KHN Morning Briefing

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Kaiser Health News Original Stories

Political Cartoon: 'Drinking The Kool-Aid?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Drinking The Kool-Aid?'" by John Hambrock.

Here's today's health policy haiku:

CENTENE CORP. FILLS GAP FOR NEVADA COUNTIES WITH NO ACA INSURANCE OPTIONS

The problem is solved…
Whew! Because those bare markets
Really are a bear!

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Summaries Of The News:

Capitol Hill Watch

CBO: Trump's Threat To Stop Health Subsidies Would Increase Premiums And The Deficit

The Congressional Budget Office found that if President Donald Trump opts to halt certain insurance subsidies it would increase the federal deficit by $194 billion and cause the premium costs for a popular Obamacare plan to increase significantly.

Bloomberg: Trump Threat On Obamacare Would Boost Deficit By $194 Billion 
Health plan premiums for some in Obamacare will surge and the federal deficit will increase by almost $200 billion over a decade if President Donald Trump follows through on a threat to halt certain insurance subsidies under the law, the Congressional Budget Office said Tuesday. The CBO, which provides nonpartisan analysis of federal policy issues for lawmakers, released the report Tuesday after the Trump administration made repeated threats to stop paying cost-sharing reduction subsidies under Obamacare. The payments go to insurers, and are used to help reduce out-of-pocket costs for poorer Americans in the program. (Tracer, 8/15)

The Associated Press: Report: Higher Premiums If Trump Halts 'Obamacare' Subsidies
Premiums for a popular type of individual health care plan would rise sharply, and more people would be left with no insurance options if President Donald Trump makes good on his threat to stop “Obamacare” payments to insurers, the Congressional Budget Office says. The nonpartisan number crunchers also estimated that cutting off payments that now reduce copays and deductibles for people of modest incomes would add $194 billion to federal deficits over a decade. That head-scratching outcome is because a different Affordable Care Act subsidy would automatically increase as premiums jump, more than wiping out any savings. (Alonso-Zaldivar, 8/15)

Kaiser Health News: CBO: Killing Cost-Sharing Subsidies Would Hike Silver Plan Premiums And Deficit
The change would not be expected to have much long-term effect on the number of uninsured people, according to the analysis. But it could cause a shift in which plans are popular with marketplace customers as insurers realign some of their prices to defray the loss of the federal payments, the CBO said. Surprisingly, some customers might find better deals by looking at higher-end products. (8/15)

The New York Times: Trump Threat To Obamacare Would Send Premiums And Deficits Higher
Even before efforts to repeal the Affordable Care Act collapsed in the Senate last month, Mr. Trump began threatening to stop paying the subsidies, known as cost-sharing reductions. He said the health care law would “implode” and Democrats would have no choice but to negotiate a replacement plan. Mr. Trump described his strategy as, “Let Obamacare implode, then deal.” Those threats continue, though the Trump administration has paid the subsidies each month. (Pear and Kaplan, 8/15)

USA Today: CBO: Ending Obamacare Cost-Sharing Subsidies Would Raise Premiums And The Deficit
Most people buying insurance sold on the health care exchanges created by the Affordable Care Act would pay a similar monthly cost to what they pay now despite premiums increasing 20% next year and increasing to 25% higher by 2020. But that’s because the federal government would be picking up the difference with tax credits that subsidize premiums through a different part of the law. (Groppe, 8/15)

Modern Healthcare: CBO: End Of CSRs Would Add To Federal Deficit
Ending cost-sharing reduction payments could cause insurers to abandon the individual market in counties that contain 5% of the U.S. population, according to a new projection from the Congressional Budget Office. Additionally, gross premiums for silver plans offered through the Affordable Care Act marketplace would jump 20% in 2018 and by 2020 would be 25% higher than if the CSRs continue. The CBO Tuesday said that if the CSR payments were cut off after insurers had already committed to 2018 rates, more insurers would exit the market in order to stem their losses. (Lee, 8/15)

The Wall Street Journal: What Are Insurance Subsidies And What Would Happen If They Were Cut?
As health insurers weigh their commitments to the Affordable Care Act’s exchanges for 2018, they point to a key issue that will affect the rates they would charge and indeed whether they will participate: Federal subsidies known as cost-sharing reductions. Those payments are likely to be a major story going forward, and on Tuesday, the Congressional Budget Office estimated that if President Donald Trump carried out his threat to halt the subsidies, it would boost premiums for middle-priced plans by 20% next year. (Wilde Mathews, 8/15)

White House Tries To Push Congress To Try Again On Obamacare Repeal

One key Trump administration target is Senate Majority Leader Mitch McConnell (R-Ky.), but the president is also keeping up his attacks on Sen. John McCain (R-Ariz.), whose no vote last month was pivotal to preventing Senate passage of any legislation to undo the Affordable Care Act. Meanwhile, Sen. Bill Cassidy (R-La.) is meeting with White House officials on his repeal-and-replace plan.

The Hill: White House To Pressure McConnell On ObamaCare
White House officials are exploring ways to pressure Senate Majority Leader Mitch McConnell (R-Ky.) to return to the controversial issue of ObamaCare repeal when the Senate returns to work in September. President Trump, who has repeatedly criticized McConnell in public, wants to hold the leader’s feet to the fire on the issue, say White House sources. (Bolton, 8/16)

The Wall Street Journal: Trump Targets McCain Over Health Vote
President Donald Trump continued his attacks against individual Senate Republicans, criticizing Sen. John McCain (R., Ariz.) and his pivotal health-care vote at a news conference Tuesday at Trump Tower in New York City. A week after Mr. Trump knocked Senate Majority Leader Mitch McConnell (R., Ky.) over the Senate’s failure to pass any legislation dismantling and replacing the Affordable Care Act, the president took aim at Mr. McCain, now in his sixth Senate term. (Peterson, 8/15)

Arizona Republic: A Question About Sen. John McCain Sets Off President Donald Trump
President Donald Trump is still clearly irritated that his on-again, off-again foil Sen. John McCain derailed the GOP health-care bill that Trump backed. At a Tuesday news conference, Trump was asked about McCain's defense of H.R. McMaster, Trump's national-security adviser, from attacks from alt-right critics. ... Trump responded with a non-sequitur. "Senator McCain? You mean the one who voted against 'Obamacare'?” Trump shot back. "You mean Senator McCain who voted against us getting good health care?"(Nowicki, 8/15)

The Hill: GOP Senator Meeting With White House On New ObamaCare Plan 
Sen. Bill Cassidy (R-La.) said he's meeting with the White House and the Trump administration "two or three times per week" on a plan to repeal and replace ObamaCare. Cassidy has teamed up with Sens. Lindsey Graham (R-S.C.) and Dean Heller (R-Nev.) on a new proposal that would essentially block-grant ObamaCare funding to the states while repealing the law's individual and employer mandates. (Hellmann, 8/15)

In other Capitol Hill news related to the Trump administration -

Stat: Congressional Democrats May Form Expert Panel On Trump's Mental Health
Three congressional Democrats have asked a psychiatrist at Yale School of Medicine to consult with them about forming an expert panel to offer the legislators advice on assessing President Trump’s mental health. Yale’s Dr. Bandy Lee told STAT that over the last few weeks members of Congress or their staff have asked her to discuss how members might convene psychiatrists, psychologists, and other mental health professionals “to review the president’s mental health, and review it on a periodic basis.” The closed meeting is expected to take place in September, she said. (Begley, 8/16)

At August Recess Town Hall Meetings, Colo. Sen. Faces Health Policy Heat

Sen. Cory Gardner faced cheers and boos from constituents -- along with lots of questions about his support for efforts on Capitol Hill to repeal the Affordable Care Act. Other members of Congress are finding themselves in similar circumstances.

Denver Post: At Cory Gardner’s Greeley Town Hall, Conversation Stubbornly Keys On Health Care 
U.S. Sen. Gardner took the stage at the second of three town halls Tuesday to a mixture of cheers and boos and, despite efforts by his aides to encourage attendees to ask a wider variety of questions, faced many inquiries on health care. They centered on his lack of support for single-payer care, what he’d do to prevent the disadvantaged from losing Medicaid and his reasons to vote to repeal the Affordable Care Act, when many his constituents don’t want him to. (Douglas, 8/15)

Politico: Colorado's Gardner Faces Blowback At Home Over Obamacare Repeal
Sen. Cory Gardner was hammered for supporting Obamacare repeal during a series of raucous town halls on Tuesday, where constituents repeatedly criticized his role in a closed-door partisan process to draft the failed GOP health bill. Gardner, who’s responsible for protecting the GOP majority in the Senate in 2018, faced heated criticism over the repeal effort that collapsed just a few weeks ago, even as congressional leaders try to pivot to tax reform when they return from the lengthy recess next month. (Pradhan, 8/15)

Roll Call: Health Care Backlash With A Side Of Charlottesville Outrage At GOP Town Halls
Coloradans pressed Sen. Cory Gardner on health care during the Republican’s first solo, in-person town hall in more than a year. Gardner wasn’t the only Republican senator who faced angry constituents this week, as Sen. Johnny Isakson held a contentious town hall in Georgia on Monday. The two Republicans heard a similar tune from their respective crowds, as people voiced concerns over healthcare. (Stewart, 8/15)

Health Law

Nevada's Insurance 'Bare Market' Now Appears Covered

The health insurer Centene Corp. decided to expand its reach in Nevada, offering health plans in rural counties that were at risk of having no options next year. The step is viewed as a victory for Obamacare supporters.

The New York Times: Obamacare’s Bare County Problem Looks Mostly Solved, For Now
A few months ago, it looked as if large swaths of the country might end up without any insurers willing to sell Obamacare insurance in 2018. But in the last few weeks the “bare county” problem, which President Trump had cited as a sign the markets were failing, has nearly solved itself. On Tuesday, Gov. Brian Sandoval of Nevada announced that Centene would offer insurance in 14 rural counties of Nevada that had been bare. That leaves only two counties in the country without insurers saying they will sell coverage; fewer than 400 Obamacare customers live in those counties. (Sanger-Katz, 8/15)

The Wall Street Journal: Nevada And Centene Reach Agreement On Insurance Markets
Roughly 8,000 consumers in Nevada were at risk of losing access to health plans on the exchange after Anthem Inc. and Prominence Health Plan said in June they would exit markets in 14 counties. Insurers can hold off on final decisions to participate in exchanges until late September, but many have exited markets, citing volatility and prolonged uncertainty about the White House’s support for the markets. (Evans, 8/15)

Bloomberg: Insurer Steps In To Cover ‘Bare’ Obamacare Markets In Nevada 
Obamacare’s supporters scored a victory as health insurer Centene Corp. decided to dramatically expand in Nevada, filling in rural counties that were at risk of having no options next year. Centene said Tuesday that it will sell statewide via its SilverSummit unit, a move that will help more of Nevada’s residents gain Affordable Care Act coverage. Nationally, the decision will reduce the number of empty counties to two: one in Ohio and one in Wisconsin. (Tracer, 8/15)

The Hill: Insurer Will Cover 'Bare' Nevada Counties 
SilverSummit Healthplan has agreed to fill Nevada's 14 "bare" counties that were slated to have no insurers on the ObamaCare exchanges next year. SilverSummit, a subsidiary of Centene, announced the decision at a press conference with Gov. Brian Sandoval (R). Those 14 rural counties became in danger of having no insurers in 2018 after Anthem announced it wouldn't sell ObamaCare plans next year in Nevada. (Hellmann, 8/15)

Medicare

HHS Rolls Back Two Programs Designed To Test New Medicare Payment Models

The Centers for Medicare & Medicaid Services said it will cancel the Obama-era pilot programs that required Medicare providers to participate in new care delivery models for things such as heart attacks, bypass surgeries, and some hip and femur fractures.

Stat: CMS Moves To Cancel Medicare Programs Overhauling Some Hospital Payments
The Centers for Medicare and Medicaid Services moved to cancel pilot programs that would have paid certain hospitals a lump sum for all of the care associated with heart attacks, bypass surgeries, and some hip and femur fractures, including the initial visit, the surgery, and follow-up care. It’s canceling a similar program that targeted cardiac rehabilitation, and the agency is also proposing to drastically reduce the number of hospitals that have to participate in a separate program already underway that offers similar lump payments for hip and knee replacements. (Mershon, 8/15)

Modern Healthcare: CMS Cancels Two Mandatory Pay Models And Scales Back A Third 
The CMS on Tuesday said it will toss two bundled-payment models and cut down the number of providers required to participate in a third, citing providers' requests to have more input in the models' designs. The agency slashed the number of mandatory geographic areas participating in the Comprehensive Care for Joint Replacement, or CJR, model from 67 to 34, it announced in a proposed rulemaking Tuesday. Comments are due Oct. 17. (Dickson, 8/15)

POLITICO Pro: HHS Scales Back Medicare Bundled Payment Programs
HHS is planning to roll back a pair of Obama-era programs requiring Medicare providers to participate in new care delivery models, reshaping the department's approach to overhauling how doctors and hospitals are paid. The proposal issued Tuesday afternoon would eliminate planned mandatory initiatives holding hospitals accountable for the cost of certain joint replacement surgeries and care for heart attacks and cardiac surgeries. (Cancryn, 8/15)

Marketplace

Startup Aledade's Ambitious Goal: Reduce Health Care Costs While Improving Care Quality

The New York Times profiles the progress the company has made at two primary care practices in Kansas. In other industry news, health insurer Oscar posts a $57.6 million first-half loss. And Sabra Health Care shareholders approve a proposed merger with Care Capital Properties.

The New York Times: A Start-Up Suggests A Fix To The Health Care Morass
If you watched the drama in Washington last month, you may have come away with the impression that the American health care system is a hopeless mess. ... So it is surprising that across the continent from Washington, investors and technology entrepreneurs in Silicon Valley see the American health care system as the next great market for reform. (Manjoo, 8/16)

Bloomberg: Obamacare Startup Oscar Posts $57.6 Million First-Half Loss 
Oscar Insurance Corp., the health-insurance startup focused on selling Obamacare plans, posted a smaller first-half loss than a year earlier, according to state regulatory filings. Oscar, whose co-founders include Joshua Kushner and Mario Schlosser, lost $57.6 million in the first half of the year in Texas, New York and California. That’s down from $83 million a year earlier. In Texas and California, the company brought in more in premiums than it spent on care, though in New York its health costs still exceeded premiums. (Tracer, 8/15)

What To Do If A Medical Bill Triggers Sticker Shock?

The Wall Street Journal suggests that consumers should negotiate medical costs, question charges and move quickly to resolve disputes or arrange payment plans. In another story, the Journal notes a trend in which consumers appear less anxious for the latest treatment or medical technology when it also is the most expensive.

The Wall Street Journal: How To Handle A Large, Unexpected Medical Bill
These days, not only are health-care costs climbing but individuals also often are bearing a greater portion of their medical bills than before, as many insurers cut back on payments and more companies expect employees to pay higher deductibles and copays.Meanwhile, many people don’t have sufficient emergency funds to pay for an unanticipated medical expense. ... Against this backdrop, advisers such as Mr. Van Zutphen (who successfully negotiated a 25% reduction on his long-ago bill) are encouraging clients to negotiate medical costs, question charges and move quickly to resolve disputes or arrange payment plans. (Dagher, 8/15)

Physicians Increasingly Support Single-Payer Health Care, Survey Finds

Fifty-six percent of doctors either expressed strong support or were somewhat supportive of a single-payer system, according to a survey by the physician recruitment firm Merritt Hawkins.

Kaiser Health News: Doctors Warm To Single-Payer Health Care
Single-payer health care is still a controversial idea in the U.S., but a majority of physicians are moving to support it, a new survey finds. Fifty-six percent of doctors registered either strong support or were somewhat supportive of a single-payer health system, according to the survey by Merritt Hawkins, a physician recruitment firm. In its 2008 survey, opinions ran the opposite way — 58 percent opposed single-payer. What’s changed? (Bluth, 8/16)

Houston Chronicle: Doctors Have A Change Of Heart On Single Payer
A majority of doctors questioned nationwide now support a single-payer health care system - an almost exact reversal of their stance nine years ago. Fifty-six percent of the 1,033 physicians who responded to the Aug. 3 Merritt Hawkins survey said they either strongly supported or somewhat supported a single-payer system. (Deam, 8/14)

Public Health And Education

South Carolina Files Lawsuit Against Maker Of OxyContin Over Alleged Deceptive Marketing

The suit accuses Purdue Pharma of violating the state's Unfair Trade Practices Act. With similar cases recently filed in Birmingham, Ala., and Cincinnati, the litigation is following in the court path used against Big Tobacco. In other news on the national crisis: teen overdose deaths rise; the lure of "body brokers"; when antidotes fail against synthetic drugs; and more.

The Associated Press: Lawsuit Accuses Drug Manufacturer Of Worsening Opioid Crisis
South Carolina on Monday became the latest state to accuse a drug manufacturer of exacerbating its opioid drug crisis by using deceptive marketing. Attorney General Alan Wilson sued Purdue Pharma on Monday, accusing the maker of OxyContin and other opioid drugs of violating South Carolina's Unfair Trade Practices Act. (Kinnard, 8/15)

The Wall Street Journal: South Carolina Sues Purdue Pharma, Alleging Deceptive Opioid Marketing
South Carolina’s suit follows efforts by several other jurisdictions to hold pharmaceutical companies accountable for what they call deceptive marketing of opioid painkillers. The states and others say that such marketing has led to an epidemic among residents, leading to addiction, overdose and deaths. The lawsuit, filed in South Carolina state court, focuses solely on Purdue Pharma, which manufactures OxyContin and other opioid drugs. New Hampshire last week filed a similar suit against Purdue. (Randazzo, 8/15)

Bloomberg: Big Pharma's Tobacco Moment As Star Lawyers Push Opioid Suits 
Big Pharma is having a Big Tobacco moment as litigation over opioids attract star lawyers and a growing list of states and local governments seeking their own multibillion-dollar payout to deal with costs of a burgeoning drug epidemic. On Tuesday, South Carolina became the sixth state to sue opioid makers alleging they have created a public health crisis. The suit filed by Joe Rice, a plaintiff lawyer who helped negotiate a $246 billion settlement with the tobacco industry in 1998, suggests states are laying the groundwork to force a resolution that provides billions of dollars to cover the costs of an epidemic blamed for 62 deaths per day. (Feeley and Hopkins, 8/15)

The Associated Press: US Teen Drug Overdose Deaths Inch Up After Years Of Decline
After years of decline, teen deaths from drug overdoses have inched up, a new U.S. government report shows. The drop in teen deaths had been a rare bright spot in the opioid epidemic that has seen adult overdose deaths surge year after year — fueled by abuse of prescription painkillers, heroin and newer drugs like fentanyl. (Stobbe, 8/15)

NPR: 'Body Brokers' Get Kickbacks To Lure People With Addictions To Bad Rehab
Some sober homes are good places. But others see a person who has an addiction as a payday. Amid the nation's growing opioid crisis, South Florida has become a mecca for drug treatment. And as more people arrive looking for help, there's more opportunity for corruption and insurance fraud. There are millions to be made in billing patients for unnecessary treatment and tests, according to officials investigating the problem. (Haden, 8/15)

Bloomberg: Heroin-Era Antidotes Can’t Handle Overdoses In Age Of Synthetics 
Addicts in the Colorado town where [Ralph Battels is] an emergency room doctor are downing such incredibly powerful opioids that the overdose-reversal agent may have to be applied two or three times -- or more -- to revive them and calm their sometimes violent highs. The budget at Pagosa Springs Medical Center is taking an unanticipated hit, another victim of a raging national epidemic. ... Hospitals and emergency-services agencies across the U.S. are confronting higher bills for the chemical compound that can block the effects of painkillers and heroin, as super-strong synthetic opioids like fentanyl and carfentanil grow increasingly popular. Not only are more doses of the remedy often required, prices for some brands of naxolone have been ticking up. (Mattingly, 8/16)

The Associated Press: Colorful Portraits Show Faces Of New Hampshire Drug Crisis
At the New Hampshire State Library’s latest art exhibit, the bright smiles and bold colors of the canvases belied the broken hearts of those who attended its opening reception. More than 80 paintings are on display this month featuring the faces of the state’s opioid epidemic. What started as one mother’s private outlet for grief has grown into a larger effort to comfort others and reduce the stigma of addiction. (Ramer, 8/16)

State Watch

Texas Governor Signs Law That Cuts Insurance Coverage Of Abortion

The measure, which passed the Legislature on a party-line vote, does not offer exceptions for cases of rape or incest. Meanwhile, in Oregon, the governor signs a bill expanding coverage for the procedure and other reproductive health services.

Texas Tribune: Abbott Signs Bill Restricting Insurance Coverage Of Abortion
Gov. Greg Abbott on Tuesday signed a bill that will require Texas women to pay an extra health insurance premium for non-emergency abortions, one of three abortion-related items the governor placed on lawmakers' agendas for the special session. The measure, House Bill 214, does not include exceptions for instances of fetal abnormalities, rape or incest. (Najmabadi, 8/15)

Reuters: Texas Governor Signs Bill To Limit Insurance Coverage For Abortions
The Republican governor of Texas signed into law on Tuesday a measure that will restrict insurance coverage for abortions, compelling women to buy a supplemental plan if they want coverage for the procedure. Governor Greg Abbott said the measure known as House Bill 214 would protect abortion opponents from subsidizing the procedure. Democratic critics decried it as forcing people to buy "rape insurance." (Herskovitz, 8/15)

The New York Times: A Changed Landscape For Abortion Rights In Texas
The drive between Del Rio and San Antonio consists of vast expanses of Texas farmland dotted with tiny towns. Along the route, a huge wooden sign in Hondo greets passers-by: “Welcome: This is God’s Country. Please don’t drive through it like hell.” By the time Kristen passed the sign on her way to get an abortion, she had been riding a Greyhound bus for four hours. The 150-mile trip was the shortest distance she could travel to visit an open clinic — Whole Woman’s Health in San Antonio. Her journey is not unique in Texas. (Van Houten, 8/16)

The Washington Post: Oregon Approves Sweeping Bill Expanding Abortion Access
Called the Reproductive Health Equity Act, the measure requires health insurers to provide birth control and abortion without charging a co-pay. It also dedicates state funds to provide reproductive health care to noncitizens excluded from Medicaid. Antiabortion groups swiftly condemned the new law, saying it will force taxpayers to foot the bill for a procedure many consider to be a form of murder, and that it cements Oregon’s status as the most liberal state when it comes to abortion. (Somashekhar, 8/15)

Georgia Medicaid Director And Aide Leave; State Officials Offer No Explanations

Linda Wiant’s departure appeared to come suddenly and followed the exit of a deputy, Marcey Alter, earlier in the week. News outlets also report on the trial involving the Mississippi Medicaid director and developments in New Hampshire and Maine.

Jackson (Miss.) Clarion-Ledger: Medicaid Chief Explains Emails, Says He Wasn't Offered Job By Contractor
The director of the Mississippi Division of Medicaid talked about job opportunities with executives — one he called a friend — for a company his agency eventually awarded a $2 billion contract. Molina Healthcare officials said they asked Medicaid Director David Dzielak to help them find candidates for leadership positions with its Mississippi Medicaid health plan — a year before they got the contract and months before the department advertised for the Mississippi Medicaid managed care contract. (Wolfe, 8/15)

New Hampshire Public Radio: Feds' Warning To N.H. Over Medicaid Expansion Raises Stakes In Key Policy Debate
New Hampshire has a long history of coming up with solutions to fund its Medicaid program that — depending on how you look at it — are either creative or a little crooked. ... The federal government recently went even further in their assessment of the funding mechanism, saying New Hampshire’s use of payments from hospitals and insurers might also possibly be illegal. (McDermott, 8/15)

Hospital Roundup: Highest-Paid Nonprofit Hospital Exec In Mass. Made $4.3M; Rural Colo. Health Centers Get Grant

Hospitals in Massachusetts, Colorado, Missouri, Pennsylvania and Illinois make news today.

Boston Globe: Partners CEO Tops Hospital Pay List
Partners HealthCare’s chief executive, Dr. David Torchiana, topped the list of executives at the state’s largest nonprofit hospitals who received sizable pay raises in 2015, according to their most recent public filings. Torchiana, who oversees the state’s largest health system and largest private employer, earned nearly $4.3 million in total compensation. (Dayal McCluskey, 8/15)

Denver Post: Colorado Health Centers Receive Nearly $2 Million In Federal Grant Money
Colorado health centers in rural or impoverished areas will receive nearly $2 million in federal grant money this year to help better serve their patients. Twenty centers are in line to receive the grants, ranging from the Metro Community Provider Network, which has been awarded about $280,000 in total grant funds, to the Colorado Coalition for the Homeless, which will receive just over $13,000. Centers in southern Colorado, on the Eastern Plains and on the Western Slope were also awarded grants. (Ingold, 8/15)

St. Louis Public Radio: MU Study Finds Successful Ways To Reduce Hospital Admissions Of St. Louis Nursing Home Residents
In 2011, one in four nursing home residents on Medicare was hospitalized. It’s an issue that impacts many facets of health care, from quality of life for nursing home residents to spending of taxpayer dollars, and on Tuesday’s St. Louis on the Air, host Don Marsh spoke with a University of Missouri Nursing School professor about ways to reduce avoidable hospital admissions. (Moffitt, 8/15)

The Philadelphia Inquirer/Philly.com: Bankruptcy Judge Tentatively Approves Girard Medical Center Sale
Pending final review, U.S. Bankruptcy Judge Magdeline D. Coleman on Tuesday said she would approve the sales of North Philadelphia Health System’s properties at Eighth Street and Girard Avenue for a combined $10.25 million. The bulk of the property, including Girard Medical Center and the associated Goldman Clinic, a methadone clinic, will go to Ironstone Real Estate Partners for $8.5 million. Ironstone intends to maintain the property as a behavioral-health and drug-treatment center as long as it has an agreement with a care provider to operate the facilities. (Brubaker, 8/15)

Chicago Tribune: Edward-Elmhurst Hospital System Plans $50 Million In Cuts, Including Layoffs
West suburban hospital system Edward-Elmhurst Health plans to slash $50 million in costs, including through layoffs, in response to many of the same financial pressures afflicting hospitals across Illinois and the country. Edward-Elmhurst CEO Mary Lou Mastro said during a call with reporters Tuesday that the system has not yet determined how many layoffs will be necessary or which positions might be affected. She said the system has already started holding vacant positions open and now has 300 positions that aren't being filled. (Schencker, 8/15)

Contaminated And Unsafe Water Flows Through Communities Across Country

A new research center will study chemicals not yet regulated by the federal government but that have been linked to cancer and other diseases. And News21 releases its investigation that finds as many as 63 million Americans are exposed to unsafe drinking water. In related news, tainted water in a North Carolina river raises questions for state lawmakers.

The Associated Press: Researchers To Study Chemical Contamination Of US Waters
University of Rhode Island and Harvard University professors are collaborating through a new research center to study chemicals that have contaminated water at sites nationwide. The chemicals, called perfluorinated chemicals, have been linked to cancer and other illnesses but aren’t federally regulated in drinking water. Water has been contaminated near sites of industrial facilities and U.S. military bases. (McDermott, 8/15)

News21: 63 Million Americans Exposed To Unsafe Drinking Water
As many as 63 million people — nearly a fifth of the United States — from rural central California to the boroughs of New York City, were exposed to potentially unsafe water more than once during the past decade, according to a News21 investigation of 680,000 water quality and monitoring violations from the Environmental Protection Agency. The findings highlight how six decades of industrial dumping, farming pollution, and water plant and distribution pipe deterioration have taken a toll on local water systems. (Philip, Sims, Houston and Konieczny, 8/14)

The Oregonian: Farm Communities Face Contaminated Water From Manure, Nitrates, Records Reveal 
Yakima County in Washington state, home to around 67 dairy farms, sits on aquifers contaminated by nitrates. In California's San Joaquin Valley, which grows nearly one-quarter of the nation's food, fertilizer and manure spread on farms' fields and orchards have contributed to unsafe nitrate levels in drinking water sources. The drinking water of millions of Americans living in or near farming communities across the country is contaminated by dangerous amounts of nitrates and coliform bacteria from fertilizer and manure widely used in agriculture, a News21 analysis of Environmental Protection Agency records shows. The records reveal that community water systems serving over 2 million people across the country were cited for excessive nitrate levels. (Wang, Tyau and Ybanez, 8/15)

The Associated Press: Unhappy With Governor, Senators Plan Hearing On Chemical
Not satisfied with the answers Democratic Gov. Roy Cooper’s administration gave to their questions about a chemical plant’s releases into a river, North Carolina Senate Republicans announced Tuesday they’re planning to soon hold a public hearing on the matter. Cooper’s health and environmental quality department secretaries are seeking $2.6 million from legislators to address The Chemours Co.’s discharges of chemical GenX into the Cape Fear River, as well as to expand water quality and safety programs statewide. (8/16)

State Highlights: Ohio Co-Op Accused Of Fraud; California Heads Toward Serious Doctor Shortage

Media outlets report on news from Ohio, California, Maryland, Missouri, Pennsylvania, New Hampshire, Texas, Arizona and Colorado.

Columbus Dispatch: Did Healthcare Co-Op Rip Off Small Ohio Communities?
A 4-year-old group of governments created to lower health-care costs for thousands of public employees has been ravaged by accusations of mismanagement and millions of dollars in deficits. The Ohio auditor’s office and some county prosecutors are investigating the Ohio Public Entity Consortium Healthcare Cooperative, a self-insurance program with headquarters near Plain City. (Narciso, 8/15)

San Jose Mercury News: UCSF Study: State Faces Shortage Of Primary Care Clinicians
California is heading for a serious shortfall of primary care doctors, physicians’ assistants and nurse practitioners over the next few decades — a crisis that could force patients to seek medical help for routine illnesses at hospital emergency rooms instead, a new study released Tuesday warns. That alternative is among the most troubling scenarios if a predicted shortage of 4,700 primary care clinicians occurs in California by 2025, according to authors of the UC San Francisco Healthforce Center report. (Seipel, 8/15)

Sacramento Bee: Diabetes Monitor Bill Will Save Lives
Assembly Bill 447, which is making its way through the Legislature, would require Medi-Cal to cover continuous glucose monitors. AB 447 would not only help improve the lives of Medi-Cal patients, but also would help lower health care spending and save taxpayer money. (Berit Bagley, 8/15)

The Baltimore Sun: As Judge Considers Holding State In Contempt, Md. Health Secretary Defends Psychiatric Care
Maryland’s top health official spent more than 90 minutes in court Tuesday morning defending the pace at which the state is moving mentally ill criminal defendants out of jail and into treatment. A Baltimore judge is weighing whether to hold the state in contempt for failing to follow court orders to immediately move those individuals into treatment. At times, they have languished in jail for months waiting for space to open in one of the state-run psychiatric hospitals. (Wood, 8/15)

The Philadelphia Inquirer/Philly.com: Public Health Management Unit Wants To Reclaim Its Independence
The National Nurse-Led Care Consortium, which has been part of Public Health Management Corp. since 2001, wants to leave the Philadelphia organization, alleging that PHMC’s escalating management fee and other problems have jeopardized the consortium’s ability to fulfill its mission of supporting community care led by nurses. The management fee PHMC charges the National Nurse-Led Care Consortium (NNCC) has soared to $403,800 for the year ended June 30 from $196,800 four years earlier, while the consortium’s overall revenue climbed just 27 percent, according to a lawsuit filed Monday in Philadelphia Common Pleas Court seeking to break that deal. (Brubaker, 8/15)

New Hampshire Union Leader: Board Of Medicine Allows Conditional Return Of Doctor Suspended Over Drug Use 
The state Board of Medicine has agreed to allow an anesthesiologist accused of diverting a powerful painkiller for his own use to resume practicing medicine on a limited basis. The board approved a conditional return for Dr. Christopher Manfred, who agreed Jan. 30 to voluntarily stop practicing medicine after the state issued an order temporarily suspending his license over allegations involving the painkiller hydromorphone, an opioid that goes by the brand name Dilaudid. (8/15)

Sacramento Bee: Sacramento Country Ordered To Close Illegal Shelter For Foster Children
More than a year after telling Sacramento County Child Protective Services to stop using a clerical office as a makeshift youth shelter, state officials have ordered the agency to end the illegal practice by a September deadline. The California Department of Social Services wrote in a July letter to Sacramento County Child Protective Services that it must stop letting kids sleep at the county office on Auburn Boulevard near Watt Avenue. (Garrison and Chabria, 8/15)

Houston Chronicle: Houston-Area Organizations Meeting Needs Of Hearing Impaired 
A big misconception among adults with a hearing impairment is that they don't think anything can be done to improve their hearing and are unaware of new hearing technology that can improve hearing in daily activities. Some adults delay getting help because they think they can't afford to purchase hearing aids. Local organizations such as Hear-Say Partners in Hearing - a nonprofit organization for adults with hearing loss that offers hearing loss counseling, recycled hearing aids and affordable new hearing aids, as well as university speech and hearing clinics - can offer hearing testing and speech therapy services that can assist adults who need low-cost services. (Benton, 8/15)

The Washington Post: There’s Plague In Arizona. Authorities Warn Of Fleas That Can Infect People And Pets.
Public health officials in two Arizona counties are warning residents about the discovery of plague bacteria, an endemic concern among those who live in the American Southwest but unsettling, nonetheless, given the disease's devastating impact on human history. Navajo and Coconino counties are adjacent to one another, and in each community the findings are identical: Fleas carrying Yersinia pestis, the bacterium that causes plague, were discovered this month and pose a potentially grave threat to people and their pets, especially cats. (deGrandpre, 8/15)

Denver Post: Lawsuit: Botched Liposuction Highlights Need For Colorado Oversight Of Drugs, Procedures At Plastic Surgery Centers
Allegations that a botched liposuction sent a patient into heart failure has raised questions about why Colorado allows plastic-surgery centers to operate without state oversight, and whether health officials are putting patients in peril by failing to root out sloppy handling of powerful painkillers and anesthetics. The lawsuit names as a defendant Elizabeth Lammot Campbell, who provided anesthetic services for several area plastic surgeons. (Osher, 8/15)

The Associated Press: Prison Doctor Sues State Alleging LGBTQ Discrimination
A psychologist at a California prison facility has alleged she was twice locked in a room with a dangerous inmate in retaliation for reporting mistreatment of LGBTQ inmates. Lori Jespersen sued the California Department of Corrections and Rehabilitation on Monday for violations of civil rights and whistleblower protection laws, as well as the Prison Rape Elimination Act and the Health Insurance Portability and Accountability Act, known as HIPAA. (Ronayne, 8/16)

Prescription Drug Watch

Drugmakers 'Game The System And Game The Rules,' FDA Head Gottlieb Says

News outlets report on stories related to pharmaceutical pricing.

USA Today: FDA Chief Says Drug Makers Are Gaming The System To Slow Generic Competition; Vows Action
A day after President Trump lashed out at the black CEO of drug maker Merck on Twitter, his new Food and Drug Administration commissioner said brand name drug companies are "gaming the system" to block generic competition and vowed to do something about it. Physician and FDA chief Scott Gottlieb declined to comment on Trump's tweet urging Merck's Kenneth Frazier to lower drug prices after Trump's response to the violent Charlottesville, Va., protests prompted Frazier to resign from the White House manufacturing council. However, in a meeting Tuesday with USA TODAY's Editorial Board, Gottlieb didn't mince words when it came to his plans to stop what he said are anti-competitive actions by brand-name pharmaceutical companies that keep prices high. (O'Donnell, 8/15)

Politico: Trump Tweets Up A Storm On Drug Prices But Delivers Little Change
Back in January, Trump had signaled his intention to go after powerful drugmakers at his very first news conference, accusing the industry of “getting away with murder.” The issue is top of mind for voters — a bigger health priority than repealing Obamacare. But the White House has invested little political capital in the issue, appointing industry insiders to key posts while abandoning key campaign pledges to allow Medicare to negotiate drug prices and import cheaper medicines from overseas. (Karlin-Smith, 8/15)

Stat: Who Gets All That Biopharma Lobbying Money?
As the winds shift in Washington, here’s something to depend on: Big pharma and health products companies will be the top spenders on lobbying, and the competition isn’t close. Since 1998, they have doled out $3.7 billion to convince, cajole, entice, or strong-arm Congress and federal agencies — more than $1 billion more than any other industry. That doesn’t count campaign contributions, donations to independent pressure groups, and outlays for politicking at the state level. Since January 2016, the industry has spent about $144 million on federal lobbying, according to data compiled by the Center for Responsive Politics. It can claim a big victory from last year’s passage of the 21st Century Cures Act, which is expected to speed up Food and Drug Administration drug approvals. (Piller, 8/16)

Bloomberg: What’s Harder Than Making Copycat Biotech Drugs? Selling Them 
Big-name drugmakers want to profit from selling lower-priced copies of rivals’ expensive biotechnology drugs. Patients and doctors want to pay less for medicine. Getting those two sides together is harder than it looks. Part of the problem: a web of relationships between drug companies and insurers that shields incumbent drugs and often sidelines upstarts until the market becomes crowded. (Hopkins, 8/15)

Stat: High Drug Prices Loom Large At Gathering Of State Legislators
A representative of the Trump administration on Tuesday made a familiar promise to a crowd of state legislators here: We know high drug prices are a problem. And we’re working to solve it. Lowering drug costs is a “priority,” and the Department of Health and Human Services is “committed to doing all we can to increase affordability and accessibility,” said Jane Norton, HHS’s point person in dealing with state governments. (Robbins, 8/8)

Kaiser Health News: Climbing Cost Of Decades-Old Drugs Threatens To Break Medicaid Bank
Skyrocketing price tags for new drugs to treat rare diseases have stoked outrage nationwide. But hundreds of old, commonly used drugs cost the Medicaid program billions of extra dollars in 2016 vs. 2015, a Kaiser Health News data analysis shows. ... Rising costs for 313 brand-name drugs lifted Medicaid’s spending by as much as $3.2 billion in 2016, the analysis shows. Nine of these brand-name drugs have been on the market since before 1970. In addition, the data reveal that Medicaid outlays for 67 generics and other non-branded drugs cost taxpayers an extra $258 million last year. (Lupkin, 8/14)

Stat: The FDA Made A ‘Grand Bargain’ On Fast Drug Approvals, But Pharma Isn’t Holding Up Its End
The FDA, in an effort to bring promising new therapies to patients as quickly as possible, has introduced a spate of shortcuts to speed up the approval process. Those programs are working as intended, new research finds, but drug companies are often loath to fulfill their obligations. The big idea behind the FDA’s accelerated drug approval program is that regulators will OK a promising drug based on clues that it will improve patient lives, so long as pharma companies later carry out larger trials to confirm those hints of efficacy. But looking at four years of data, a team of researchers found that only 50 percent of those trials actually took place within three years of approval. (Damian Garde, 8/15)

Cleveland Plain Dealer: Poll: Most Ohioans Unclear About Prescription Drug Issue 2
The forces for and against Issue 2 are spending so much money that they could set new records in Ohio in election spending. But six out of 10 registered Ohio voters told Survey USA they don't know much, if anything about Issue 2, according to WOIO Cleveland 19 News, which commissioned the poll with WXIX 19 Cincinnati and WTOL 11 Toledo. (Hancock, 8/8)

The Wall Street Journal: England’s NHS Turns To Clinical Trial To Make Cheaper HIV Drug Available
A branded HIV drug that has been shown to reduce the risk of infection with the virus by 86% is proving too expensive for some at-risk European patients. England’s National Health Service thinks it has a solution. The high price of Gilead Sciences Inc .’s HIV drug Truvada has deterred many countries from providing the pill as a preventive treatment for people at high risk of contracting the AIDS-causing virus, doctors, activists and patients say. (Mancini, 8/11)

Perspectives: Drug Companies Getting Stingy With Subsidies; Supreme Court Deals Blow To Consumers

Read recent commentaries about drug-cost issues.

Los Angeles Times: Drug Companies Are Growing Less Generous In Helping Patients Pay For Meds
Industry watchers say soaring drug prices have prompted many pharmaceutical companies to rethink long-standing programs to help subsidize purchases or even give meds away for free. “More and more people have become aware of these programs, and demand has gone up,” said David P. Wilson, president of PRAM Insurance Services, a Brea firm that helps employers with prescription-drug benefits. (David Lazarus, 8/15)

Stat: A Supreme Court Pharma Case Deals Consumers A Big Loss
The U.S. Supreme Court case of Bristol-Myers Squibb Co. vs. Superior Court of California, which was decided in favor of BMS in June, may seem like an arcane question of legal jurisdiction. It’s anything but.The case centered on a drug called Plavix that BMS developed. Plavix, also known by its generic name, clopidogrel, is an anti-platelet used to prevent blood from clotting inside blood vessels. Ever since the drug was approved by the FDA in 1997, thousands of people have claimed that it caused them gastrointestinal bleeding, severe bleeding from relatively minor cuts, and even brain damage. (Michael Burg, 8/14)

Stat: Eli Lilly's Odyssey To Use A Fake Rule And Fake News To Protect Bad Patents
The story begins in 1991, when Eli Lilly applied for a Canadian patent for its antipsychotic drug, Zyprexa. Five years later, it applied for a Canadian patent for its attention deficit hyperactivity disorder drug, Strattera. In both cases, the company copied its U.S. patent applications without making changes to address the specificities of Canadian patent law, presumably as a cost-saving measure. (E. Richard Gold, 8/16)

JAMA: Value-Based Pricing And State Reform Of Prescription Drug Costs
Faced with increasing prescription drug costs and congressional gridlock, some states have enacted meaningful reforms. In April 2017, New York State became the first public payer in the United States to authorize limits on prescription drug costs based on their therapeutic benefits. Under its new budget legislation, the state can identify high-cost drugs, determine a value-based price, and use enhanced powers to negotiate supplemental rebates to achieve this target price for its Medicaid program. (Thomas J. Hwang, Aaron S. Kesselheim and Ameet Sarpatwari, 8/15)

Editorials And Opinions

Viewpoints: Trump Driving Premium Increases; Opioid Treatment For Prisoners

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

The New York Times: How Donald Trump Is Driving Up Health Insurance Premiums
Health insurance premiums for 2018 are on the rise for many, and for that, most of the blame falls squarely on the shoulders of President Trump. In recent days, a bevy of insurers have announced significant increases for Americans who purchase their coverage on the exchanges .... Reinforcing these developments is an analysis by Charles Gaba of acasignups.net, who projected that at the moment, average premium increases next year are likely to total around 29 percent. Of that, just 8 percentage points will result from medical inflation, and 2 percentage points will stem from the reinstatement of an Obamacare health insurance tax; the balance will be related to the uncertainty that Mr. Trump has created around key pieces of Obamacare. (Steven Rattner, 8/15)

Health Affairs: The ‘Tanning Tax’ Is A Public Health Success Story
When the [tanning] tax was enacted in 2010, the non-partisan Congressional Joint Committee on Taxation estimated that it would bring in $2.7 billion in revenue over 10 years, and would offset some of the costs of the ACA overall. After four years, however, the tax had only brought in about $367 million, far less than the approximate $1 billion originally projected by that time. Some detractors then declared the tax a “failure” and blamed it for the loss of tens of thousands of jobs. Yet these arguments discount the notion that the revenue was perhaps a secondary goal of the tax, behind its ability to deter people from engaging in the dangerous pursuit of indoor tanning. (Elisabeth Ryan, 8/15)

The Wall Street Journal: Medicaid’s Opioid Fix
President Trump last week declared the opioid epidemic a national emergency, which given the human toll may be an understatement. As states beg Washington for more money to treat drug abuse, one question worth asking is whether the gusher of Medicaid dollars has contributed to the crisis. (8/15)

Bloomberg: Prisoners Need Opioid-Addiction Treatment
President Donald Trump’s initial bombastic comments about North Korea last week overshadowed the event he was holding to highlight his administration’s efforts to fight opioid addiction. Unfortunately, there wasn’t much to overshadow. Trump failed to mention, much less embrace, any of the recommendations contained in a new report from his Commission on Combating Drug Addiction and the Opioid Crisis. ... One of the most effective steps the federal government could take went unmentioned: treating addicts who end up behind bars. Each year, about one-third of heroin users spend time locked up, yet federal prisons do not offer medication-assisted addiction treatment. (8/15)

Stat: The FDA Made A ‘Grand Bargain’ On Fast Drug Approvals, But Pharma Isn’t Holding Up Its End
The FDA, in an effort to bring promising new therapies to patients as quickly as possible, has introduced a spate of shortcuts to speed up the approval process. Those programs are working as intended, new research finds, but drug companies are often loath to fulfill their obligations. The big idea behind the FDA’s accelerated drug approval program is that regulators will OK a promising drug based on clues that it will improve patient lives, so long as pharma companies later carry out larger trials to confirm those hints of efficacy. But looking at four years of data, a team of researchers found that only 50 percent of those trials actually took place within three years of approval. (Damian Garde, 8/15)

Stat: I Went To Medical School In Charlottesville. I Know White Anger Well
After watching the violence unfold in Charlottesville, Va., over the weekend, after watching white supremacists descend on the city where I went to medical school, and onto the University of Virginia campus where I became a doctor, this is what I said to myself. I’ve seen this anger before. For four years, my task was to learn to treat people who were sick. Even the ones who wore their Confederate pride openly, even the ones who threatened to shoot me on home health visits. My task was to learn from experienced physicians how to help people get well. Even when they witnessed racist behavior directed toward me. Even when they glossed over that bigotry. (Jennifer Adaeze Okwerekwu, 8/14)

Los Angeles Times: Vaccination Rates Are Up In California, But Pockets Of Resistance Still Threaten Everyone
As the new school year begins, parents have reason to worry about what their kids may be exposed to in the classroom. Despite an overall increase in kindergarten vaccination rates to 95.6% since 2015, when the Legislature stopped allowing public school students to skip their shots simply because of their “personal beliefs,” a Los Angeles Times analysis found that at nearly 750 California schools, most of them charter or private schools, 90% or fewer of the kindergartners had their full course of vaccinations against diseases such as measles, polio, and whooping cough. The optimal rate for preventing a measles outbreak is 95%. (8/15)

The New York Times: 10 Things My Chronic Illness Taught My Children
My children have a mother with a chronic illness. They live with my rheumatoid arthritis just as much as I do. I was given my diagnosis when all three of them were young, and since then I’ve spent a lot of time worrying about what the daily uncertainty of my condition would mean to them, and whether it would affect their development. They are all teenagers now, one getting ready for college, and I can attest that my illness has indeed affected them. Here’s how. (Paula M. Fitzgibbons, 8/16)

Sacramento Bee: Democrats Must Stand Up For Abortion Rights
As Democratic leaders search for ways to win in 2018, some have recently suggested that women’s rights and reproductive health care are dispensable. ...Such a strategy would not only betray what it means to be a Democrat, it would also be destined to fail. (Amy Everitt, 8/15)

Arizona Republic: Arizona's Abortion Crusade Just Cost Us Another $600,000
Cathi Herrod’s crusade to make life as miserable as possible for women who seek abortions just cost us another $600,000. A U.S. District Court judge on Monday ordered the state to reimburse Planned Parenthood and other abortion providers for their costs in fighting yet another unconstitutional law passed by our leaders. (Laurie Roberts, 8/15)

Des Moines Register: How You Can Prevent Medication Errors
[T]he risk of preventable drug errors does not end when you leave the hospital. Consumers are accidentally harming themselves at home with their own medications. The rate of serious medication mix-ups has doubled since 2000, according to a new study. ... Too many Americans take the wrong medication, take drugs in the wrong dose or inadvertently take them twice. ... Among the simple suggestions from the Centers for Disease Control and Prevention: don’t share prescriptions or take anyone else’s, read the label and warnings, dispose of drugs you’re no longer supposed to take, turn on a light to check bottles if you take medication at night and keep prescriptions away from children. (8/15)

Atlanta Journal-Constitution: Glen Campbell’s Death ‘Brings Alzheimer’s Out Of The Shadows.’ Now What?
Campbell was diagnosed in 2011. He died a week ago at age 81, having helped bring “Alzheimer’s out of the shadows and into the spotlight.” He became a public face of the disease in 2014 when he allowed a film crew to shoot his final tour for the award-winning documentary “I’ll Be Me.” Alzheimer’s, a progressive disease of the brain, is best known for causing memory loss, but it also has other debilitating effects on the body, and can affect people’s ability to move and eat by themselves. There is no cure for the illness. If you’re fortunate enough to have to imagine what that’s like, count it a blessing and hope it never happens to you. Anyone left holding the memories will tell you there’s never been a more lonely or trying place. (Gracie Bonds Staples, 8/15)

JAMA: Consideration Of Dental, Vision, And Hearing Services To Be Covered Under Medicare
[T]here is public and legislative support for the recognition of dental, vision, and hearing services as an integral part of overall health and health services. The evidence points to consideration of ways to include such services in available coverage options under the Medicare program. Low-income older adults are at a greater risk of forgoing necessary services not covered by Medicare that have consequences for the rising costs of the covered services such as avoidable hospitalizations and emergency department visits. (Amber Willink, Cathy Schoen and Karen Davis, 8/15)