KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Kaiser Health News Original Stories

Political Cartoon: 'Now And Later?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Now And Later?'" by RJ Matson.

Here's today's health policy haiku:

DRUG PRICES AND POPULARITY

Trump blasts head of Merck
But drug prices will not fall.
Only poll numbers.

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Summaries Of The News:

Administration News

After Hemming And Hawing, White House Says It Will Make August Payments To Insurers

These payments, known as cost-sharing reductions, are paid to health plans to offset the costs of providing coverage to low-income consumers. The decision, which drew criticism from some congressional conservatives, signals, for now, that the administration has decided against triggering a collapse of the health law's individual market. This step could create a window of time and opportunity for Congress to pass some fixes to stabilize the markets.

The Associated Press: White House: Gov't To Make Health Law Payments This Month
The government will make this month’s payments to insurers under the Obama-era health care law that President Donald Trump still wants to repeal and replace, a White House official said Wednesday. ... A White House spokesman said “the August payment will be made,” insisting on anonymity to discuss the decision ahead of the official announcement. The so-called “cost-sharing” subsidies total about $7 billion this year and are considered vital to guarantee stability for consumers who buy their own individual health insurance policies. (Alonso-Zaldivar, 8/16)

The Hill: Trump To Make ObamaCare Payments To Insurers For August 
Insurers have been asking Congress and the administration for certainty that they’ll continue to receive cost-sharing reduction payments (CSRs), which compensate insurers for subsidizing the out-of-pocket costs for low-income enrollees. Instead, the administration has been making the payments on a monthly basis. (Roubein, 8/16)

The Wall Street Journal: White House: Health-Insurer Payments Will Be Made In August
Governors and Democratic lawmakers have been urging President Donald Trump to continue the payments, known as cost-sharing reduction payments, because insurers have said they may pull out of the ACA’s insurance markets or raise premiums in 2018 without the funding. The nonpartisan Congressional Budget Office said in a report Tuesday that premiums for popular, midprice plans on the ACA exchanges would rise 20% next year without the payments. (Armour and Radnofsky, 8/17)

Los Angeles Times: Trump Administration, Facing Pressure, Agrees To Continue Obamacare Subsidy For Now
The decision to make this month’s payment, which was due next week, signaled that the administration has decided against immediately precipitating a collapse, potentially giving Congress time to pass a bipartisan package of fixes to some of the law’s problems. Leading Republican members of Congress have pressed the administration to keep making the payments, fearing that any move to cut them off would cause chaos in insurance markets. Trump has said voters would blame Democrats for any problems with the markets, but few Republican elected officials share that view. (Lauter, 8/16)

Politico: Trump Administration Will Make This Month’s Obamacare Payments But Leaves Program’s Future In Limbo
The administration's decision was immediately denounced by an influential GOP House conservative, suggesting mounting tensions among Republicans about how to move forward on health care after the repeal effort collapsed in the Senate late last month. ... "Instead of the executive branch issuing unconstitutional payments to bail out insurance companies, the Senate should continue working until they have passed a bill to repeal and replace Obamacare," [Rep. Mark] Walker said in a statement. "Their constituents are tired of their inability to fulfill their promise." (Demko, 8/16)

Trump Poised To End Contraception Requirement For Employee Health Benefits

President Donald Trump is expected to issue a regulation allowing employers with religious objections to omit coverage for contraception from their workers’ insurance plans. In other Trump administration news: the Department of Health and Human Services names 14 people to its mental health panel; the cancellation of several payment reforms is complicating efforts by the Centers for Medicare & Medicaid Services to promote value-based care; and the National Parks Service lifts a ban on selling plastic water bottles in the parks.

The Wall Street Journal: Trump Set To Roll Back Obama-Era Contraception Rule
The Trump administration is poised to issue a rule unwinding an Obama -era requirement that employee health benefits include contraception, which will spark a fresh round of litigation over an issue that has been before courts for six years. Federal health officials are expected to finalize a regulation that would allow employers with religious or moral objections to birth control to omit coverage for contraception from their workers’ plans, according to two people familiar with its contents. The regulation closely mirrors an earlier, leaked draft, they said. (Hackman and Radnofsky, 8/16)

Stat: HHS Picks Members From The Public For New Mental Health Commission
The Department of Health and Human Services on Wednesday appointed 14 people from outside government to join a new commission tasked with addressing serious mental illness throughout the United States. The Interdepartmental Serious Mental Illness Coordinating Committee, which consists of 10 leaders or designees from federal departments and 14 outside experts, was created via the 21st Century Cures Act, which then-President Barack Obama signed into law in December. (Facher, 8/16)

Modern Healthcare: Cancellation Of Bundled Payment Models Reflects White House's Stance On Value Based Care
The Trump administration's moves to cancel two mandatory bundled payment models and scale back on another means the CMS has to work hard to push providers into value-based care, experts say. On Tuesday, the CMS cut the number of locations mandated to participate in the Comprehensive Care for Joint Replacement, or CJR, model from 67 to 34. It also canceled Episode Payment Models and the Cardiac Rehabilitation incentive payment models that were supposed to begin on Jan. 1, 2018. (Dickson, 8/16)

CQ Roll Call: CMS Bids To End, Alter Medicare Pay Tests Draw Mixed Reactions
The Trump administration's bid to end or alter three Obama-era tests of alternative approaches to Medicare payments prompted both applause and disappointment on Wednesday from the health care industry. Some groups expressed a desire to push ahead with a drive to use reimbursement policy to try to improve the quality of health care, while others conveyed relief at the prospect of an end to potential payment challenges. (Clason, 8/16)

San Francisco Chronicle: Trump Administration Kills Push To Ban Bottled Water In National Parks
The National Park Service announced Wednesday that, effective immediately, it will no longer allow parks to ban the sale of plastic water bottles, which have long been criticized for littering lakes and forests. Since 2011, as part of the Green Parks Plan adopted under former President Barack Obama, the Park Service has encouraged the use of tap water and refillable bottles on federal lands, while allowing parks the option to prohibit the sale of disposable water bottles in shops, hotels and vending machines. (Alexander, 8/16)

Health Law

Three N.H. Insurers Confirm Their Intent To Stay In The Obamacare Exchange

The companies -- Anthem, Harvard Pilgrim and Ambetter by NH Healthy Families -- will offer plans on the health exchange for 2018. But the continuing uncertainty regarding federal health law action led regulators in nearby Massachusetts to delay the approval of individual and small business insurance rates that are set to take effect Jan. 1. News outlets also report on rate hikes and turmoil in Iowa and Georgia.

The Associated Press: Companies Set To Participate New Hampshire Insurance Market
Uncertainty over which health insurers will continue coverage under the Affordable Care Act in New Hampshire ended Wednesday, with three companies confirming their participation before the deadline. ... Anthem, Harvard Pilgrim, Ambetter by NH Healthy Families all had indicated earlier this year they planned to continue in the marketplace, but in recent weeks declined to reaffirm their commitments. All three, however, had done so by Wednesday’s deadline for states to submit all 2018 plan information, other than rates, to the federal government. (Ramer, 8/16)

New Hampshire Union Leader: Anthem, Harvard Pilgrim To Offer Plans On Obamacare Exchange In 2018
Anthem and Harvard Pilgrim have confirmed they will offer plans on the Obamacare health exchange in New Hampshire for 2018, along with Ambetter, state officials announced Wednesday. But Minuteman Health, which announced in June it was pulling out of the New Hampshire market in 2018, said its senior management wasn’t able to meet Wednesday’s deadline to secure licensing approval for a new health insurance company, Minuteman Insurance Company, to offer policies on the exchange. (Cousineau, 8/16)

Concord Monitor: Three Companies Will Stay In N.H.’s Health Insurance Market
The New Hampshire health insurance marketplace will have three companies in 2018, after Anthem and Harvard Pilgrim confirmed Wednesday that they will offer plans through the exchange. Anthem covers about 27,000 state residents, and Harvard Pilgrim covers about 11,000 residents through HealthCare.gov and the state’s Medicaid expansion program. (8/16)

Boston Globe: Minuteman Health Won’t Relaunch As For-Profit
Minuteman Health Inc., a small Boston-based health insurer, has failed to raise enough money to continue selling plans next year, forcing thousands of people in Massachusetts and New Hampshire to find new health insurance for 2018. ... Insurance companies are required by state regulators to keep a certain level of cash on hand to pay claims. (Dayal McCluskey, 8/16)

Boston Globe: Amid Uncertainty, State Delays Approval Of 2018 Insurance Rates
The uncertainty about the future of national health policy reverberated in Massachusetts Wednesday when state regulators delayed approving insurance rates for individuals and small businesses that are set to kick in Jan. 1. ...Without the subsidies — expected to total $132 million in Massachusetts next year — insurers would be forced to sharply increase their prices, they say. (Dayal McCluskey, 8/16)

Des Moines Register: Sole Obamacare Insurer In Iowa Seeks 57 Percent Rate Hike
Iowans who buy their own health insurance through the Affordable Care Act exchange would see their rates increase nearly 57 percent next year under a revised rate proposed Wednesday. The proposal is 13 percentage points higher than previously was estimated by Medica, the one remaining carrier selling individual policies in Iowa next year. Medica attributed the additional increase to uncertainties over federal health care subsidies, the insurer said in a release. (Clayworth, 8/16)

In related news —

Politico Pro: Failure Of Obamacare Repeal Raises Stakes For State Waiver Bids
The demise of Republicans’ Obamacare repeal effort is putting more pressure on the Trump administration to allow states more leeway to carve out major pieces of the 2010 health care law. ... More requests could follow to force people who get subsidized insurance to pay part of the cost based on their incomes and subject those who’ve let their coverage lapse to waiting periods before they can re-enroll. (Colliver, 8/16)

Capitol Hill Watch

Questions About Congressional Rules Could Complicate Further Repeal Efforts

Politico Pro reports that the Senate parliamentarian is looking into whether Republicans can continue to debate the replacement of the federal health law using fast-track procedures set up under the 2017 budget after the fiscal year ends on Sept. 30. In other news, Sen. Johnny Isakson talks about health issues and a look at how women view the health care debate.

Politico Pro: Parliamentarian Weighs Whether Senate GOP Can Push Fast-Track Repeal After Fiscal 2017
As President Donald Trump and conservatives push the Senate to take another stab after the August recess, the parliamentarian is considering whether the 2017 budget — which set up the rules for the expedited process of passing legislation with a simple majority — can still apply after the 2017 fiscal year ends on Sept. 30, according to Democratic sources. There is no precedent for using a budget reconciliation bill after the fiscal year ends. (Haberkorn, 8/17)

Kaiser Health News: Often Missing In The Health Care Debate: Women’s Voices
Women are hardly speaking in unison when it comes to overhauling health care. “Women’s health” means very different things to different people, based on their backgrounds and ages. A 20-year-old may care more about how to get free contraception, while a 30-year-old may be more concerned about maternity coverage. Women in their 50s might be worried about access to mammograms, and those in their 60s may fear not being able to afford insurance before Medicare kicks in at 65. ... To get a richer sense of women’s viewpoints on health care as the national debate continues, we asked several around the country and across generations to share their thoughts and personal experiences. (Gorman and Gold, 8/17)

Marketplace

UnitedHealth CEO Stephen Hemsley Steps Down

The insurer's current president David Wichmann will take over the position while Hemsley, who has been with the health plan since 1997, will move into a newly created role as executive chairman of the board of directors.

The Wall Street Journal: UnitedHealth Names David Wichmann As New CEO
UnitedHealth Group Inc. said David S. Wichmann, its current president, will next month succeed Stephen J. Hemsley as chief executive, a widely expected transition at the top of the nation’s largest health insurer. Mr. Wichmann, 54 years old, will take over the CEO job on Sept. 1, and Mr. Hemsley, 65, who has held the title since 2006, will become executive chairman. UnitedHealth Group’s current board chairman, Richard Burke, will then take the title of lead independent director. (Wilde Mathews, 8/16)

The Associated Press: UnitedHealth CEO To Step Down After Run Of More Than Decade
UnitedHealth Group has picked company President David Wichmann to replace CEO Stephen Hemsley in a long-planned transition that Wall Street greeted with polite applause.The nation’s largest health insurer says Wichmann, 54, will take over Sept. 1, and Hemsley will become executive chairman of the company’s board. Current Chairman Richard Burke will shift to lead independent director. (Murphy, 8/17)

Modern Healthcare: UnitedHealth CEO Hemsley Stepping Down
UnitedHealth CEO Stephen Hemsley is stepping down from the helm of the nation's largest health insurer. David Wichmann, the Minnetonka, Minn.-based insurer's president, will take over as CEO and become a director of the company on Sept. 1. Hemsley, who has been with the health plan since 1997, will remain with the insurer in a newly created role as executive chairman of the board of directors. (Livingston, 8/16)

Hacks Targeting Health Care Data Spike 162% Over Last Year

Security experts account for the jump by saying that hacking has gotten easier and more organizations are now reporting incidents. Meanwhile, Bayada Home Health Care and St. Luke's Health System also make industry news.

Modern Healthcare: Healthcare Data Breaches Caused By Hacks Are On The Rise 
Data breaches caused by hacking, so-called IT incidents and unauthorized access are on the rise, with 162% more incidents at healthcare organizations so far in 2017 as there were in all of 2016, according to data from HHS' Office for Civil Rights. Security experts said that's because hacking has gotten easier and organizations are now reporting incidents they previously might have kept quiet about. (Arndt, 8/16)

The Philadelphia Inquirer/Philly.com: Bayada Home Health Transfer To Nonprofit Will Start Next Spring
Giving away a health-care business with operations in 22 states and five foreign countries is not easy. That’s what J. Mark Baiada has found since June 2016, when he announced his intention to turn Bayada Home Health Care into a nonprofit to protect it from a sale and ensure that its mission endures. The process will start in April and is expected to take 18 months to two years because it is a complicated process, Baiada said Wednesday. (Brubaker, 8/17)

Houston Chronicle: Deposed St. Luke's CEO Staying On Longer 
In an unusual change of plans, deposed St. Luke's Health System CEO Michael Covert is staying on until his replacement is selected and assumes office. Catholic Health Initiatives, St. Luke's owner, in late June announced that Covert had submitted his resignation and said they expected to name interim leadership in the next two weeks. A statement at the time said the interim leader would work with the board of directors to launch a national search. (Ackerman, 8/16)

Public Health And Education

Some N.H. Communities To Follow Lead Of State A.G. And Take Legal Action Against Opioid Company

In related news, the nation's largest pharmacy benefit manager is taking the controversial step of limiting the number and strength of first-time prescriptions for opioids. And let's not forget about drugged drivers' risk of overdose and new statistics that indicate the nation is drinking more.

New Hampshire Public Radio: Manchester Likely To File Its Own Lawsuit Against Opioid Companies
Last week, the New Hampshire Attorney General’s Office took its first steps to sue an opioid company — Purdue Pharma — over its alleged role in the state’s addiction crisis. Now, some local communities may soon follow with lawsuits of their own. Back in May, Manchester officials signed a contract with a New York-based law firm — Napoli Shkolnik — to explore the possibility of legal action against drug manufacturers. (McDermott, 8/16)

The Associated Press: Express Scripts To Limit Opioids; Doctors Concerned
The nation’s largest pharmacy benefit manager will soon limit the number and strength of opioid drugs prescribed to first-time users as part of a wide-ranging effort to curb an epidemic affecting millions of Americans. But the new program from Express Scripts is drawing criticism from the American Medical Association, the largest association of physicians and medical students in the U.S., which believes treatment plans should be left to doctors and their patients. (Salter, 8/17)

The Associated Press: Overdoses On The Road: Drugged Driving Rises As A Menace
Car crashes caused by overdosing drivers are becoming so commonplace, authorities say, that some rescue crews immediately administer the antidote, naloxone, to any unresponsive driver they find at an accident scene. People who use heroin and related drugs are sometimes so eager to get high, or so sick from withdrawal, that they’ll shoot up in the car as soon as they get their hands on more, police say. Often they’re back on the road before the overdose takes hold, and they lose consciousness, a recipe for traffic accidents. (Stacy and Welsh-Huggins, 8/17)

NPR: With Heavy Drinking On The Rise, How Much Is Too Much?
If one glass of wine takes the edge off, why not drink a few more? This thinking may help explain the findings of a new study that points to an increase in drinking among adults in the U.S., especially women. "We found that both alcohol use and high-risk drinking, which is sometimes called binge-drinking, increased over time," says Deborah Hasin, a professor of epidemiology at the Columbia University Medical Center and an author of the study. (Aubrey, 8/16)

Nurses Need Better Education About Maternal Mortality To Help New Moms, Survey Finds

Postpartum nurses often fail to warn mothers about potentially life-threatening complications following childbirth due to their own lack of information. In other maternal health care news, hospitals and groups work to close the breast-feeding disparities among African-American and Hispanic women. And research finds that microbes may help reduce the risk of sepsis in newborns.

NPR and ProPublica: Many Nurses Lack Knowledge Of Health Risks To Mothers After Childbirth
In recent months, mothers who nearly died in the hours and days after giving birth have repeatedly told ProPublica and NPR that their doctors and nurses were often slow to recognize the warning signs that their bodies weren't healing properly. A study published Tuesday in MCN: The American Journal of Maternal/Child Nursing substantiates some of those concerns. Researchers surveyed 372 postpartum nurses nationwide and found that many of them were ill-informed about the dangers mothers face after giving birth. (Martin and Montagne, 8/17)

The New York Times: Working To Close The Breast-Feeding Gap
“When your mother hasn’t breast-fed, it’s hard to get that support to breast-feed your own child,” Dr. McKinney said. “This is where health care providers have the opportunity to step in.” ... She was the lead author of a National Institutes of Health community study published last summer in Pediatrics, which found that the newborns of African-American women were nine times more likely than the babies of white mothers to be given formula in hospitals – a factor the researchers considered a significant contributor to the entrenched disparity in breast-feeding rates between black, white and Hispanic mothers. (Miller, 8/17)

NPR: Sepsis Risk For Newborns Reduced By Probiotic Bacteria
Feeding babies the microbes dramatically reduces the risk newborns will develop sepsis, scientists report Wednesday in the journal Nature. Sepsis is a top killer of newborns worldwide. Each year more than 600,000 babies die of the blood infections, which can strike very quickly. (Doucleff, 8/16)

State Watch

Court Finds Ark. Can Keep Medicaid Funding From Planned Parenthood

The decision, reversing earlier lower court injunctions, was issued by the 8th Circuit Court of Appeals.

Politico: Court Rules Arkansas Can Block Medicaid Funding From Planned Parenthood
The ruling Wednesday by the 8th U.S. Circuit Court of Appeals vacates preliminary injunctions from a federal judge that required the state to continue Medicaid payments following legal challenges brought by three patients challenging Gov. Asa Hutchinson's 2015 decision to end the state's Medicaid contract with the women's health group. (Ehley, 8/16)

The Associated Press: Federal Court: Arkansas Can Block Planned Parenthood Money
A federal appeals court panel ruled Wednesday that Arkansas can block Medicaid funding to Planned Parenthood, two years after the state ended its contract with the group over videos secretly recorded by an anti-abortion group. In a 2-1 ruling, an 8th U.S. Circuit Court of Appeals panel vacated preliminary injunctions a federal judge issued preventing the state from suspending any Medicaid payments for services rendered to patients from Planned Parenthood. Republican Gov. Asa Hutchinson ended the state’s Medicaid contract with the organization in 2015. (DeMillo, 8/17)

KUAR (Little Rock, Ark., Public Radio): Appeals Court Rules Arkansas Can Block Money For Planned Parenthood
"Clearly we disagree with this," Planned Parenthood spokeswoman Bonyen Lee-Gilmore told KUAR News. A decision about whether to appeal this decision to the full 8th Circuit or U.S. Supreme Court has not yet been made, she said. "We are exploring all of our options to affirm our patients rights to access healthcare. And it’s not only our belief, but every other federal court has protected Medicaid patients who rely on Planned Parenthood, including the 5th, 6th, 7th and 9th circuits." (Hibblen, 8/16)

Feds Want Texas To Pay $18.9M Back To Medicaid For Improper School Health Services Bills

Reimbursement requested by the Texas Health and Human Services Commission between 2010 and 2011 were not “reasonable, adequately supported, and otherwise allowable” for some school-based health services, according to an Inspector General's report. Meanwhile, Kansas' privatized Medicaid sytem ranks last in a customer satsifaction survey among the 36 states that offer managed care programs.

Dallas Morning News: Medicaid Overpaid Texas $18.9 Million For School-Based Health Services, Seeks Refund
Texas received $18.9 million from Medicaid for school-based health services that were billed improperly, and the federal government is seeking to get the money back. The School Health and Related Services, or SHARS program, allows Texas school districts to request Medicaid reimbursement for providing medically necessary health services to qualified children, age 20 or younger, who have disabilities. Among other things, the services can include counseling, physical and speech therapy, transportation and nursing. (Rice, 8/16)

Kansas City Star: J.D. Power Ranks KanCare Last In Customer Satisfaction
Kansas’ privatized Medicaid system, KanCare, came in last among 36 states’ managed care Medicaid programs in a customer satisfaction survey conducted by the firm J.D. Power. The firm ranked patient satisfaction on a 1,000-point scale based on how consumers responded to questions about six areas: provider choice, coverage and benefits, customer service, cost, information and communication, and claims processing. (Marso, 8/16)

And in New Hampshire —

Concord Monitor: N.H. Reliance On ‘Voluntary’ Donations To Pay For Expanded Medicaid Questioned Before 
The federal government’s warning that New Hampshire must change the way it pays for expanded Medicaid or risk losing funding isn’t the first time the state’s reliance on “voluntary” contributions has been questioned. By law, New Hampshire requires donations from the state’s hospital and insurance associations to make up the difference as federal funds decline. Because of that funding structure – expected to be about $50 million over a two-year period – there’s no way to know which hospitals or insurers pay how much, and according to what formula. (Duffort, 8/16)

New Hampshire Union Leader: Medicaid: Hassan Enlisted Hired Gun As Governor 
Then-Gov. Maggie Hassan deployed a prominent New York law firm 15 months ago to convince the Obama administration to drop opposition to how the state would help pay for New Hampshire’s Medicaid expansion, according to documents the New Hampshire Union Leader has obtained. While this got the key federal agency to silence its unrest through the 2016 election, that opposition came roaring back this spring with a new President and program administrator. (Landrigan, 8/17)

Kansas' Osawatomie State Hospital Passes Inspection

The psychiatric hospital lost its certification in 2015, which resulted in a loss of about $1 million a month in federal funding for the state, but it now appears to be back on track. Meanwhile, in Oregon, Willamette Valley Behavioral Health plans to sue the state over the rejection of its plan to build a 100-bed psychiatric hospital. In addition, the cause of the illness at New Hampshire's Exeter Hospital is still unclear and two Florida cancer centers face fraud allegations.

Wichita Eagle: Osawatomie State Hospital Passes Inspection
A Kansas psychiatric hospital that lost its federal certification in 2015 — causing the state to lose $1 million a month in federal funding — passed an initial inspection this week, a first step toward getting recertified. Osawatomie State Hospital completed a successful inspection on Tuesday, said the Kansas Department for Aging and Disability Services. (Shorman, 8/16)

KCUR: Osawatomie State Hospital Back On Track For Recertification, Officials Say
Kansas officials have cleared an initial hurdle in their effort to regain federal certification for Osawatomie State Hospital. Problems that federal inspectors cited in May have been fixed, making the state’s largest mental health hospital eligible for a full recertification inspection, according to the Kansas Department for Aging and Disability Services. That inspection must take place within the next 120 days, according to KDADS Secretary Tim Keck. (McLean, 8/16)

The Oregonian: Hospital Chain To Sue State Over Rejection Of Wilsonville Plan
The beleaguered Oregon Health Authority, under fire since the release of internal records revealed its plan to smear a health care provider it regulates, got more bad news Wednesday. Willamette Valley Behavioral Health has notified the state it will be filing a lawsuit in connection with the agency's rejection of a proposed 100-bed psychiatric hospital in Wilsonville. Jason Conger, a former state legislator now practicing law in Bend and representing Willamette, accused the agency of acting on behalf of competing mental health treatment providers. (Manning, 8/16)

New Hampshire Union Leader: Cause Of Exeter Hospital 'Illness' Still Unknown
Nearly a week after 19 workers at Exeter Hospital suddenly felt dizzy and nauseous inside the operating department, officials say the cause of the illness remains a mystery. The hospital said it’s conducting an internal investigation in hopes of finding the source, but so far no one has been able to pinpoint the culprit. (Schreiber, 8/16)

The News-Press: 2 Florida Cancer Centers Accused Of Medicare Fraud, Unsafe Practices
Two of the nation’s largest cancer-care providers are accused of engaging in an illegal “gentleman’s agreement” to divide up treatment services in Florida. The allegation against Florida Cancer Specialists & Research Institute and 21st Century Oncology lists multiple claims — gender discrimination, fraudulent Medicare billing and unsafe medical practices — against the companies in a 50-page federal whistleblower lawsuit filed last year that had, until recently, been under seal and out of the public eye. (Gluck, 8/16)

State Highlights: ER Doctors Face Racism From Patients; More Cities Use Doulas To Combat Infant Mortality

Media outlets report on news from Oregon, Maryland, New York, Illinois, Arizona, California, Virginia, Alaska, Washington and Massachusetts.

Sacramento Bee: Racism In ER: Patients Refuse Doctor's Treatment Because Of Her Race
A doctor in Oregon has touched a nerve with a series of tweets revealing that some “white nationalists” have refused treatment from her because of her race. Esther Choo, an emergency physician and associate professor at Oregon Health & Science University in Portland, according to Refinery 29, described on Sunday how she treats those patients with “compassion” because “the best thing I can do is make sure their hate finds no purchase here.” (Gutierrez, 8/16)

Stateline: Cities Enlist ‘Doulas’ To Reduce Infant Mortality
African-American women have a long history with doulas, particularly during the Jim Crow era when hospitals denied access to pregnant black women, forcing many to deliver their children at home, said Andrea Williams-Salaam, a doula trainer in the Baltimore program. But as legal racial barriers vanished and the medical profession strongly promoted hospital deliveries as the safest option, fewer women practiced as doulas. A few continued to work in Baltimore, she said, but when the city decided to start training doulas, it followed the example of New York, which started its doula program in 2010. So far New York has trained 68 doulas who have attended 580 births. (Ollove, 8/17)

The Associated Press: Transgender New Yorkers Have New Health Insurance Protection
Transgender individuals in New York state have new protections when it comes to health insurance coverage.Democratic Gov. Andrew Cuomo says health insurers can't deny coverage based on gender identity. A state Department of Financial Services letter Wednesday tells health insurers to take reasonable steps to determine if the insured is eligible for services before denying a claim. (8/17)

Chicago Sun Times: Chicago Making Progress In Closing Racial Gap In Breast Cancer Deaths
Chicago is making “remarkable” progress in a longstanding battle to improve public health—by closing the “mortality” gap between black and white women diagnosed with breast cancer. According to a new study published by Cancer Cause & Control, an international journal of studies of cancer in human populations, Chicago made the “most progress” among nine major cities with the nation’s largest black populations in reducing “racial disparities in breast cancer mortality.” (Spielman, 8/16)

USA Today: Bubonic Plague In Arizona: Fleas Found Carrying Infectious Disease
Fleas tested positive for the the bubonic plague in two counties in Arizona, with public health officials warning the infectious disease that claimed millions in the Middle Ages may exist in other nearby locations, too. The plague's presence in Arizona follows three confirmed human cases in New Mexico earlier this year. (Hafner, 8/16)

The Mercury News: Santa Clara County Report Shows Surge In Homeless Deaths
The number of homeless deaths in Santa Clara County increased 164 percent from 2011 to 2016 — with a sharp spike in the last year — some of which can be attributed to an increasingly aging population, according to a new report. ...While the full report is expected to be available in coming days, the summary released Wednesday showed that the average age of the deceased homeless has been over 50 through the years, and jumped to 62 in 2016. (Kurhi, 8/16)

The Associated Press: Governor Approves $700,000 Grant For Company
A biotech nonprofit is planning to expand its global headquarters in Virginia Beach thanks in part to help with state funds. Virginia Gov. Terry McAuliffe’s office announced Monday that LifeNet Health will spend $12.24 million for the expansion and create 321 new jobs. (8/17)

The Associated Press: Governors Of 2 Pot States Push Back On Trump Administration
Governors in at least two states that have legalized recreational marijuana are pushing back against the Trump administration and defending their efforts to regulate the industry. Alaska Gov. Bill Walker, a one-time Republican no longer affiliated with a party, sent a letter to U.S. Attorney General Jeff Sessions this week asking the Department of Justice to maintain the Obama administration’s more hands-off enforcement approach to states that have legalized the drug still banned at the federal level. (Bohrer, 8/17)

Boston Globe: When It Comes To Marijuana Foods, Regulation Drives Innovation
Marijuana-infused product manufacturers, which make a highly regulated, often psychoactive product that’s still illegal under federal law, face more than most — a reality coming soon to Massachusetts. ...The struggles and triumphs of such businesses in Colorado, where stores have been selling retail marijuana for three years and seven months, offer a preview of Massachusetts’ future. (Miller, 8/16)

Weekend Reading

Longer Looks: Opioids, European Health Care And White Nationalism

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

The New Yorker: Trump Misdiagnoses The Opioid Crisis
During the 2016 Presidential campaign, when Donald Trump was asked about the opioid crisis he often mentioned that he first learned about the severity of the situation in New Hampshire, which he visited several times ahead of that state’s primary. In 2014, after West Virginia, New Hampshire had the second-highest rate of death from opioid and heroin overdoses, at twenty-two out of every hundred thousand residents. (Amy Davidson Sorkin, 8/13)

The Economist: The Fix For American Health Care Can Be Found In Europe
Mitch McConnell was visibly distraught after the Republicans’ “skinny repeal” of Obamacare was defeated in the Senate, but he was not too out of sorts to get in a dig at Europe. The majority leader wondered acidly what ideas Democrats might have for fixing American health insurance, and noted that most Democratic senators had voted “present” on a bill proposing that America should embrace a single-payer system. (8/10)

The Atlantic: Is It Unhealthy To Be Overweight? 
Is being a little bit overweight bad for you? Could it lead to an untimely death? It’s a question with real consequences. Many overweight people feel locked in a fruitless battle with their size. (Olga Khazan, 8/14)

Stat: White Nationalists Flock To Genetic Ancestry Tests. Some Don't Like The Result
It was a strange moment of triumph against racism: The gun-slinging white supremacist Craig Cobb, dressed up for daytime TV in a dark suit and red tie, hearing that his DNA testing revealed his ancestry to be only “86 percent European, and … 14 percent Sub-Saharan African.” The studio audience whooped and laughed and cheered. (Eric Boodman, 8/16)

Vox: 4 Fixes For The Astonishing Lack Of Vegetables In The American Diet
Doctors and health advocates have been urging Americans to choose broccoli over brownies for years, to no avail. So it’s abundantly clear that we now need to find other ways to incentivize and entice people to make different choices at the market.There is some good news here. A variety of strategies — from subsidizing produce to enlisting celebrities to market it to enabling doctors to write prescriptions for it — are being tested across the nation. (Julia Belluz, 8/15)

Editorials And Opinions

Viewpoints: CBO's Surprising Findings; Medicaid Enrollees Feel Powerless

A selection of opinions on health care from across the nation.

The Wall Street Journal: Blame-Sharing On ObamaCare
The oracles at the Congressional Budget Office this week descended from Delphi to predict 20% premium increases if the Trump Administration ends illegal Obama Care subsidies for insurers, and Democrats are happy to agree. Yet a careful reading of the report reveals some surprising results that are far less ominous and for consumers mostly benign. CBO and the Joint Committee on Taxation analyze what would happen if the Trump Administration cut off “cost-sharing” subsidies, which are government payments to insurers that defray deductibles and co-pays for certain people below 250% of the poverty line. (8/16)

San Antonio Press-Express: Free Market Not The Health Care Panacea
It is arguable that some business-type approaches are aspects of a health care system, and I suspect they are incorporated even in countries with universal or purported “socialist” health care system. Nonetheless, I would like [Sen. John] Cornyn and [Sen. Ted] Cruz or like-minded colleagues to name one developed country where a free market health care system is established that works for everyone or even the majority. (Juan H. Flores, 8/16)

The Washington Post: People Who Get Medicaid Are Made To Feel Powerless. That Pushes Them Out Of Politics And Toward Fatalism.
During the debate over the Republicans’ unsuccessful push to repeal and replace Obamacare this summer, thousands of activists across the country held rallies, attended town hall meetings and staged protests in an effort to stop the GOP. News coverage regularly featured protesters from the disability community, many of whom would have been affected by potential cuts to Medicaid. ... But very few of the 70 million low-income and disabled Americans who receive Medicaid benefits actually participated in the debates, despite the fact that changes to the federal program could have had fundamental consequences for their lives. ... people enrolled in Medicaid often feel stigmatized by the system. They can be frustrated by differences in the way the program is administered across states and even local communities. As a result, they disengage from politics. (Jamila Michener, 8/17)

Oregonian: Insurers Are Setting Patients Up For Failure
Thomas Edison once said, "I have not failed. I've just found 10,000 ways that won't work." While his words illustrated an insatiable passion to invent new technologies like the light bulb, a larger idea belies a fatal flaw we're seeing insurance companies apply to modern medicine. Through a practice called step therapy or fail first, insurers demand failure upon the people whose lives they've been entrusted. (David Russo, 8/16)

NPR: How Doctors Deal With Hate, Racism And Their Own Biases
The events that unfolded in Charlottesville last weekend are a stark reminder of how far we haven't come as a nation. Like so many Americans, I am horrified that white supremacist and neo-Nazi adherents have recently found sanction to put hateful ideologies more overtly on display. ... For doctors, public emergencies bring to mind ethical duties and dilemmas that never go away. Current events compel us to examine our core beliefs and do a gut-check of our own ethical standards and sense of professionalism. (John Henning Schumann, 8/16)

Morning Consult: Missouri, The ‘Show Me (The Money)’ State
Up until recently, Missouri was the only state without a Prescription Drug Monitoring Program for opioids. The good news is that’s changing — sort of. Last month, Gov. Eric Greitens issued an executive order creating one. The governor’s order directs the state Department of Health and Senior Services to build a database, which will be designed to help identify suspicious patterns of prescriptions of controlled substances — including opioids. Good news? Seems to be, until you look into the details — where the devil resides. (Peter Pitts, 8/17)

Bloomberg: Take The Addiction Out Of Smoking
Imagine a world in which teenagers who experiment with cigarettes never make a habit of smoking them. This is a future the Food and Drug Administration envisions with its bold new plan to rid cigarettes of most of their nicotine, the substance that makes them so highly addictive. It's an intriguing idea, potentially one of the best to come along in the decades-old fight against smoking -- which still kills almost half a million Americans a year. (8/16)

The New England Journal of Medicine: A Nicotine-Focused Framework For Public Health
With the tools provided to the Food and Drug Administration (FDA) under the Family Smoking Prevention and Tobacco Control Act of 2009, the agency has taken consequential steps to prevent sales of tobacco products to children, expand the science base for understanding traditional and newer tobacco products, and conduct public education campaigns. But the agency needs to do more to protect Americans; in particular, we must shape a regulatory framework that reduces their use of combustible cigarettes. (Scott Gottlieb and Mitchell Zeller, 8/16)

The New England Journal of Medicine: Saying Goodbye To Lectures In Medical School — Paradigm Shift Or Passing Fad?
“Become a doctor, no lectures required.” This headline about the University of Vermont’s proposed new approach to medical education generated considerable controversy. Although this proposed change is more drastic than the curriculum reform taking place at other medical schools, the movement away from traditional lecture-based courses has been under way in U.S. medical schools for more than three decades. ... But are the newest proposed changes evidence-based, or are they merely the latest fad in medical education? (Richard M. Schwartzstein and David H. Roberts, 8/17)

The New England Journal of Medicine: Medical Education In The Era Of Alternative Facts
Students currently entering U.S. medical schools arrive in an era of increasing distrust of large institutions, expanded use of social media for information, a political lexicon in which uncomfortable facts are derided as “fake news” while fabrications masquerade as reality, and the erosion of truth that such trends entail. The challenges for medical education are imminent and formidable. How do we, as teachers, merit the trust of future physicians? How do we pass on to them science’s preeminent legacy of propelling advances in understanding, preventing, and curing illnesses? How do we instill in them a lifelong appreciation for the importance of hypothesis testing, peer review, and critical analysis of research? (Richard P. Wenzel, 8/17)