KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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From Kaiser Health News - Latest Stories:

Kaiser Health News Original Stories

Drowning In A ‘High-Risk Insurance Pool’ — At $18,000 A Year

Minnesota had one of the most successful high-risk insurance pools in the country, and GOP leaders are eyeing this special insurance for sick people as an Obamacare replacement. But analysts say costs were high and many people in need were left out. (Mark Zdechlik, Minnesota Public Radio, 2/27)

To Pay Or Not To Pay – That Is The Question

With the future of Obamacare up in the air, many consumers are wondering if they must comply with the tax requirements related to the law, including whether to pay the penalty for being uninsured. (Emily Bazar, 2/27)

Political Cartoon: 'Wild Child?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Wild Child?'" by Rick Kirkman and Jerry Scott.

Here's today's health policy haiku:

GOP LEADERS EMBRACE HIGH-RISK INSURANCE POOLS, BUT SOME PATIENTS DON’T

If you swim in it
You’ve got worries beyond health.
Cash flow could hurt, too.

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

GOP Draft Repeal Plan Scraps Subsidies And Individual Mandate, Rolls Back Medicaid

The replacement would be paid for by limiting tax breaks on generous health plans people get at work.

Politico: Leaked GOP Obamacare Replacement Shrinks Subsidies, Medicaid Expansion
A draft House Republican repeal bill would dismantle the Obamacare subsidies and scrap its Medicaid expansion, according to a copy of the proposal obtained by POLITICO. The legislation would take down the foundation of Obamacare, including the unpopular individual mandate, subsidies based on people’s income, and all of the law’s taxes. It would significantly roll back Medicaid spending and give states money to create high risk pools for some people with pre-existing conditions. Some elements would be effective right away; others not until 2020. (Demko, 2/24)

Stat: The GOP Plan To Replace Obamacare: 5 Takeaways
The final version is likely to be different — how much different, it’s hard to say. The draft obtained by Politico is dated two weeks ago, and rumors have been swirling here that Republicans received an unfavorable analysis from the Congressional Budget Office, the official scorekeepers on the cost and coverage implications of legislation. But this is nonetheless an important milestone — real legislative text, prepared with an eye toward the complex parliamentary procedures needed to pass ACA repeal with only Republican votes, and presumably with the endorsement of House leadership. (Scott, 2/24)

The Associated Press: GOP Proposal Aims To End Insurance Mandate In 'Obamacare'
A draft Republican bill replacing President Barack Obama's health care law would end its Medicaid expansion, scrap fines on people not buying insurance and eliminate taxes on the medical industry and higher earners.Instead, it would create tax credits worth up to $4,000, allow bigger contributions to personal health savings accounts and impose a new levy on expensive health coverage some employees get at work. (Fram, 2/25)

The Washington Post: House GOP Plans To Keep Some Medicaid Expansion — And Steer Money To States That Never Bought In
Congressional Republicans have been struggling for months to resolve one of the most vexing problems in their tortuous effort to replace the Affordable Care Act: What to do about the generous federal funding for states that broadened their Medicaid programs under the law, while not shortchanging the 19 states that balked at expansion? Now, as the House begins to hone details of its legislative proposal, a possible compromise has emerged. It would temporarily keep federal dollars flowing to cover almost the entire cost of the roughly 11 million Americans who have gained Medicaid coverage but would block that enhanced funding for any new participants. (Goldstein and Eilperin, 2/24)

The Wall Street Journal: GOP’s New Plan To Repeal Obamacare: Dare Fellow Republicans To Block Effort
Republican leaders are betting that the only way for Congress to repeal the Affordable Care Act is to set a bill in motion and gamble that fellow GOP lawmakers won’t dare to block it. Party leaders are poised to act on the strategy as early as this week, after it has become obvious they can’t craft a proposal that will carry an easy majority in either chamber. Lawmakers return to Washington Monday after a week of raucous town halls in their districts that amplified pressure on Republicans to forge ahead with their health-care plans. (Radnofsky, Peterson and Armour, 2/27)

NPR: Obamacare Rollback Bill Would Replace Subsidies With Tax Credits
The draft bill is consistent with what Republicans have been saying they want to see in place of Obamacare, says Rodney Whitlock, vice president of health policy at ML Strategies. "No surprises here," says Whitlock, who was formerly the Republican health policy director for the Senate Finance Committee. "These are all ideas Republicans have championed. Now the Congressional Budget Office will decide if they agree." (Kodjak, 2/24)

Bloomberg: GOP Obamacare Plan Would Cover Fewer People; Blowback Grows 
At the core of the Republican argument in favor of their plan is that it will expand access to insurance for those who want it, rather than expanding total coverage by forcing people to. The requirements for repealing the ACA mean it’s not possible to keep the same number of people covered, said Representative Trent Franks, an Arizona Republican. (Tracer, House and Edney, 2/24)

Forbes: Hospitals Where Trump Won Face Closure If GOP Repeals Medicaid Expansion
News that Paul Ryan and the Republican-led U.S. House of Representatives want to roll back the Affordable Care Act’s Medicaid expansion has rural hospitals facing a huge financial hit with hundreds of health facilities already facing closure. ... Even without an effort to repeal the Affordable Care Act, more than 670 rural hospitals are at risk for closure, according to The Chartis Group , which released a study earlier this month at the Rural Health Policy Institute. The group examined hospital performance across nine measures, including a population health metric that shows impact on their communities and a loss of 137,000 “community jobs” including 99,000 jobs in healthcare, the Chartis Group report said. (Japsen, 2/26)

Bloomberg: Abortion Spat Imperils GOP Obamacare Repeal And Risks Shutdown 
Republicans in Congress have made cutting off funding to Planned Parenthood one of their top priorities, but the issue could stymie President Donald Trump’s Obamacare repeal plans and even trigger a government shutdown. House Republicans insist that the emerging plan to end Obamacare must cut off an estimated $500 million in annual federal funding for Planned Parenthood over its provision of abortions, aiming to carry out two longtime GOP campaign promises at once. Democrats are equally determined to ensure that won’t happen, and a few Republicans may stand with them. (Kapur, John and House, 2/27)

The Associated Press: Pre-Existing Conditions Complicate Health Care Replacement
As Republicans try to unite around a replacement for the Affordable Care Act, one of the most popular parts of the law will be among the most difficult to replace: the guarantee of health coverage for people with pre-existing conditions. The challenge of providing insurance for Americans who have no other alternative has some congressional Republicans considering whether to ask the states to reboot high-risk pools, an option with a rocky history. In the past, the pools served as insurers of last resort for people in poor health who could not get an individual policy from a commercial insurer. (Johnson and Alonso-Zaldivar, 2/25)

The New York Times: Key Republican In Health Law’s Fate Hails From A State That Embraced It
When Representative Greg Walden of Oregon visits his expansive district, which swallows two-thirds of a very blue West Coast state, his constituents grouse amiably to their longtime Republican congressman about environmental regulations and federal lands policy. And then the conversation shifts to the Affordable Care Act and what its repeal would mean for the struggling rural workers who have long voted for Mr. Walden, and for children like 11-year-old Rocco Stone. Because of the health law, Rocco has been able to live at home, attend school and have a nearly normal life despite having autism and a rare genetic disorder. (Pear, 2/25)

After Governors' Meeting, The Big Question Remains: What To Do With Medicaid?

The state leaders gathered for the National Governors Association winter meeting but were stymied over the problem of how to handle Medicaid. They want to make sure a repeal of the health law doesn't penalize states that took billions of dollars in federal funds to expand the program.

The Wall Street Journal: Talks Between Republican Governors Don’t Yield Agreement On Key Health-Law Issue
Governors gathered Saturday to discuss health-care policy said they didn’t reach a consensus on the future of the Medicaid program, an issue hamstringing Republicans’ bid to alter the Affordable Care Act. The governors’ meeting came at a key moment in the debate over the future of the health law, which Republicans have pledged to overturn. The party controls the White House, the Senate, the House of Representatives and 33 state governorships. (Radnofsky and Hackman, 2/26)

Politico: GOP Governors Split On Obamacare Replacement
The governors are split on whether to ask Congress to preserve the federal funding boost Obamacare made available to cover millions of additional low-income adults and broader structural changes. “We’re working through many different ideas,” said Oklahoma Gov. Mary Fallin, one of about a dozen governors trying to craft a compromise. Fallin, whose state did not expand its program, said it would be “very challenging” for her to revamp the program if Oklahoma winds up with less federal money than it currently gets. (Pradhan and Ehley, 2/25)

The Associated Press: Democrats, GOP Spar Over Medicaid Reform At Govs' Meeting
Tensions emerged Saturday between Democratic and Republican U.S. governors over a GOP-led proposal for a major overhaul to Medicaid, with Democrats saying the changes would take away people's health coverage to finance tax cuts for the wealthy. GOP governors intend to present Congress with a plan that they say would give states more flexibility to administer health coverage for poorer residents while protecting states from absorbing the costs of repealing the Affordable Care Act. Democratic governors said Saturday that their Republican counterparts were being dishonest about the effects of their plan. (Nuckols, 2/25)

CNN: Governors Mull Medicaid Expansion Ahead Of Trump Meeting
A group of governors huddled Saturday with Health and Human Services Secretary Tom Price in Washington to air their concerns on Medicaid and the effort to repeal Obamacare. ... Price only briefly talked about his meeting Saturday as he dashed out of the room, surrounded by staffers, calling it "a good, candid exchange." The Health and Human Services Department later said in a release that "they discussed real, positive solutions." Governors said afterward that much of the focus was on how to treat states that expanded Medicaid under the Affordable Care Act and those that didn't fairly. (LoBianco, Siegel and Luhby, 2/26)

Meanwhile, The New York Times looks at the effects of a work requirement for Medicaid —

The New York Times: The Adults A Medicaid Work Requirement Would Leave Behind
On a frigid morning here, Nancy Godinez was piling bread and other staples into her car outside a food pantry. She had lost her job as a custodian, her unemployment checks had run out, and her job search had proved fruitless. One thing she still had was health insurance, acquired three years ago after Arkansas’ Republican-controlled legislature agreed to expand Medicaid under the Affordable Care Act. The coverage, she said, has allowed her to get regular checkups and treatment for tendinitis in her foot. But unless she finds a new job, Ms. Godinez, 55, could be at risk of losing her insurance, too. (Goodnough, 2/25)

Report For Governors Warns About Gaps In Funding Under GOP Plan To Revamp Medicaid

Health consultants Avalere and McKinsey & Co. looked at how plans to switch Medicaid to a block-grant system or a per capita funded program would affect states and enrollment.

The Associated Press: Report Warns Of Gaps If Federal Health Care Dollars Are Cut
A sobering report to governors about the potential consequences of repealing the Obama-era health care law warns that federal spending cuts probably would create funding gaps for states and threaten many people with the loss of insurance coverage. ... The report said the combination of phasing out Medicaid expansion money from the U.S. government, plus transforming the overall program from an open-ended federal entitlement to one that operates under a cap would likely result in state funding gaps. States that expanded Medicaid would face the deepest cuts. (Nuckols and Alonso-Zaldivar, 2/27)

Modern Healthcare: Millions Would Lose Coverage Under GOP Plans To Cut Medicaid 
Avalere Health consultants were commissioned by the National Governors Association to analyze how state budgets and residents in expansion and non-expansion states would be affected by congressional Republicans' proposals to change Medicaid into a per capita program or one that distributes block grants. Republicans in Congress are floating the ideas as a alternatives to rolling back Medicaid expansion made possible through the ACA. If those proposals were implemented, up to 51% of those who purchased coverage through the ACA marketplace could lose coverage in non-expansion states, while those that did expand Medicaid eligibility could see coverage slashed by 30%. (2/26)

Bloomberg: Coverage May Decline With Obamacare Repeal, Governors Told 
The presentation, from consulting firms Avalere Health and McKinsey & Co., separately estimates that changes to Medicaid could limit funding for the program, reducing enrollment, without estimating exactly how many people would lose insurance. “Tens of thousands who would not be able to afford their coverage and would lose their coverage,” Democratic Governor Jay Inslee of Washington said after the closed-door meeting. “It was a pretty disturbing briefing.” He has been a critic of Republicans’ repeal plans. (Edney and Tracer, 2/25)

The Washington Post: GOP Changes To Obamacare Could Cost States, Reduce Coverage, Governors Are Told
A Republican outline for replacing the Affordable Care Act (ACA) could significantly reduce the number of Americans with health insurance and potentially cost states billions of dollars over five years, according to an analysis prepared for the National Governors Association on Saturday. ... Health-care restructuring is a major focus of the governors at their annual winter meeting, given likely changes to Medicaid that have potentially large implications for state budgets. Republican governors have been meeting among themselves and with members of Congress, seeking consensus on a way forward, but so far have not found it. (Balz, 2/25)

Kasich Takes Pitch To Save Medicaid Expansion To White House

"I'm on a plane and he's the pilot," Ohio Gov. John Kasich said. "And you know the fact is, I want the pilot to be successful. But you know what? Every once and a while ... you need to yell into the cockpit."

The Washington Post: A Divided White House Still Offers Little Guidance On Replacing Obamacare
A meeting Friday afternoon between President Trump and Ohio Gov. John Kasich, his former rival in the GOP primaries, had no set agenda. But Kasich came armed with one anyway: his hope to blunt drastic changes to the nation’s health-care system envisioned by some conservatives in Washington. Over the next 45 minutes, according to Kasich and others briefed on the session, the governor made his pitch while the president eagerly called in several top aides and then got Health and Human Services Secretary Tom Price on the phone. At one point, senior adviser Jared Kushner reminded his father-in-law that House Republicans are sketching out a different approach to providing access to coverage. “Well, I like this better,” Trump replied, according to a Kasich adviser. (Eilperin and Goldstein, 2/26)

The Wall Street Journal: John Kasich Makes Nice With Trump Amid Medicaid Push
Mr. Kasich said that a long and cordial Oval Office meeting had led him to believe the president was responsive to his arguments about how Republicans should end a bigger fight over Medicaid, the federal-state program for the poor that 14 Republican-led states including his expanded under the 2010 Affordable Care Act and 17 Republican-led states did not. He is aiming to win over Republican governors to a compromise over the future of federal funding for states that did expand this weekend. “He listened very carefully to what I have to say about it,” said Mr. Kasich, who added that he repeated his points two or three times as different people came in and out of the room, among them, Mr. Trump’s chief of staff Reince Priebus, son-in-law and senior adviser Jared Kushner, and economic adviser Gary Cohn. (Radnofsky, 2/24)

Cleveland.com: John Kasich Lobbies In D.C. To Save Medicaid Expansion
The governor suggested on "Face the Nation" Sunday that conservative members of Congress would be the the biggest obstacle to passing an Obamacare replacement law. Kasich: "I think there are some very conservative Republicans in the House who are going to say just get rid of the whole thing. And that's not acceptable when you have 20 million people, or 700,000 people in my state, because where do the mentally ill go? Where do the drug addicted go?" (Pelzer, 2/27)

As It Faces Possible Dismantling, Health Law's Support Stronger Than Ever

From polls to protests, the health law is getting the kind of backing it hasn't seen for most of the time since it passed.

The Wall Street Journal: Recent Warmth Toward Affordable Care Act Persists, WSJ/NBC Poll Shows
Voters’ warmer views of the Affordable Care Act held up in February, according to a new Wall Street Journal/NBC News poll, with supporters narrowly outweighing detractors for a second month. Opposition to the health law often known as Obamacare had outpolled support in every WSJ/NBC survey since the law was passed until the start of this year, when the debate began in earnest about passing repeal legislation that Republican President Donald Trump could sign. (Radnofsky, 2/24)

The Washington Post: Activist Muscle Gives Obamacare A Lift
Seven years after the passage of the Affordable Care Act, Democrats seem finally to have secured a crucial element for its preservation: a robust grass-roots movement supporting it. Pro-ACA protesters attended more than 100 rallies held Saturday across the country, organized by an activist group affiliated with Sen. Bernie Sanders (I-Vt.). That followed a congressional recess week during which GOP lawmakers were confronted by defenders of the health-care law in town hall meetings across the country. Numerous Democratic officeholders also held events touting the law’s successes. (DeBonis and Weigel, 2/25)

Arizona Republic: Medical Providers, ACA Supporters Rally For Health Care At McCain, Flake Offices In Phoenix
Medical professionals and Affordable Care Act supporters lined the sidewalk along Camelback Road near the offices of U.S. Sens. John McCain and Jeff Flake on Saturday afternoon to express their disbelief and disappointment in federal efforts to repeal the health-insurance measure. Supporters said the possibility of losing insurance granted through the ACA, widely referred to as "Obamacare," is a matter of life or death. (Mitchell, 2/25)

With ACA's Future Uncertain, Calif. And Vermont Consider New Models For Health Care

California officials are looking at moving to a "single-payer" health system if Republicans gut the federal health law, but they face big challenges. Yet across the country, tiny Vermont is embarking on an experiment, blessed by the federal government, to change how health care is paid for. Also in the news, Wisconsin Gov. Scott Walker says his state may have a model that could be used if the federal law is repealed.

Los Angeles Times: With Obamacare In Jeopardy, California Considers Going It Alone With 'Single-Payer' System
With President Trump now vowing to put forward a replacement for the Affordable Care Act in March, some California politicians and healthcare advocates are once again promoting the idea of a state-run “single-payer” system that operates like Medicare. Backers say the uncertainty surrounding Trump’s promise to repeal Obamacare presents California with a chance to rethink how healthcare is delivered to its 39 million residents. (Karlamangla, 2/26)

Kaiser Health News: Liberal Vermont Tests The Waters On GOP Health Care Overhaul
Tiny — and very blue — Vermont could be at the leading edge of the health reforms envisioned by the Trump administration and a Republican Congress. The Green Mountain State, population around 626,000, got a broad waiver last October from the federal government to redesign how its health care is delivered and paid for. The statewide experiment aims to test new payment systems, prevent unnecessary treatments, constrain overall growth in the cost of services and drugs, and address public health problems such as opioid abuse. (Findlay, 2/27)

Milwaukee Journal Sentinel: Scott Walker Touts State's Health Care For Poor As Obamacare Alternative
Wisconsin Gov. Scott Walker touted the state's program for health insurance coverage for the poor on "Fox News Sunday with Chris Wallace," calling it "a model of exactly what will happen" under plans to replace Obamacare. ... Walker told Wallace that Wisconsin's program, which was criticized in 2013 for pushing some low-income residents out of Medicaid and into the subsidized private insurance exchanges, dramatically lowered the number of uninsured without taking federal dollars for Medicaid expansion. (Johnson, 2/26)

KCUR: Kansas Congressman’s Survey On Affordable Care Act May Be Misleading 
The Republican majority in Congress is intent on repealing the Affordable Care Act, also known as Obamacare. Freshman Kansas 1st District Rep. Roger Marshall is on board. So he’s gathering input from constituents on how to proceed with repealing and replacing the ACA with what he calls needed “free-market reforms.” The Great Bend Republican recently mailed a survey to 50,000 households in the Big First. (Thompson, 2/25)

Meanwhile, a former Connecticut and federal health official looks forward --

The CT Mirror: Kevin Counihan On The ACA: ‘Whatever Happens, Trump Is Going To Own This’
[Kevin] Counihan was the first chief executive of Connecticut’s exchange, Access Health CT, launching the coverage marketplace during the rollout of the Affordable Care Act. Now he’s a customer. ... While visiting Connecticut last week, Counihan spoke to The Mirror about efforts to replace the Affordable Care Act, why the health law has gotten more popular since Obama left office, the need to address health care costs, how to keep insurance companies from fleeing exchanges, and what can be done to make it easier to buy coverage. (Levin Becker, 2/26)

Administration News

Trump To Offer Health Law Plan Details In Speech To Congress

The president will address a joint session of Congress on Tuesday. Meanwhile, both chambers are back in session and the health law is at the top of lawmakers' agenda.

Reuters: Trump To Lay Out Healthcare Revamp Details In Speech To Congress
President Donald Trump said on Sunday he will offer details on how he would like to overhaul President Barack Obama's signature healthcare law in a speech to the U.S. Congress on Tuesday. Since they now control the White House and Congress, Republicans are under pressure to fulfill their pledge to repeal and replace the Obamacare law although they have found no easy way to do it. (Holland, 2/26)

The Associated Press: Health Care, Supreme Court On Agenda As Congress Returns
Congress returns to Washington this week to confront dramatic decisions on health care and the Supreme Court that may help determine the course of Donald Trump's presidency. First, the president will have his say, in his maiden speech to a joint session of Congress on Tuesday night. Majority Republicans in the House and Senate will be closely watching the prime-time address for guidance, marching orders or any specifics Trump might embrace on health care or taxes, areas where some of his preferences remain a mystery. (Werner, 2/27)

Trump To Hold Round Table With Insurers Over Future Of Health Law

The president is expected to seek the executives' support on Republicans' efforts to dismantle and replace the Affordable Care Act.

The Wall Street Journal: Trump To Meet With Insurance Executives On Repeal Of Affordable Care Act
President Donald Trump is planning to hold a round-table meeting with health-insurance executives at the White House on Monday, according to people close to the planning, as the administration looks to encourage insurers to sign onto Republicans’ health-care overhaul efforts. The gathering is expected to focus on getting the industry leaders’ support for the GOP initiative, which would dismantle much of the Affordable Care Act and introduce several measures supported by many Republicans, including age-adjusted tax credits and expanded access to health-savings accounts. (Armour, Wilde Mathews and Hackman, 2/24)

The Wall Street Journal: Health Insurers Hope For Nothing
The specter of gridlock in Washington presents a risk for the surging stock market. For health insurers, gridlock might be exactly what investors need. President Donald Trump is set to hold a meeting with insurance executives on Monday. For most businesses, such meetings haven’t been a bad thing as the president talks up his pro-business policies. This meeting is more of a wild card. President Trump has made repealing and replacing the Affordable Care Act a top priority. On Friday he referred to the law as an “absolute and total catastrophe.” (Grant, 2/26)

Reuters: Anthem And Blue Crosses Loom Large In Obamacare Talks
Anthem Inc. and other U.S. health insurers complained to the White House for more than a year that they were losing money on people who waited to sign up for Obamacare coverage until they were sick. They pleaded with the Obama administration to stem their losses by tightening up on the enrolment rules. When their pleas went unmet, UnitedHealth Group Inc, Humana Inc, and Aetna Inc pulled out of most of the government subsidized health insurance market. (Humer, Abutaleb and Cornwell, 2/27)

Trump Policies Having Chilling Effect On Immigrants Seeking Medical Care

Patients are canceling their appointments due to fears of being deported.

Stat: Immigrants, Fearing Trump’s Deportation Policies, Avoid Doctor Visits
As President Trump continues to step up immigration enforcement, medical centers say the changes are indeed keeping immigrants out — of hospitals and clinics...Evidence that undocumented immigrants are avoiding clinics or hospitals because of the new guidelines is only anecdotal. But researchers have previously found that tightening of immigration policies have resulted in at least some increased fear in immigrant communities, with residents reluctant to leave their homes, go to the doctor, or take other actions they think might put themselves at risk. (Swetlitz, 2/24)

In other news —

Chicago Sun Times: Doctors Gave Fake Medical Opinions To Help Win Citizenship 
Psychiatrists and other doctors in Chicago and across the country have been caught helping immigrants gain U.S. citizenship by providing fake medical opinions, records show. An estimated 1,000 people a year submit a form to immigration officials in Chicago alone to waive the requirements that someone seeking citizenship must understand English and pass a test in U.S. history and civics. The obscure Form N-648 requires a doctor to list any physical or mental ailment that would prevent a patient from meeting the language requirements of citizenship. (Main, 2/24)

Veterans' Health Care

Only Handful Of VA Employees Fired Or Reprimanded In Over 11,000 Reported Incidents Of Drug Theft, Loss

The Associated Press reports that Veterans Affairs disciplined more than 370 employees across 160 medical centers and 1,000 clinics since 2010 for drug- or alcohol related infractions.

The Associated Press: VA Data Show Low Rate Of Discipline For Drug Loss, Theft
Doctors, nurses or pharmacy staff at the Department of Veterans Affairs’ hospitals were fired or reprimanded in only a small fraction of thousands of reported cases of opioid theft and missing prescriptions since 2010, according to government data obtained by The Associated Press. About 372 VA employees were disciplined for a drug or alcohol-related issue across a network of 160 medical centers and 1,000 clinics over the last six years, according to internal figures kept by the facilities that were reported to VA’s headquarters. During that time, there were more than 11,000 reported incidents of drug loss or theft at federal hospitals — the vast majority within the VA, according to law enforcement data. Roughly translated, VA employees were disciplined in 3 percent of cases. (Yen, 2/27)

Quality

Direct Primary Doctors Provide More Affordable Alternative To 'Concierge' Care

A small but growing number of doctors is bypassing insurance and charging patients a monthly fee for services.

The Wall Street Journal: With Direct Primary Care, It’s Just Doctor And Patient
There’s no waiting room at Linnea Meyer’s tiny primary-care practice in downtown Boston. That’s because there’s rarely a wait to see her. She has only 50 patients to date and often interacts with them by text, phone or email. There’s no office staff because Dr. Meyer doesn’t charge for visits or file insurance claims. Patients pay her a monthly fee—$25 to $125, depending on age—which covers all the primary care they need. “Getting that third-party payer out of the room frees me up to focus on patient care,” says Dr. Meyer, who hopes to expand her year-old practice to 200 patients and is relying on savings until then. “This kind of practice is why I went into medicine, and that feels so good.” (Beck, 2/26)

In other doctor-patient news —

California Healthline: When You Don’t Speak The Same Language As Your Child’s Doctor
When Margarita Ruiz takes her children to the doctor’s office, she has no choice but to trust that nurses and front desk staff are translating medical orders accurately. She doesn’t speak English and her children’s pediatrician speaks very little Spanish. Ruiz, of Rosemead, Calif., said she feels grateful that staff members at the office of her children’s current doctor are usually available to translate. In the past, in a different doctor’s office, her oldest son, 14, translated for her. “It wasn’t ideal, but I didn’t have much of a choice,” said the 33-year-old homemaker. Health care experts say it is not advisable to use untrained interpreters, whether they are medical office staff members or your own family members. (Ibarra, 2/27)

Public Health And Education

Artificial Blood Has Long-Bedeviled Scientists, But Breakthrough May Be On The Horizon

The artificial blood could be freeze-dried and stored safely for years. In other public health news: antibiotic-resistant infections, aid in dying, gene editing, alcoholism, obesity and more.

Stat: Artificial Blood: The Quest For One Of Science's Holy Grails
The need for such a product is clear. Blood loss from traumatic injuries is responsible for thousands of deaths annually, and even when people survive, oxygen depletion can leave tissue permanently injured. Fresh blood can only be stored for 42 days, and only lasts for a few hours unrefrigerated. A substitute could be vital in settings like battlefields or rural areas without easy access to blood, used as a stopgap measure to keep the injured alive until they get to a hospital. But the quest to develop substitute blood has bedeviled researchers in academia, the military, and the biopharma industry, with several companies — including Baxter, Northfield Laboratories, and Biopure — abandoning their attempts. (Joseph, 2/27)

The Washington Post: Dangerous Antibiotic-Resistant Infections On The Rise For Children In The U.S., Study Finds
Rising infections caused by a type of bacteria resistant to multiple antibiotics is causing longer hospitalizations and may mean a higher risk of death for children in the United States, according to a new study. The study, published this week in the Journal of the Pediatric Infectious Diseases Society, found that 3 out of 5 children admitted to hospitals already had an antibiotic-resistant infection — suggesting these infections are spreading more often in the community. (Naqvi, 2/25)

The New York Times: Gorsuch Staunchly Opposes ‘Aid In Dying.’ Does It Matter?
Ever since President Trump nominated Judge Neil M. Gorsuch to fill the empty seat on the Supreme Court, interested parties have been combing through his writings and appellate court rulings looking for signs and portents. If he’s confirmed, how might Judge Gorsuch vote on affirmative action questions? Or challenges to Roe v. Wade? But nobody has to do much head-scratching over his position on medical aid in dying. (Span, 2/24)

The Wall Street Journal: DIY Gene Editing: Fast, Cheap—And Worrisome
Kian Sadeghi has postponed homework assignments, sports practice and all the other demands of being a 17-year-old high-school junior for today. On a Saturday afternoon, he is in a lab learning how to use Crispr-Cas9, a gene-editing technique that has electrified scientists around the world—and sparked a widespread debate about its use. Scientific breakthroughs often raise big ethical questions. Moral concerns around the 1996 cloning of Dolly the sheep or the 2000 announcement of a rough draft of the human genome still reverberate today. The public benefits from scientific advances, particularly in improving health. But some scientists say the power to alter the DNA of plants, animals or people, and the profound impact such changes may have on individuals and society, merits public discussion. (Marcus, 2/26)

NPR: A Medicine That Blunts Opioids Can Help Problem Drinkers, Too
If you drink more alcohol than you want to or should, you're not alone. A nationwide survey by the National Institutes of Health found that 28 percent of adults in the U.S. are heavy drinkers or drink more than is recommended.Yet, most heavy drinkers don't get the help they need. "The biggest problem we have in the field is that less than 10 percent of individuals with an alcohol use disorder get any treatment whatsoever," says George Koob, director of the National Institute on Alcohol Abuse and Alcoholism. (Aubrey, 2/27)

Boston Globe: Violence As A Disease: Hospitals Treat Wounds, Physical And Otherwise 
The victim’s arrival signals that more violence is likely to occur, and opens an opportunity to heal the social and emotional maladies that feed violence. As many as 45 percent of people who go to the hospital with violent injuries return within five years, shot or stabbed again, sometimes fatally. And retaliation can lead to further shootings. (Freyer, 2/27)

NPR: Patients Speak Up To Improve Medical Science — And Their Own Care
Many studies designed to try out new drugs simply languish. They don't attract enough patients, and they aren't completed. That slows medical progress. But here's a story of one study that has bucked that trend — in fact, it is so popular, scientists had to put the brakes on it for a while. The study is called the NCI-MATCH trial. It upends the normal way of classifying cancers for treatment: Instead of categorizing malignancies by the organ where they first appear, this method of sorting focuses on particular mutations in the genes of cancer cells. (Harris, 2/24)

The New York Times: Doctors Consider A Last Best Hope For Obese Teenagers: Surgery
If all goes well, Aliayha Carrasco-Garcia will have an operation next month that will change her life. She will shed many of the 240 pounds that now burden her 5-foot-2 frame. Like many who have bariatric surgery, she has tried diets and exercise to no avail. Surgery is her last best hope. But there is a difference between Aliayha and almost everyone else who has had this operation: She is only 15. (Kolata, 2/24)

Stateline: Should People Be Barred From Buying Junk Food With Food Stamps?
Twenty-three cents of every food stamp dollar is used to buy candy, desserts, salty snacks, sugar and sweetened beverages, according to a November report from the U.S. Department of Agriculture that for the first time revealed purchasing habits under the program in detail. The report, along with the election of President Donald Trump, who may be more inclined to tighten welfare rules, has reignited a long-standing debate on whether the government should allow people to use food stamps to buy unhealthy food. Lawmakers in at least five states — Arkansas, Florida, Mississippi, New Mexico and Tennessee — introduced bills this year to ask the USDA for permission to ban the purchase of certain kinds of food or drinks, such as candy and soda, with food stamps. Since the USDA administers the program, states can’t create their own restrictions. But the department can give a state permission to conduct a pilot to test new ideas — something it has so far been unwilling to do. (Fifield, 2/24)

Boston Globe: Startups’ Latest Nut To Crack: Food Allergies
As more Americans are diagnosed with food allergies — as many as 15 million and counting — there’s a growing consensus that the research has not kept pace. In November, the National Academies of Sciences released a damning report warning that “insufficient or inconsistent data and studies” have left the allergic casting about for answers. (Nanos, 2/26)

San Francisco Chronicle: Science Closing In On Polio-Like Virus That Paralyzed Children 
Scientists are closer than ever to proving that new strains of an old virus are to blame for recent waves of polio-like paralysis in children that have stumped doctors and alarmed parents across the country. Laboratory mice exposed to the virus, called Enterovirus D68, often developed sudden-onset paralysis in one or more limbs a few days later, according to research published last week by a team of scientists from UCSF, the University of Colorado School of Medicine and the California Department of Public Health. (Allday, 2/26)

Miami Herald: New Study Reveals LGBT Seniors Have Higher Health Risks But Are Also Very Resilient 
A series of reports believed to comprise the first longitudinal study of its kind found that LGBT Americans aged 50 and older are at a higher risk of disability, cardiovascular disease, depression and social isolation. But the group — at 2.7 million strong — is also resilient, choosing to be active in the community, participate in wellness activities and serve in the military. (Veciana-Suarez, 2/24)

Mo. Foster Care Flooded With Young Kids Of Parents Addicted To Heroin

In other news on the nation's opioid and heroin epidemic, police departments in Virginia and Ohio expand the use of naloxone by officers to combat overdoses.

St. Louis Post Dispatch: Tiniest Victims Of Missouri's Heroin Epidemic Flood Into Foster Care
The tiny babies typically arrive at Jill Bundschuh’s foster home in Rock Hill around her family’s dinner time. Social workers bring them on short notice, with maybe some formula and a few diapers. There are no extra onesies. No swaddling blankets. No car seats. The paperwork is usually sparse beyond a name and maybe a few clues about the baby’s first few days or weeks of life. Bundschuh knows from experience to quickly read the hospital notes before the caseworker leaves with the file. Even when there is no medical history, this relatively new foster parent knows what to expect in the long night ahead. (Cambria, 2/26)

Richmond Times Dispatch: Hanover Law Enforcement Plans To Buy Opioid Antidote 
Hanover County Sheriff David R. Hines said this month that his officers will begin this year carrying a drug that can reverse heroin and painkiller overdoses. The announcement that the Hanover Sheriff’s Office plans to buy Narcan, a brand of naloxone, came during a speech Hines gave to Hanover’s Board of Supervisors at a special county budget meeting. (Thompson, 2/26)

State Watch

State Highlights: Conn. Hospitals Complain About Hefty Hidden Tax In Gov.'s Budget; Wis. State Workers Would Have Fewer Choices Under Health Coverage Proposal

Outlets report on news from Connecticut, Wisconsin, Virginia, Florida, Colorado, Georgia, Maryland, Pennsylvania, Minnesota and Ohio.

The CT Mirror: Hospitals Say They Face Hidden, $156M Tax Hike In Malloy Budget 
Connecticut hospitals would pay $156 million more in state taxes over the next two years under Gov. Dannel P. Malloy’s new budget — an increase Malloy did not report to legislators when presenting his biennial plan on Feb. 8, the Connecticut Hospital Association says. But the administration, which has had a rocky history with the industry, says hospitals only would owe more taxes if they are making more money. (Phaneuf, 2/27)

Milwaukee Journal Sentinel: Proposed Plan Would Revamp Health Benefits Program For State, Municipal Workers
A proposed plan to revamp how the state provides health benefits for its employees would sharply limit their choice of health plans but could save the state an estimated $60 million in the next two-year budget... The proposed changes would not result in reduced benefits, according to the board. However, roughly 2% of the people now covered by the state health benefits program would have to change doctors. (Boulton, 2/25)

Richmond Times Dispatch: Case Sheds Light On Lack Of Oversight At Independent Living Facilities In Virginia
The family of a woman who was left unchecked for four days at an independent living facility in Albemarle County is hoping to shed light on what can happen at unregulated facilities. Diane Franklin, 75, who died of cancer last year, was residing at Commonwealth Senior Living’s independent living facility in Albemarle when she broke her clavicle in bed and found herself unable to move. The facility had a check-in system offered to independent residents, but Franklin was not checked on by staff for four days. (Wrabel, 2/26)

Denver Post: Grants Help Colorado Doctors In Rural, Low-Income Areas Repay Student Loans
A Colorado program that helps repay the student loans of doctors who work in rural or underserved areas is gearing up for what could be its largest grant class ever. The Colorado Health Service Corps will begin accepting applications for the new grants on March 1, and Steve Holloway, who oversees the program for the Colorado Department of Public Health and Environment, said as much as $5 million could be available to repay loans for as many as 60 physicians and other providers. Already, Holloway said, the corps is the largest such state-based program in the country. The federal government funds a similar National Health Service Corps. (Ingold, 2/24)

Denver Post: Access To Birth Control Widens As Colorado Pharmacists Prepare To Prescribe Oral Contraceptives 
Colorado pharmacists soon can begin prescribing oral contraceptives under a new protocol that will provide unprecedented access to birth control in this state. Women who are at least 18 can complete a questionnaire, blood-pressure check and a 10- to 15-minute consultation with a pharmacist, then walk out with birth-control pills or patches, under new rules set in motion by a 2016 state law with bipartisan support. Colorado is just the third state with such access, joining Oregon and California. (Brown, 2/27)

Tampa Bay Times: In Harm's Way: What Could Florida Lawmakers Do To Keep Kids From Being Shot? 
Statewide, the number of children killed by guns has risen nearly 20 percent since 2010, a Tampa Bay Times analysis has found. Child gun injuries went up 36 percent. Not surprisingly, the solutions up for consideration this year differ radically along party lines. Democrats want to tighten the existing law that hold adults criminally liable when kids access their firearms, and increase the penalties. But the lawmaker with the most power over the matter has a different idea. (McGrory, 2/25)

The Baltimore Sun: Doctors Could Admit To Mistakes Without Facing Liability In Court Under Proposed Legislation
Wrestling with rising malpractice costs, hospital administrators want to see more cases worked out in the same manner and are pushing legislation in the General Assembly that they say would make it easier for doctors to acknowledge when a procedure or surgery goes wrong without that acknowledgment becoming admissible in court. They argue it would put more compensation in the hands of patients, rather than lawyers, and enable hospitals to develop treatment plans more quickly for patients. But a trial lawyers organization said such changes would leave patients in a vulnerable position, and call the proposal an attempt to keep such cases out of court and away from juries. (McDaniels, 2/26)

The Philadelphia Inquirer: Pa. Department Of Health Investigates Mumps Cases At Penn State
The Pennsylvania Department of Health said Friday that it is investigating confirmed and potential cases of mumps at Penn State University. It did not say how many students have been sick and added that it would release no further information "due to confidentiality reasons. "However, Shelley Haffner, infectious disease manager for the university's health center, said there have been five confirmed cases and 15 more are under investigation.  The first case was confirmed Jan. 29.  Cases have picked up in the last week. (Burling, 2/24)

The Star Tribune: HCMC, Nice Ride Partner On New Program To Help People With Mental Illness By Providing Free Bikes
A recent collaboration between the Nice Ride Minnesota bike share program and Hennepin County Medical Center is helping people deal with mental illness by giving them free bike memberships. The program, which starts its second year April 1, is part of a broader shift in mental health treatment to prescribe physical exercise for people with depression, anxiety or other mental illnesses. (Smith, 2/25)

Columbus Dispatch: State Rules For Medical Marijuana Use THC, Not Weight, For Purchase
Buying medical marijuana in Ohio will require a knowledge of THC content, not just how many ounces of plant material or edibles are on the scale. Proposed rules outlined Thursday by the Ohio State Board of Pharmacy would make Ohio the only state to determine how much medical marijuana can be purchased based on the amount of tetrahydrocannabinol — the active chemical ingredient that produces a high — it contains. (Johnson, 2/24)

Editorials And Opinions

The Twists And Turns Of Unraveling The Health Law And Related Federal Policies

Opinion writers examine the issues in play -- and how people might be affected by them -- as the repeal-replace-repair debate continues.

The Wall Street Journal: To End ObamaCare, Be Bold
The current Republican plan for partial repeal of ObamaCare is replete with downsides that make political opportunists on the left salivate. But consider the recent statement by Aetna’s CEO that ObamaCare is entering a “death spiral” as higher premiums drive healthier customers from the marketplace. This permits a better approach. (Heather R. Higgins, 2/26)

The New York Times: Why Undoing Obamacare Will Be So Hard
House Republicans will be unveiling their replacement for the Affordable Care Act (a/k/a Obamacare) next week and the White House has been signaling that it may reveal its thoughts not long after. But what is becoming increasingly clear is the extent to which Obamacare has become embedded in the American health care structure and how difficult it will be to craft an acceptable replacement. (Steven Rattner, 2/24)

The Washington Post: Face It: When It Comes To Health Care, People Are Hard To Please
Pass the Affordable Care Act, and for seven years, Americans tell pollsters they do not like it. Threaten to take away the ACA, and Americans tell pollsters, in effect, “How dare you take away the ACA!” Are people fickle, contrarian? Perhaps, but they are also deeply risk averse when it comes to their health and that of their family. Therein rests a cautionary tale for Republicans bent on repealing Obamacare. (Jennifer Rubin, 2/24)

RealClear Health: Don’t Throw Children Under The School Bus: Medicaid Is A Smart Investment In Our Nation’s Children
Medicaid provides millions of America’s children with that critical link to health and success. Children make up the single largest group of individuals who rely on Medicaid for their health care coverage. Medicaid has been working for kids for over 50 years now. What’s more, Medicaid includes a unique child-centered benefit package known as Early Periodic Screening Diagnostic and Treatment (EPSDT) so that children are not denied coverage for services they need to stay on track developmentally. This important provision helps our nation’s most vulnerable children have the best shot possible of reaching their full potential. (Joan Alker, 2/27)

Los Angeles Times: Trump's Pick To Run Medicare And Medicaid Thinks Maternity Coverage Should Be Optional. Here's Why She's Dead Wrong
With these words, [Seema] Verma demonstrated either utter ignorance about how health insurance works, or such desperation for this job that she’s willing to profess ignorance and paper it over with conservative shibboleths about “individual choice” and the freedom to make one’s own decision. She deliberately overlooked that prior to the ACA, there was no such freedom, and women were typically not given a practical choice of whether to take maternity benefits or not; they simply weren’t offered. (Michael Hiltzik, 2/24)

Cleveland Plain Dealer: Keep Defending Ohio Medicaid Expansion, Gov. Kasich
Some fellow Republicans will undoubtedly pressure Kasich to get with the Trump administration's program, whatever it is. But "repeal and repair" is really mostly about repeal -- and about walking away from those in Ohio who are counting on Kasich to stand firm. John Kasich must not agree to such a proposal. Given Ohioans' needs, he simply cannot. (2/25)

Nashville Tennessean: TN Health Insurance: Hope For Best, Prepare For Worst
Humana’s recent decision to cease offering individual health coverage on the Affordable Care Act exchanges in 2018 reflects the fact that there is more uncertainty than ever before about health insurance — both in Tennessee and nationwide. In the face of so much uncertainty, insurers are facing a May filing deadline related to whether they intend to sell individual plans next year. Without further intervention from President Trump’s administration or Congress, more insurers may follow Humana’s lead and decide not to offer individual coverage in 2018. This could create a worst-case scenario in 2018 where some Americans cannot get health insurance at all because no insurer offers it in their market. In fact, right now this seems more likely than not in 16 Tennessee counties where Humana is the only carrier in 2017. (Alex Tolbert, 2/26)

Richmond Times Dispatch: Inova’s Plan To Help People Enjoy Better Health At Lower Cost
As Republicans and Democrats brace for a battle royal over Obamacare and what might replace it, they would do well to pay heed to an important experiment south of the Potomac. In Congress the debate centers on who pays for health care and how costs can be shifted to someone else — a zero-sum game. At Inova Health System, the dominant health-care provider in Northern Virginia, the focus is on improving peoples’ health at lower cost by practicing medicine differently. If Inova is successful, everyone wins. (James A, Bacon, 2/25)

Viewpoints: Where Opioid Addiction Sometimes Starts; Improving End-Of-Life Care

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

Los Angeles Times: Long-Term Opioid Addiction Can Start In The ER
There’s a common thread in many accounts of opioid addiction: It all started with a single prescription after a minor injury or other medical issue. There are plenty of culprits in the opioid epidemic raging across the country, including the pharmaceutical industry, drug traffickers and economic stagnation. But there is little doubt that many thousands of opioid users got their first introduction to an opioid from a physician who wanted to treat their pain. And we’ve found unsettling evidence that whether you are prescribed an opioid, and whether a first opioid prescription turns into many, could be just a matter of chance. (Michael Barnett and Anupam B. Jena, 2/27)

Stat: Strict Limits On Opioid Prescribing Risk ‘Inhumane Treatment’ Of Pain Patients
Amid a rising toll of opioid overdoses, recommendations discouraging their use to treat pain seem to make sense. Yet the devil is in the details: how recommendations play out in real life can harm the very patients they purport to protect. A new proposal from the Centers for Medicare and Medicaid Services to enforce hard limits on opioid dosing is a dangerous case in point. (Stefan G. Kertesz and Adam J. Gordon, 2/24)

Stat: 5 Ways To Improve Care At The End Of Life
As baby boomers continue to age, swelling the ranks of the elderly and those near death, how seriously ill people approaching the end of life are cared for must be reformed. We had the honor of chairing the Aspen Health Strategy Group, composed of 23 experienced leaders in health care, technology, and the media, as it explored ways to improve care at the end of life. Here are five of the transformative ideas we included in the group’s report, “Improving Care at the End of Life.” (Kathleen G. Sebelius and Tommy G. Thompson, 2/24)

The Wall Street Journal: A National Right To Life
One job President Trump should fill as soon as possible is commissioner of the Food and Drug Administration, which has for decades slowed or strangled potentially lifesaving therapies. The promising news is that Mr. Trump and Congress have noticed and are proposing to help patients secure treatment more quickly. (2/26)

The New York Times: Mental Illness, Untreated Behind Bars
President Trump has talked quite a bit about cracking down on a nonexistent crime wave. Rarely does he talk about the different kinds of support law enforcement needs or what actually keeps communities safe. So it might have come as a surprise to him when a member of the National Sheriffs’ Association at a White House meeting earlier this month brought up an urgent problem sheriffs’ offices all face — the mental health crisis that has filled jails to bursting with mentally ill people who would be more effectively dealt with through treatment. (2/27)

Modern Healthcare: The Medical Imperative For Data-Sharing
Bryan Olson, a 47-year-old prostate cancer survivor with short spiky hair, dark glasses and the pallor of someone who has spent too many hours staring at computer screens, has become an evangelist for unlocking medical records through data-sharing and interoperability. The Intel marketing executive wants to link medical records from across the U.S. and the world into a vast virtual warehouse for research. It's key, he says, to achieving research breakthroughs for cancers like his and the other diseases that are characterized by genetic mutations. (Merrill Goozner, 2/25)

The Des Moines Register: Medical Errors Rise, But Malpractice Lawsuits Fall
It seems that with every legislative session, lawmakers introduce a bill or bills that significantly seek to rein in the rights of persons injured by medical malpractice. Most recently, legislation was introduced to arbitrarily cap or limit damages for pain, suffering and disability at $250,000. This amount may seem large to those viewing this issue through the prism of big business and big insurance. To a patient and their family struggling with significant lifelong injuries resulting in unrelenting pain, discomfort, and debility, it is a pittance. (Thomas P. Slater, 2/26)