KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Kaiser Health News Original Stories

Most Hospital Palliative Care Programs Are Understaffed

Guidelines recommend that hospitals have a physician, an advanced practice or registered nurse, a social worker and chaplain on the palliative care team, but only about 25 percent of hospitals meet that standard. (Michelle Andrews, 9/30)

Political Cartoon: 'Any Hand'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Any Hand'" by Dan Piraro.

Here's today's health policy haiku:

FAMILY CAREGIVERS FACE DISTINCT CHALLENGES

For these caregivers
Part of their watchfulness is
their own well-being.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Summaries Of The News:

Health Law Issues And Implementation

Watchdog: HHS Improperly Favoring Insurers Over Treasury In Distributing Health Law Funds

The Government Accountability Office says money that was paid to insurers should have gone to the Treasury. The administration defended its interpretation of the law, while Republican seized on it as vindication that the Affordable Care Act is hurting taxpayers.

The New York Times: U.S. Paid Insurers Funds Meant For Treasury, Auditors Say
Federal auditors ruled on Thursday that the Obama administration had violated the law by paying health insurance companies more than allowed under the Affordable Care Act in an effort to hold down insurance premiums. Some of the money was supposed to be deposited in the Treasury, said auditors from the Government Accountability Office. (Pear, 9/29)

The Wall Street Journal: Watchdog Says Treasury Shortchanged In Affordable Care Program
The 2010 health law required federal health officials to collect fees from unions, employers and insurance companies for a program called ‘reinsurance,’ to reimburse health plans that sustained a heavier burden of medical claims during the first few years of the law’s life. A portion of those fees was also set to go to the Treasury, the Government Accountability Office said, and following a shortfall in expected collections, HHS opted instead to prioritize payments to insurers. (Radnofsky, 9/29)

The Associated Press: Report Says Obama Administration Failed To Follow Health Law
The opinion from the Government Accountability Office is a setback for the White House and bolsters Republican complaints that administration officials bent the law as problems arose carrying out its complex provisions. The finding may complicate efforts to stabilize premiums in the law's insurance marketplaces, where about 11 million people get coverage. The Obama administration said it "strongly disagrees" with the GAO's conclusion. (9/29)

Politico: Watchdog Knocks Administration For Misusing Obamacare Funds
Republicans, who asked the GAO investigate the issue, hailed the GAO's finding as vindication for their longstanding claims that the Obama administration is wrongly prioritizing insurers over taxpayers. “This new opinion from the government’s top watchdog confirms that the Obama administration is not above the law,” said Republican members of the House Energy and Commerce Committee in a statement. "The administration needs to put an end to the Great Obamacare Heist immediately.” (Demko, 9/29)

The Hill: Watchdog: ObamaCare Program Made Illegal Payments 
A nonpartisan government watchdog said Thursday that the Obama administration is violating the law by directing funds in an ObamaCare program to insurers instead of to the U.S. Treasury. Republicans, who had argued that the payments were illegal, hailed the Government Accountability Office (GAO) opinion. At issue is ObamaCare’s so-called reinsurance program, which is designed to stabilize the market and protect against premium hikes in the early years of the healthcare law. (Sullivan, 9/29)

Morning Consult: GAO Sides With GOP, Saying HHS Owes Treasury an ACA Deposit
The Obama administration is illegally refusing to make payments to the U.S. Treasury and instead giving funds collected under Obamacare to insurers, according to a new report from an independent government watchdog. The administration disagrees with the findings. The funds in question were collected as part of Obamacare’s reinsurance program, one of three programs included in the health care law to reduce risk for insurers participating on exchanges. Siding with Republicans who have been investigating the program, the Government Accountability Office said Thursday that the law mandates that some of the money collected must be deposited into federal coffers. (Owens, 9/29)

In other health law news —

The Washington Post: Obama Administration May Use Obscure Fund To Pay Billions To ACA Insurers
The Obama administration is maneuvering to pay health insurers billions of dollars the government owes under the Affordable Care Act, through a move that could circumvent Congress and help shore up the president’s signature legislative achievement before he leaves office. Justice Department officials have privately told several health plans suing over the unpaid money that they are eager to negotiate a broad settlement, which could end up offering payments to about 175 health plans selling coverage on ACA marketplaces, according to insurance executives and lawyers familiar with the talks. (Goldstein, 9/29)

Harken Health To Leave Obamacare Exchanges In Illinois, Georgia

In related news, Arise Health Plan will exit the Affordable Care Act marketplaces in Wisconsin. Meanwhile, the health plan choices are finalized in Kansas, and Utah regulators announce the average premium rate increases for 2017.

Chicago Tribune: Harken To Exit Illinois Obamacare Exchange
Harken Health is abandoning the state's Obamacare health insurance marketplace. Harken, a subsidiary of UnitedHealthcare, said Thursday it will not offer plans on the exchange next year. Insurers Aetna, UnitedHealthcare and Land of Lincoln already have announced they won't offer plans on the exchange next year. "It's just another reduction in options for Illinois consumers," said Phil Lackman, CEO of the Independent Insurance Agents of Illinois. (Schencker, 9/29)

Bloomberg: Harken Exits Obamacare Markets As UnitedHealth Startup Struggles
UnitedHealth Group Inc., the biggest U.S. health insurer, is scaling back its experiment in Obamacare markets as its Harken Health Insurance Co. startup withdraws from the two exchanges where it was selling plans. Harken will not offer individual plans through Obamacare exchanges in Georgia and Chicago in 2017, the company said Thursday in an e-mailed statement. It will continue to offer individual plans off the exchange, Harken said. (Tracer, 9/29)

Modern Healthcare: UnitedHealth Subsidiary Ditches ACA Exchange After Posting Losses
UnitedHealth Group's experimental health plan subsidiary is pulling out of the Affordable Care Act exchange markets in Chicago and Atlanta after losing nearly $70 million in the first six months of 2016. And its founding CEO, who spearheaded the plan's primary care-focused benefit design, has been replaced by a new leader. Harken Health started selling individual and group plans on and off the exchange in the two markets last January. It reportedly has about 35,000 members in those markets. (Meyer, 9/29)

Milwaukee Journal Sentinel: Arise To Leave ACA Marketplaces
Arise Health Plan, a subsidiary of WPS Health Solutions, said Thursday that it will not sell health plans on the marketplaces set up through the Affordable Care Act next year, becoming the latest company to abandon the market. Arise and WPS Health Insurance also will sell only high-deductible health plans for individuals and their families off the marketplace, and those plans will be available only in a limited number of counties. (Boulton, 9/29)

Kansas Health Institute: Kansans’ Marketplace Choices Finalized For 2017 Coverage 
Kansans will get to choose between two insurance companies when open enrollment begins Nov. 1 for 2017 coverage through the Affordable Care Act’s online marketplace. But for Kansans outside the Kansas City metropolitan area, one company will offer only HMO plans that restrict coverage to in-network providers. The Kansas Insurance Department published an overview of the marketplace choices this week. A new insurer, Minnesota-based Medica, has entered the Kansas market and will sell seven traditional health insurance plans — with varying premiums and levels of coverage — in all counties. (Marso, 9/29)

Deseret News: Individual Exchange Health Plans To Go Up Average Of 30 Percent
Rates for health insurance plans on the individual marketplace are likely to rise by an average of 30 percent next year, the Utah Department of Insurance said Thursday. The second-lowest silver plan — the benchmark plan used to calculate tax subsidies for enrollees on the marketplace — is a SelectHealth plan with premiums of a little over $200 a month, according to insurance department officials. (Chen, 9/29)

Capitol Hill Watch

Lawmakers Say Biomedical Research, 'Cures' Bills Will Make Lame-Duck Agenda

In other news from Capitol Hill, Sen. Harry Reid deals a setback to "right-to-try" legislation. And election-year politics keep Democrats from working with vulnerable Republican senators.

The Wall Street Journal: Congressional Leaders Put Medical-Research Bill On Priority List
Congressional leaders said Thursday that legislation to inject billions of dollars into federal biomedical research and ease drug approvals is a main priority for the lame-duck session after the November elections. The measure is one of the biggest pieces of legislation left on the table as lawmakers left town on Thursday to campaign for re-election. The fact that both Senate Majority Leader Mitch McConnell (R., Ky.) and House Speaker Paul Ryan (R., Wis.) put it on the agenda for the session suggests it has a strong chance of advancing in the weeks after the election. (Hughes and Burton, 9/29)

The Hill: McConnell: Cures Bill A 'Top Priority' In Lame-Duck 
Senate Majority Leader Mitch McConnell (R-Ky.) said Thursday that a medical cures bill will be a “top priority” in the lame-duck session after the election. “We’ve got about three weeks back here after the election,” McConnell said at a press conference. “My own personal priorities are funding the government and the 21st Century Cures bill, which I think could end up being the most significant piece of legislation we pass in the whole Congress.” (Sullivan, 9/29)

Stat: Senate Effort To Increase Access To Experimental Drugs Is Blocked
An effort to get the US Senate to pass a so-called Right to Try bill failed Wednesday when Senate Minority Leader Harry Reid blocked the effort, because a hearing was never held to review the legislation and only two of the 42 sponsors was a Democrat. “It hasn’t been through the committee process as we were promised given the outstanding issues dealing with this policy,” Reid, a Nevada Democrat, told the Senate after Senator Ron Johnson (R-Wis.) attempted to win unanimous consent from the Senate for his legislation. “There are major players who have not had an opportunity to say what’s wrong with the bill.” (Silverman, 9/29)

The Hill: Election-Year Politics: Senate Dems Shun GOP Vulnerables
Senate Democratic leaders have ­discouraged their colleagues throughout this year from working with vulnerable Republican senators, according to lawmakers in both parties. The election-year effort is aimed at depriving Republicans of bipartisan achievements they can tout back home. Control of the Senate is up for grabs this year as the GOP seeks to preserve its four-seat majority. Republicans are defending 24 seats while Democrats are only defending 10. There are nine incumbent Republican senators who are in challenging races this fall. (Bolton, 9/29)

Administration News

Federal Officials Worry Changes In Flu Vaccine Policy May Leave Some People Unprotected

The recommendation earlier this year to switch children from the nasal spray vaccine to shots may result in fewer children getting immunized, the head of the Centers for Disease Control and Prevention says. In addition, officials are concerned about a recent drop in vaccination rates among Americans over the age of 50.

The Washington Post: CDC Officials Worry That New Flu Vaccine Recommendations Could Reduce Use
Flu season is about to start, and public health officials are worried that their recommendation earlier this year to avoid using the nasal spray version of the annual vaccine will result in fewer people getting protection. The CDC has recommended annual flu shots for everyone ages 6 months and older for the past six years. During the 2014-2015 season, federal health officials had recommended the nasal spray vaccine for young children. But an expert panel on vaccines said in June that the nasal spray, FluMist, used by millions, failed to protect children last year for the third year in a row and should not be used this coming flu season. (Sun, 9/29)

NPR: CDC Urges Americans To Get A Flu Shot As Soon As Possible
Federal health officials are urging all Americans to get their flu shots as soon as possible, and are especially concerned that too few elderly people are getting vaccinated. "Flu is serious. Flu is unpredictable," Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention, told reporters during a joint briefing Thursday with the National Foundation for Infectious Diseases. "Flu often does not get enough respect." (Stein, 9/29)

San Francisco Chronicle: Federal Officials Encourage Flu Shots, Not FluMist Spray 
The U.S. Centers for Disease Control and Prevention on Thursday recommended that everyone aged 6 months or older get this year’s flu vaccine. But this year, following the recommendations of an expert panel in June, officials warned the public not to get the nasal version, known as FluMist, because studies showed it didn’t work. (Colliver, 9/29)

The Baltimore Sun: Schools, Health Officials Retool Flu Clinics To Offer Vaccine Injections Only
The FluMist nasal spray version of the vaccine popular with needle-averse kids, and their parents, is no longer available. A task force advising the U.S. Centers for Disease Control and Prevention recommended earlier this year that people not use it after studies found it ineffective. Schools, health departments, drugstores and doctors' offices are now stocking up on the injectable flu vaccine. School flu clinics are being retooled for the more time-consuming, angst-producing shots. And worried parents may bring their children to doctors' offices so they can be there for them. (Cohn, 9/29)

CDC Issues New Zika Travel Advisory For Pregnant Women

The warning focuses on travel to countries in Southeast Asia. Meanwhile, turnaround times for Zika testing in Florida is starting to improve, officials say.

The New York Times: C.D.C. Advises Against Travel To Zika-Affected Countries In Southeast Asia
Federal health officials on Thursday advised pregnant women to “consider postponing nonessential” travel to 11 countries in Southeast Asia where the Zika virus was circulating. The warning from the Centers for Disease Control and Prevention was not as urgent as those issued starting in January, which advised pregnant women to avoid Latin American and Caribbean countries overwhelmed by the Zika epidemic. (McNeil, 9/29)

Miami Herald: Zika Virus: Testing Wait Times Improve In Florida 
Local physicians reported that state labs are beginning to improve turnaround times for delivering test results to pregnant women even as Florida officials on Thursday confirmed six more mosquito-borne Zika infections and five new travel-related cases — all of them in Miami-Dade County. The additional mosquito-borne infections include one Miami-Dade resident exposed to the virus in Miami Beach and three more local people whose cases are under investigation to determine where transmission occurred, the Florida Department of Health reported. (Chang, 9/29)

Pharmaceuticals

Wall Street Stumbles On News Of Drug Companies' Cost Woes

Meanwhile, the controversy around the high cost of EpiPens continues to make headlines.

Kaiser Health News: The Need To Replace EpiPens Regularly Adds To Concerns About Cost
As controversy about the pricing of EpiPens reverberates from Capitol Hill to school districts across the country, one recurring complaint from consumers is that the high cost is magnified because the drug expires quickly, forcing users to regularly bear the cost of replacing the medicine that saves lives in the event of a severe allergic reaction. So what exactly determines its longevity? It turns out storage and distribution can play as important a role in the drug’s shelf life as the chemical compounds. (Rodriguez, 9/30)

Georgia Health News: Pencils, Pens And EpiPens: How A Medical Device Became Standard In Hundreds Of Georgia Schools 
Georgia’s Emergency Epinephrine Act was introduced by Sen. Chuck Hufstetler (R-Rome), backed by Harris’ advocacy group, and signed into law by Gov. Nathan Deal in 2013. That same year, Mylan’s political action committee donated $1,000 to Hufstetler and an equal amount to Deal and Lt. Gov. Casey Cagle, among its numerous other political donations. Harris said Mylan has not donated to FAKA.Although the Georgia law does not require that schools stock EpiPens for emergency use, it encourages this and authorizes a physician, advanced practice nurse or physician assistant to write a prescription in the name of a public or private school. Some states mandate that schools carry epinephrine. (Fite, 9/29)

Morning Consult: Burwell Calls For HHS To Negotiate Drug Prices
Health and Human Services Secretary Sylvia Burwell on Thursday said the federal government should be able to negotiate drug prices for high-cost and specialty drugs. “One of the most important tools that we could gain would be an ability to negotiate,” Burwell said at the Atlantic’s Washington Ideas Forum. Burwell’s comments came in response to a question about the outrage over EpiPen pricing. The uproar may have been avoided if Medicare and Medicaid could negotiate directly with pharmaceutical companies such as Mylan Pharmaceuticals, she said. (McIntire, 9/29)

And KHN looks at how FDA's fast-track review voucher is being misused from its original purpose —

Kaiser Health News: A Golden Ticket That Fast-Tracks A Drug Through The FDA
Drugmaker Sarepta Therapeutics won a big victory when its $300,000 muscular dystrophy drug was recently approved, but the company had other reasons to celebrate, too. They were also awarded the drug world’s equivalent of a Willy Wonka golden ticket. The ticket, known as a rare pediatric disease priority review voucher, is part of a program created by Congress in 2007 to encourage the development of drugs for tropical diseases and later expanded to rare pediatric disorders. (Tribble, 9/30)

Public Health And Education

Aggressive, Illegal Marketing For Powerful Painkiller Cited As Cause Of Woman's Death

Sarah Fuller was given a prescription version of fentanyl, a drug 100 times more potent than morphine, for her back and neck pain. A year later she was found dead in her bathroom.

Stat: Potent Painkiller Fentanyl, And A Drive To Sell It, Faulted In Woman's Death
There was a stranger waiting for Sarah Fuller when she visited her doctor to discuss switching medications for her back and neck pain — a saleswoman pitching a prescription version of the potent opioid fentanyl. The drug, called Subsys, is so powerful, and the risk of addiction and overdose so formidable, that the Food and Drug Administration requires doctors to undergo special training before they are allowed to prescribe it. And it has approved Subsys only for cancer patients who suffer intense flares of pain. (Armstong, 9/30)

Reuters: Ex-Insys Sales Manager Arrested In U.S. Fentanyl-Kickback Case
A former Insys Therapeutics Inc district sales manager was arrested on Thursday on charges he participated in a scheme to pay kickbacks to doctors to prescribe a drug containing the opioid fentanyl, U.S. prosecutors said. Jeffrey Pearlman, 49, was charged in a criminal complaint filed in federal court in New Haven, Connecticut, becoming the latest individual to face prosecution in connection with probes involving Insys' drug Subsys. (Raymond, 9/29)

In other news, Columbus, Ohio, is hit with another wave of overdoses just days after the first one, an analysis finds that drug and alcohol abuse is costing Americans nearly $300 billion a year, and more from the opioid crisis —

Columbus Dispatch: Another 21 Heroin Overdoses Hit Columbus
Between 8 a.m. Tuesday and 8 a.m. Wednesday, 27 people overdosed in the city, prompting police and health officials to issue a public warning Tuesday night and host a news conference Wednesday. A second wave of 21 people, including the person Bechtel and health department employees saved, were treated between 8 a.m. Wednesday and 8 a.m. Thursday, according to Columbus Division of Fire. Columbus fire battalion Chief Steve Martin said in each case, police officers and paramedics administered naloxone, also called by the brand name Narcan, to revive the victims. (Widman Neese, 9/30)

Atlanta Journal Constitution: Drug & Alcohol Addiction Costs Americans $276 Billion A Year
Americans spend an estimated $276 billion every year drinking, smoking and taking drugs, according to a recent analysis. To give that huge figure some perspective, that’s more than the federal government spent in 2015 on education and veterans’ benefits combined. About half of the spending goes toward alcohol and nicotine, according to the analysis by Addiction-Treatment.com, a Santa Monica, California-based organization that helps connect people with substance abuse disorders with treatment providers. (Brinkley-Badgett, 9/30)

Miami Herald: Canada Legalizes Prescription Heroin To Help Fight Addiction 
Heroin addicts in Canada don’t have to find their next hit on the street. They can go to their doctor instead.It is now legal for the country’s physicians to prescribe the drug to addicts who are looking to kick their habit. Doctors must apply for a permit from Canada’s Special Access Program to prescribe dicetylmorphine, which is a pharmaceutical grade heroin. (Welsh, 9/29)

Denver Post: Denver Drug Court Starts Methadone Program 
A new multi-agency program announced Thursday will begin administering methadone to drug offenders who volunteer to get treated and can prove they’re addicted to heroin or prescription painkillers. It is aimed at combating the city’s opioid epidemic, which reflects a national trend. Previously, the sheriff’s department would administer methadone to offenders if they already had been prescribed the medication. Now, the Medication Assisted Treatment Induction Program provides probationers in Denver’s drug court system with the option to begin methadone treatment in jail. In addition, their sentence will be reduced. (Siegelbaum, 9/29)

Mercury News: Menlo Park Couple Helping Fight Addiction
In 2012, with a small group that includes other recovering addicts, he [Clennan Williams] helped form Battlefield Ministry, a support network for addicts at Westside Church of Christ in San Mateo. The main group members all have experience working with people suffering from addictions. Battlefield, which meets at the church at 1 p.m. Sundays and 5:30 p.m. Tuesdays, also supports people with compulsive behavior and performs outreach to the homeless community and works with at-risk youth. Peggy helps by cooking for potlucks and fundraisers. (Kelly, 9/29)

More Options Emerging For Women Diagnosed With Breast Cancer While Pregnant

Before, women were recommended to end the pregnancy, but with the right team, doctors are finding ways to deliver a health baby while still treating the mother. Meanwhile, experts say the best defense against breast cancer is being able to recognize any changes that could signal a problem.

Orlando Sentinel: Pregnant Women With Breast Cancer Can Be Treated Successfully 
Every year 1 in 3,000 women in the U.S. will be diagnosed with breast cancer during pregnancy, according to the National Cancer Institute. Terminating pregnancies was encouraged in the past for women who were diagnosed with cancer... Certain treatments can cause harm, but with physicians who have experience in treating pregnant women with breast cancer, individually designed plans of action can successfully treat cancer while keeping the baby healthy. (Sadick, 9/29)

Tampa Bay Times: Your Doctor Can Clear Up Confusion On When To Get Breast Screening 
Trying to decide when to start and how often to have a routine mammogram can make your head spin. It used to be easy: starting at 40 have an annual mammogram. End of discussion. Now, the major medical groups we have long relied on to tell women what to do about breast cancer screening aren't in complete agreement when it comes to women of average risk — that's the majority of us who have never had breast cancer and who don't have a mother, sister or child who had the disease. High-risk women have their own set of guidelines, which includes annual mammograms and breast MRI beginning as early as age 25 for some. (Maher, 9/29)

WBUR: Study: Breastfeeding Even More Of A Health Issue For Moms Than For Babies
Researchers found that more than 3,340 premature deaths in the U.S. annually, and $3 billion in medical costs, were associated with so-called "suboptimal breastfeeding," meaning less than the medical recommendations of exclusive breastfeeding for six months with continued breastfeeding for one year for each child. The vast majority of the those deaths, notably heart attacks and diabetes in women and sudden infant death syndrome among infants, were maternal. (Zimmerman, 9/29)

Fatal Police Shooting Of Mentally Ill Man Highlights Issue Plaguing The Country

People with severe mental illness are 16 times more likely to be killed by police. States across the U.S. are trying to address the problem, but police officials say part of the problem is the decay of the country's mental health system.

Reuters: California Shooting Shows Police Ill-Equipped To Handle Mentally Ill
The fatal shooting by police of a mentally unstable California man and the anguished response of his sister who had called 911 seeking help highlight the risks of a U.S. system that often relies on law enforcement to respond to mental health crises. Alfred Olango, 38, a Ugandan-born immigrant, was shot by one officer even as another, who had been trained to deal with mentally ill people, attempted to subdue him with a Taser, police said. (Bernstein, 9/29)

WABE: Fulton County Police Consider Crisis Intervention Units 
In the wake of recent police shootings across the country, Fulton County’s police chief said he’s considering the creation of special units to help officers in the field respond to people with mental illnesses. At a meeting of Fulton County mayors Wednesday, Chief Gary Stiles cited the recent fatal shooting this week of a black man in California, when police were called to investigate a report about a mentally unstable man. (Yu, 9/29)

Wrenching Choices Face Families Over An Aging Parent's Living Situation

The Philadelphia Inquirer has two stories on the challenges that adult children face caring for elders. And Bloomberg and NPR report on developments on Alzheimer's.

The Philadelphia Inquirer/Philly.com: The Dilemmas Of Parents Aging At Home
The story of Mary Casavecchia and the house she won't leave began decades ago. ... Her love for this house and refusal to part with it have thrust mother and daughter into one of the toughest challenges families face: what to do when aging parents insist on staying in the family home even after it has become risky or isolating. Even loving families can find themselves in a standoff, each generation unable to see the other's point of view. (Burling, 9/29)

The Philadelphia Inquirer: How To Talk With A Stubborn Parent About Health Issues
Before a crisis, families should discuss contingency plans if an elder breaks a hip or develops dementia, said Barry Jacobs, a Delaware County psychologist who specializes in family caregiving. It's good to tour different types of facilities together. Seniors may respond better if their adult children bring up the topic of housing slowly, simply, and without a lot of drama. Work with facts. Experts suggested getting a neuropsychological and medical evaluation for a parent with cognitive problems or disabilities. Experts can also evaluate driving ability. (Burling, 9/29)

Bloomberg: Bearing The Financial Burden Of Alzheimer’s
One in nine Americans age 65 or older has Alzheimer’s—a total of 5.2 million people—and that number is expected to triple by 2050. Patients typically live 8 to 10 years after diagnosis, and families can quickly exhaust their savings caring for them. The cost of an assisted living facility averages $43,200 a year, while a semiprivate room at a nursing home runs $80,300, according to the Alzheimer’s Association. Medicare doesn’t cover that expense. Medicaid does—if you’re poor enough. A single person must have no more than $2,000 of assets to qualify, says Todd Lutsky, an elder-care attorney at Cushing & Dolan. “If you’re married, the healthy spouse gets to keep $119,220 and the home.” (Braham, 9/29)

NPR: Rats! They Could Be Better Than Mice For Testing Alzheimer's Drugs
What rats can remember may help people who forget. Researchers are reporting evidence that rats possess "episodic memories," the kind of memories that allow us to go back in time and recall specific events. These memories are among the first to disappear in people who develop Alzheimer's disease. (Hamilton, 9/29)

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

State Watch

Calif. Tries To Rein In Overuse Of Psychiatric Drug For Foster Kids By Monitoring Doctors

The bill, signed by Gov. Jerry Brown, increases oversight of doctors who have high prescription numbers, and allows the medical board to take action.

Mercury News: Drugging Our Kids: Brown Passes Two Psych Med Bills, Vetoes Another
Capping years of efforts to stop California’s foster care system from overmedicating the state’s most vulnerable children, Gov. Jerry Brown on Thursday signed a controversial bill that for the first time puts doctors who recklessly prescribe psychiatric drugs at risk of losing their medical license. The measure is part of a series of sweeping legislative reforms inspired by this news organization’s series “Drugging Our Kids” that disclosed the state’s dependence on psychotropic medications to control troubled children in the country’s largest child welfare system. (Seipel, 9/29)

San Francisco Chronicle: Brown Signs Two More Laws To Curb Overuse Of Meds On Foster Youth 
California Gov. Jerry Brown Thursday signed two more bills to protect traumatized foster children from psychiatric care that is overly reliant on risky medications — cementing what is now the most comprehensive set of laws in the nation. Following three laws passed last year, the additional legislation will subject overprescribing physicians to stepped-up investigations and ensure that counties offer mental health services for foster children that include non-drug treatments. Brown vetoed a bill that would have enhanced juvenile court oversight of prescribing. But the courts have already launched a sweeping set of new standards requiring doctors to justify their prescriptions before judges approve them, and ensuring that foster children have a say in whether they want to take the untested drugs. (De Sa, 9/29)

Some States Complain Medicaid Rule To Assess Enrollees' Access To Care Is Too Burdensome

States with at least 90 percent of beneficiaries in managed care, like Florida, say there's no point in spending the time to conduct the assessment of its Medicaid population. “We have a tiny fee-for-service population,” said Justin Senior, deputy secretary of the Division of Medicaid in Florida at the 2016 Medicaid Health Plans of America last week, according to Modern Healthcare. “We're having to do as much work under the access rule as we are to comply with the managed Medicaid rule. It doesn't make any sense.” News outlets also report on Medicaid developments in Nevada and Utah.

Modern Healthcare: States Say Medicaid Provider Access Rule Is Ineffective And Burdensome
Last year, the CMS finalized a rule requiring states to assess how easy it it is for fee-for-service Medicaid beneficiaries to receive primary care and pre-and post-natal obstetric services and see specialists and behavioral health experts, among other services. The CMS felt that there are adequate provider network standards for managed-care beneficiaries so they are excluded. ... States with at least 90% beneficiaries in managed care, like Florida, say there's no point in spending the time time to conduct the assessment of its Medicaid population. In the final access rule, the CMS estimated it could take states as long as 15,000 hours to develop the plans. (Dickson, 9/29)

Reno Gazette-Journal: Saint Mary’s, Health Plan Of Nevada At Odds Over Medicaid Coverage Once Again
The fight between Saint Mary’s Health Network and Health Plan of Nevada is on once again following disagreements regarding payment. Saint Mary’s says it informed HPN earlier this month that it will stop accepting its HPN Medicaid plan unless ongoing issues are resolved by Oct. 9. Saint Mary’s accused HPN of not upholding its end of their contract agreement. If issues are not resolved, Saint Mary’s will stop accepting HPN Medicaid, Senior Dimensions and HPN commercial products on Oct. 19. Saint Mary’s also said that it will continue to accept patients using fee-for-service Medicaid products as well as Medicaid Amerigroup. (Hidalgo, 9/29)

Salt Lake Tribune: Utahns Likely Won’t Be Able To Sign Up For Medicaid Expansion On Jan. 1
Utahns eligible for the state's small-scale Medicaid expansion plan, even if it is approved by the federal government, likely will be unable to enroll in the program on the estimated Jan. 1 start date. The plan, projected to cover 9,000 to 11,000 people, recently underwent federal public comment. It targets childless adults who are chronically homeless, involved in the justice system or in need of mental-health or substance-abuse treatment. It also expands coverage of low-income parents with dependent children previously not covered by Medicaid. (Stuckey, 9/29)

Bloomberg: Medicaid Expansion Will Drive Affordability, Insurance Leader Says
Medicaid expansion will force the U.S. to address the cost of health care, health insurance trade association chief Marilyn Tavenner said Sept. 28. “Medicaid is going to become the bigger issue [from the] affordability perspective,” said Tavenner, president and CEO of America’s Health Insurance Plans (AHIP), who spoke at the McKesson Health Solutions Conference in Orlando, Fla. She said she would like to see the 19 states that haven’t yet expanded the health-care program for low-income people under the Affordable Care Act do so, and doing that would likely be more difficult if Republican nominee Donald Trump is elected president than if Democratic candidate Hillary Clinton is elected. (Hansard, 9/28)

State Highlights: Conn. Hospitals Show Weaker Financial Performance In 2015; Ohio OKs Bill To Address Infant Mortality Rate

Outlets report on health news from Connecticut, Ohio, Arkansas, California, Wisconsin, Minnesota, Florida, Texas, Maryland and Georgia.

The CT Mirror: CT Hospital Finances Weakened In 2015
The finances of Connecticut hospitals weakened during the 2015 fiscal year, with a drop in the average margin and fewer hospitals turning a profit. Even so, the majority of hospitals in the state remained profitable, and the cost of uncompensated care fell by 15.6 percent, according to a report by the state Office of Health Care Access. Seventeen of the state’s 28 hospitals had positive margins during the 2015 fiscal year, down from 24 in 2014. The average total margin – which takes into account both operating revenues and non-operating revenues that include investments, endowments and donations – fell from 6.22 percent in 2014 to 3.89 percent in 2015. (Levin Becker, 9/29)

Cleveland Plain-Dealer: Ohio Senate Passes Infant Mortality Bill 
The Ohio Senate Wednesday passed a bill that aims to decrease the state's high infant mortality rate by improving data access and reporting and by making sure providers are using only the best, evidence-based practices. Senate Bill 332 also attempts to address some of the complex social contributors to infant mortality in Ohio by creating a community group to review relevant state policies and programs and by requiring state agencies to include pregnancy as a priority in housing and emergency shelter programs. (Zeltner, 9/29)

The Associated Press: Federal Judge Blocks Arkansas Planned Parenthood Defunding
A federal judge on Thursday temporarily prohibited Arkansas from blocking Medicaid payments to Planned Parenthood, expanding her order requiring the state to continue paying for services for three patients who had sued over the move. U.S. District Judge Kristine Baker issued a preliminary injunction preventing Arkansas from suspending payments to Planned Parenthood for any services to Medicaid patients in the state. (9/29)

California Healthline: UnitedHealth And University Of California To Forge Unique Alliance
The nation’s largest health insurer and the University of California Health system are joining forces to create a new health plan option for employers and expand research into patient data. Under the 10-year partnership unveiled Thursday, UnitedHealth Group Inc. and the UC system will form an accountable care organization that will be offered to large, self-funded employers statewide. In accountable care organizations, or ACOs, physicians, hospitals and an insurer work together to coordinate care, control spending and share savings. (Terhune, 9/29)

Milwaukee Journal Sentinel: Northwestern Mutual To Cut 'Hundreds' Of Jobs
The company said earlier this month that it expected to eliminate some jobs as it dealt with lingering low interest rates that have made it harder to increase profits. Low interest rates make it more difficult for insurers to grow earnings because insurance companies invest premiums from policy owners mostly in relatively safe investments tied to rates. (Gores, 9/29)

Pioneer Press: Allina Nurses Strike: MN Union Logs Patient Concerns
United is one of five Twin Cities Allina facilities where nurses are on strike. The nurse Banovetz dealt with was one of 1,500 replacement workers. “I worry about patients in vulnerable health who can’t advocate for themselves or ask the right questions,” Banovetz said. Minneapolis-based Allina Health says its hospitals continue to operate at normal volumes during the strike and that there is no risk to patient care. Meanwhile, the union, the Minnesota Nurses Association, says it has taken steps to document patient complaints through its website and direct the complaints to the appropriate agencies. (Cooney, 9/29)

Orlando Sentinel: Shepherd's Hope Building 1st Permanent Home In West Orange 
After more than two decades of sharing space with other organizations to provide free medical care to Central Florida's uninsured population, Shepherd's Hope is getting its own building. The nonprofit free clinic is collaborating with West Orange Healthcare District and the City of Winter Garden to build a 10,000-square-foot facility, which will house a medical clinic and Shepherd's Hope's administrative offices. (Miller, 9/29)

Houston Chronicle: Empower Pharmacy Opens $4.7M Compounding Facility
A Houston compounding pharmacy has relocated to a $4.7 million facility built to meet higher standards of quality and safety in an industry that has faced increased federal scrutiny in recent years. Empower Pharmacy on Thursday debuted its new lab and service center near Beltway 8 and U.S. 290 on the city's northwest side, a 15,000-square-foot space that took more than two years to prepare. It's one of a relatively small number of facilities registered with the Food and Drug Administration to provide sterile, customized prescriptions to patients and physicians across the U.S. (Blunt, 9/29)

The Baltimore Sun: Tissue Analytics Wins Beta City's Pitch Competition 
Tissue Analytics, a Baltimore mobile health company, took home top honors — and $50,000 — Thursday at Beta City's startup pitch competition. Tissue Analytics, which developed a mobile application for tracking wound healing, was among eight startups that presented their business plans to a panel of judges during the Venture Capital Pitch Day at Sagamore Ventures' City Garage in Port Covington. (Gantz, 9/29)

Georgia Health News: Mental Health Center Expanding To Serve More Young Adults 
Skyland Trail, a nonprofit mental health treatment organization, will open a new Atlanta campus in October that will serve young adults like Ziggy. The expansion, funded by $19 million in philanthropic donations or grants, will add a residence and treatment facility with 32 beds for young adults ages 18 to 26. The new area will be called the Rollins Campus, recognizing a gift from the O. Wayne Rollins Foundation. Currently, Skyland Trail operates 48 beds between two Atlanta campuses, and 60 percent of patients are in that young adult age range. (Miller, 9/29)

Health Policy Research

Research Roundup: Screening Colonoscopies For Seniors; Safety-Net Hospital Readmissions

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

Annals of Internal Medicine: Effectiveness Of Screening Colonoscopy To Prevent Colorectal Cancer Among Medicare Beneficiaries Aged 70 To 79 Years
The Medicare program ... reimburses screening colonoscopy without an upper age limit [so researchers sought to] evaluate the effectiveness and safety of screening colonoscopy to prevent colorectal cancer (CRC) in persons aged 70 to 74 and those aged 75 to 79 years [through a] large-scale, population-based, prospective study. ... In beneficiaries aged 70 to 74 years, the 8-year risk for CRC was 2.19% ... in the screening colonoscopy group and 2.62% ... in the no-screening group .... Among those aged 75 to 79 years, the 8-year risk for CRC was 2.84% ... in the screening colonoscopy group and 2.97% ... in the no-screening group .... Screening colonoscopy may have had a modest benefit in preventing CRC in beneficiaries aged 70 to 74 years and a smaller benefit in older beneficiaries. The risk for adverse events was low but greater among older persons. (García-Albéniz et al., 9/27)

Health Affairs: Hospital Readmissions Reduction Program: Safety-Net Hospitals Show Improvement, Modifications To Penalty Formula Still Needed
Many observers are calling for modification of Medicare’s Hospital Readmissions Reduction Program (HRRP) to relieve an unfair burden on safety-net hospitals, which serve low-income populations and consequently have relatively high readmission rates. To broaden the perspective on this issue, we addressed the fundamental question of whether the HRRP has been an effective tool for reducing thirty-day readmissions in safety-net hospitals. In the first three years of the program, these hospitals reduced readmissions for heart attack by 2.86 percentage points, heart failure by 2.78 percentage points, and pneumonia by 1.77 percentage points, and they also reduced the disparity between their readmission rates and those of other hospitals. (Carey and Lin, 9/21)

Avalere: Premium Increases For Most Popular Medicare Drug Benefit Plans, Market For Medicare Advantage Plans Appears Stable In 2017
According to a new Avalere analysis of data from the Centers for Medicare & Medicaid Services (CMS), premiums for stand-alone prescription drug plans (PDPs) will increase and the number of PDPs available in 2017 will decrease. Conversely, the Medicare Advantage market appears strong as nearly 8 in 10 beneficiaries have access to MA plans that offer prescription drug benefits. (9/28)

The Kaiser Family Foundation: Findings From The Field: Enrollment And Consumer Assistance In Four States In Year Three Of The ACA
In Spring 2016, the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) conducted case studies to gain an on-the-ground view of ACA implementation in four states, Colorado, Connecticut, Kentucky, and Washington .... In the four study states, eligibility systems were working well, and Medicaid and Marketplace enrollment continued to grow. Consumer awareness of available coverage options has improved as has their knowledge of how to navigate enrollment and renewal processes and where to go to get help. Outreach and consumer assistance in year three built on successful strategies from prior years and remained an important component of state efforts to find and enroll eligible individuals. (Artiga et al., 9/20)

The Kaiser Family Foundation: Findings From The Field: Medicaid Delivery Systems And Access To Care In Four States In Year Three Of The ACA
This brief provides an on-the-ground view of Medicaid delivery systems and access to care in four states—Connecticut, Colorado, Kentucky, and Washington—three years into implementation of the ACA .... these four states have had significant enrollment growth in their Medicaid programs through the Medicaid expansion. With this growth, they have increasingly turned attention to delivery of and access to care for the increasing population covered by the program. The case study states vary in how they deliver care through their Medicaid programs, but all include elements to coordinate care for enrollees. Overall, these case study and focus group findings suggest that, despite the large enrollment growth since implementing the ACA, Medicaid enrollees generally are able to access the preventive, primary, and specialty care they need. However, they do face some access challenges. (Artiga et al., 9/20)

Editorials And Opinions

Viewpoints: 'Public Option' Doesn't Work; Developing A Zika Vaccine; Pockets Of Innovation

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

USA Today: Discredited 'Public Option' Will Fail
For middle-class families with Obamacare, summer 2016 was plagued with headline headscratchers as they learned costs would be going up and choices would be going down. Today, as the fourth enrollment season nears, the news is not getting any better. ... Yet, despite the maze of federal rules, taxes and penalties Obamacare created for the private health insurance market, Democrats are doubling down on government interference in healthcare once again. This time, by advocating for an old, already passed-upon idea: a government-run plan option, or a so-called “public option.” But what they forget is why this idea was not included in their original plan: it simply doesn’t work. (Sen. Orrin Hatch, R-Utah, and Rep. Fred Upton, R-Mich., 9/29)

U.S. News & World Report: A Poor Fix for Obamacare
I spent most of my adult life in elected politics in Mississippi, and I saw firsthand the inequities of our health care system. One of the most disconcerting aspects of this inequality existed before the Affordable Care Act, or Obamacare, when insurance companies denied health coverage for a patient's pre-existing condition. The health care law changed all that. The law remains a political lightning rod, but it accomplished at least one thing that Democrats and Republicans agree needed to be done: It outlawed the practice by insurers of telling a seriously ill patient that she won't be covered for the very care she needs to battle her disease. (Ronnie Shows, 9/29)

The New England Journal Of Medicine: Fast-Track Zika Vaccine Development — Is It Possible?
[Zika virus] ZIKV vaccine development is advancing rapidly thanks to collaborations among academia, governments, and industry. Current knowledge gaps related to the properties, epidemiology, and pathology of ZIKV increase the complexity of vaccine development, ... but historical success in developing other flavivirus vaccines encourages optimism. (Stephen J. Thomas, Maïna L’Azou, Alan D.T. Barrett and Nicholas A.C. Jackson, 9/29)

The New England Journal Of Medicine: Considerations For Developing A Zika Virus Vaccine
The rapid spread of Zika virus through the Americas and its devastating consequences for pregnant women and infants have precipitated an international, multisectoral response. Current prevention strategies focus on mosquito control, protection of the blood supply, barrier protection during sex, and other forms of contraception. When this explosive epidemic abates, Zika virus could remain endemic in many countries, where the risk to pregnant women, the general public, and travelers will persist. Therefore, a safe and effective vaccine is essential. (Hilary D. Marston, Nicole Lurie, Luciana L. Borio and Anthony S. Fauci, 9/29)

Health Affairs Blog: Fail To Scale: Why Great Ideas In Health Care Don’t Thrive Everywhere
In the world of fine wine, it is well known that some types of wine grapes grow only in very specific climates and ecologies. The concept borrowed from the French is “terroir” (ter-WAHR). ... Health policy advocates have sought for generations to propagate promising forms of health care organization across the country. Yet one finds repeatedly that some forms of organization that prosper in one part of the country fail to thrive in others. Is it possible that the concept of terroir also applies in health care? (Jeff Goldsmith and Lawton Burns, 9/29)

USA Today: Insure California's Undocumented Immigrants
Last week a group of California lawmakers asked the Obama Administration to allow them to go forward with a plan to offer health insurance to undocumented immigrants. Under the terms of the Affordable Care Act, the undocumented are currently prohibited from accessing “Obamacare” coverage, with or without federal subsidies. Now California is seeking an “Innovation Waiver” from the government under a section of the ACA that allows states to experiment with approaches to getting residents covered. If approved, up to 30% of the state’s 2 million undocumented residents could potentially be eligible to buy into the state’s health insurance exchange. (Raul Reyes, 9/29)

Stat: Prostate Cancer Treatment Needs To Get More Personalized
As a group, men who choose not to treat their early-stage prostate cancer aren’t any more likely to die from the disease within 10 years as men who choose treatment with surgery or radiation, which often come with potentially life-changing side effects. That’s the main finding of a landmark trial published recently in the New England Journal of Medicine. While important, this finding cloaks the reality that active surveillance — forgoing immediate treatment but regularly monitoring the cancer — isn’t a good option for all men. (Brian Helfand, 9/30)

Miami Herald: As Gay Black Men Face HIV Crisis, Advocate Says ‘No Choice But Hillary Clinton’ 
Last week, I traveled to Hollywood to attend the 20th annual US Conference on AIDS. The stakes there, as they are in this election, could not have been clearer. If current trends continue, one in two black men who has sex with men (MSM) will contract HIV in our lifetime. The rate for Latino MSM is one in four. I shudder to think what the rate would be for young, transgender women who are also disproportionately affected by HIV. This shouldn’t be happening in today’s America, where we’ve made great strides in HIV prevention, treatment, and care. And yet, it is — largely because of structural barriers including stigma, discrimination, and poverty. (Noël Gordon, 9/27)

PBS NewsHour: The Psychology Behind Why Clowns Creep Us Out 
But as a psychologist, I’m not just interested in pointing out that clowns give us the creeps; I’m also interested in why we find them so disturbing. Earlier this year I published a study entitled “On the Nature of Creepiness” with one of my students, Sara Koehnke, in the journal New Ideas in Psychology. While the study was not specifically looking at the creepiness of clowns, much of what we discovered can help explain this intriguing phenomenon. (Frank T. McAndrew, 9/29)

St. Louis Post-Dispatch: Making Sure Bayer, Monsanto Live Up To Their Promises
On the morning Bayer announced its intention to purchase Monsanto, I spoke with both Monsanto CEO Hugh Grant and Bayer Chairman Werner Baumann about the pending merger of these biotech pioneers, and its potential impact on job growth and innovation in Missouri. I gave both of these leaders the same message: Missouri is a world leader in plant and agricultural science, and we intend to stay that way. (Gov. Jay Nixon, 9/30)