The Inexplicable Horror Of The Deaths Of Eight Elderly People In Florida
“Unfathomable." "Inexcusable." Those were the words used respectively by Florida Gov. Rick Scott (R) and Sen. Bill Nelson (D-Fla.) to describe the deaths of eight elderly people found in a sweltering nursing home in the aftermath of Hurricane Irma last week. Those descriptions, while accurate, nonetheless fail to capture the full, inexplicable horror of the deaths. That people who were so vulnerable and needed special care were instead treated as an afterthought is insupportable. (9/17)

The Charlotte Observer: We Need To Talk About Mental Health
As we reflect on lessons learned one year after Keith Lamont Scott’s death and the subsequent community uprising, it’s time to start asking how we can provide more help to treat mental illness – which may be an underlying factor in crime, violence and misunderstanding. Research has shown that up to one half of people killed by law enforcement officers suffered from a disability, typically those with a mental illness or, in the case of Keith Lamont Scott, a traumatic brain injury. Yet stories in the public narrative often ignore the disability component or blame the victim. (John Cleghorn, Ophelia Garmon-Brown and Brandon Risher, 9/15)

San Jose Mercury News: Homelessness, Health Care Crises Overlap At VMC
Housing provides immediate stability and independence, and this stabilizing force can lead to vastly improved health outcomes. Traditionally, housing programs for the homeless – particularly those run by the government – have required that patients “get clean” before they can earn housing. But that view has been changing. (Nuriel Moghavem, 9/15)

Los Angeles Times: Refusing To Build Public Toilets Doesn't Make Homeless People Go Away. It Creates A Public Health Crisis
Faced with an appalling shortage of public toilets in the Skid Row area, Los Angeles city officials promised in July to put up 10 more toilets by mid-September. Time’s up, but the toilets are not — at least not yet. City officials say they will unveil within a month a mobile “hygiene center” in the midst of Skid Row on a city-owned parking lot, offering toilets, hand-washing stations, showers, and half a dozen stacked washers and dryers for laundry. There will be security personnel as well as formerly homeless people working at the site, along with outreach workers who can steer people to housing and services. So, if downtown homeless people can hold it for a month, they’ll get 10 toilets and more. (9/16)