KHN Morning Briefing

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Kaiser Health News Original Stories

Hidden Stroke Victims: The Young

The number of hospitalizations for stroke is rising quickly among young people, even as it drops across the U.S. population as a whole. (Anna Gorman, 8/24)

Political Cartoon: 'Hard-Headed'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Hard-Headed'" by John Deering from "Strange Brew".

Here's today's health policy haiku:

MORE WOES FOR THOSE WITH ALLERGIES

Nuts. Shellfish. Bee stings.
Add EpiPen costs to list
Of allergy fears.

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

Insurance Startup Oscar Pulling Out Of Health Law Marketplaces In N.J. and Texas

The company says it has suffered significant losses on the Obamacare markets and is rethinking its approach.

Bloomberg: Insurance Startup Oscar Quits Two Markets, Rethinks Obamacare Plans
Health insurance startup Oscar Insurance Corp. will reevaluate its approach to Obamacare after suffering significant losses under the U.S. program and will pull out of two markets next year. Oscar, which pitches itself as a tech-savvy alternative to traditional health insurers, plans to end sales of Affordable Care Act plans in Dallas, a market it entered this year, and New Jersey. It’s part of a more conservative approach by the New York-based company as it plans to introduce insurance products for businesses next year. (Tracer, 8/23)

Boston Globe: Charlie Baker-Backed Startup Insurer To Exit Two Markets After Losses On Obamacare
A health insurance startup that was one of Governor Charlie Baker’s favorites in his venture capital days will pull out of two markets after losing money under Obamacare. ... Oscar has become a darling not only of Baker, a health care policy wonk who used to run Harvard Pilgrim Health Care, but of numerous investment firms. Boston-based Fidelity in February led a $400 million round of funding that raised the company’s valuation to $2.7 billion. (Healy, 8/24)

The Texas Tribune: Health Insurers' Exit Spells Trouble For Obamacare In Texas 
The roughly 1.3 million Texans who bought health insurance under the Affordable Care Act will likely have fewer, more expensive coverage options in 2017, as health plans continue to announce they will no longer sell their products in Texas. Insurance start-up Oscar announced on Tuesday it would pull out of the Texas market, joining veteran health plans Aetna, UnitedHealthcare and Scott and White on the list of companies that recently announced they would abandon the marketplace created by President Obama’s signature health law. The companies said their costs of providing coverage to middle-income Texans have been unsustainable, fueling concerns about a lack of competition and consumer choice within the health insurance market next year. (Walters, 8/24)

Dallas Morning News: Insurer Oscar To Stop Serving D-FW Citing 'Uncertainties' Of Area Market 
Oscar launched in New York in 2013 and expanded to Texas in 2016 with plans offered in Bexar, Collin, Dallas and Tarrant counties. The company insures about 7,000 people in Dallas. The post from Schlosser on Tuesday said “uncertainties” in the Dallas-Fort Worth market make it challenging to operate effectively. ... Blue Cross Blue Shield of Texas says it has not made a decision about whether or not it will remain in the Obamacare marketplace in 2017. In May, it asked to increase the rate for individual plans it sells on the exchange market by and average of nearly 60 percent. (Rice, 8/23)

The Fiscal Times: Obamacare Startup Latest To Pull Out Of Health Care Markets
Big insurers like Aetna, Humana and UnitedHealthcare aren’t the only ones why say they’re struggling to make a profit on the public exchanges set up under the Affordable Care Act. Oscar Insurance Corp., a startup created specifically to cater to customers on the Obamacare exchanges, has also seen significant losses, prompting the young company to pull out of two markets next year, Bloomberg reports. (Braverman, 8/23)

Morning Consult: Insurance Startup Oscar To Retreat From Two Insurance Markets
Oscar’s announcement comes a week after Aetna became the third major insurer to announce it would withdraw from some exchanges in 2017, prompting questions about what steps may be necessary to stabilize the exchanges. The company will enter the San Francisco market, and will continue to offer plans in the New York, San Antonio, Los Angeles and Orange County markets, [CEO Mario Schlosser] said. The company is also poised to begin providing small group insurance coverage in some markets next year. (McIntire, 8/23)

The Hill: Health Insurer Oscar Pulling Out Of Some ObamaCare Markets 
Health insurance startup Oscar is pulling out of two ObamaCare markets next year, saying like large insurers that the company is having trouble making money. Oscar has been closely watched as a tech-savvy competitor that sought to make health insurance more consumer-friendly. (Sullivan, 8/23)

Approving Stiff Rate Hikes, Tenn. Insurance Chief Says Obamacare Exchange 'Very Near Collapse'

Commissioner Julie Mix McPeak said the increases in rates were necessary to ensure health care options throughout the state. News outlets also report on marketplace developments in Alabama, Georgia and Texas.

Tennessean: Tennessee Insurance Commissioner: Obamacare Exchange 'Very Near Collapse'
Tennessee's insurance regulator proclaimed the state's Obamacare exchange "very near collapse" Tuesday, after signing off on hefty premium hikes in an extraordinary bid to keep the program afloat. Her remarks largely overshadowing the dramatic premium increases, Commissioner Julie Mix McPeak thrust the issue of preserving competition into the spotlight at a moment when states around the country are grappling with dwindling numbers of insurers willing to sell on the exchange. (Fletcher, 8/23)

Marketplace: Alabama Ends Up With A Single Health-Exchange Insurer
People who buy individual health plans through the federal exchange in Alabama might soon see a big premium jump, anywhere from 26 to 41 percent over last year. Blue Cross and Blue Shield of Alabama, soon to be the state’s only health insurance provider, has proposed the rate hike to take effect in 2017. The same is true in other states, and those increases are projected to be steeper than in previous years, according to a new report from the Kaiser Family Foundation. (Douban, 8/23)

Georgia Health News: State Accepts New Hike In Blue Cross Exchange Premiums
The state insurance department Tuesday approved an average premium increase of 21.4 percent for Blue Cross and Blue Shield of Georgia for the 2017 health insurance exchange in Georgia. The company earlier had requested an average premium of 15.1 percent, but it raised the request in the wake of Aetna’s pullout from exchanges in Georgia and 10 other states last week. Blue Cross, the largest health insurer in the state, had told GHN late last week that it was considering upping its current premium proposal. (Miller, 8/23)

Houston Chronicle: Uninsured Rate For Young Adults In Texas Drops Dramatically 
The number of young adult Texans with health insurance is rising, a new survey shows. That is seen as good news for the Affordable Care Act because the 18-to-34 age group is important for the broader risk pool.The rate of uninsured in that age bracket dropped to 21 percent across the state in March, down from 33 percent in September 2013, a report released Tuesday by the Rice University's Baker Institute for Public Policy and Houston's Episcopal Health Foundation found. (Deam, 8/23)

And in national insurance news --

CBS News: Obamacare Orphan? Here's What You Can Do 
After Aetna (AET), the country’s third-largest insurer, announced last week that it plans to sharply scale back its participation in Obamacare, people started counting. With other mega-insurers including Humana and UnitedHealth also edging away from the federal health program, that will leave five U.S. states with only a single insurance carrier offering coverage through the exchanges. ... Here’s what you can do if your insurer is abandoning Obamacare. (Konrad, 8/24)

Morning Consult: Analysis Predicts 10.1 Million Will Be Enrolled In Exchanges At End Of 2016
A new analysis predicts there will be 10.1 million people enrolled in exchange plans by the end of 2016, less than half of the number originally predicted by the Congressional Budget Office in 2010. The analysis, conducted by Avalere Health, is about on par with the Obama administration, which said in January it expects 10 million enrollees by the end of the year. Avalere is an independent consulting firm. (Owens, 8/23)

Morning Consult: Analysis: GOP Obamacare Replacement Plan Would Decrease Coverage, Lower Premiums
The House GOP’s Obamacare replacement plan would decrease coverage over the next 10 years, but lower individual insurance premiums and decrease the federal deficit by $481 billion, according to an analysis publishing today by the Center for Health and Economy and provided in advance to Morning Consult. The Center for Health and Economy is a nonpartisan research organization that provides analysis on health care in the U.S. While the analysis makes several assumptions because of the lack of detail in the Republican plan, it is among the first to evaluate the impact of the proposal. The analysis compares the GOP plan to projections under current law. (Owens, 8/24)

Administration News

Five States Sue To Halt Obama Administration Rules On Transgender Health

The Department of Health and Human Services' rules seek to keep insurers from blanket bans on coverage of gender reassignment services and ban health care providers from refusing to care for transgender patients. The states say the regulations could force doctors to perform gender transition procedures on children.

Reuters: Texas, Four Other States Sue Over U.S. Transgender Health Policy
Texas and four other states sued the Obama administration on Tuesday over extending its healthcare nondiscrimination law to transgender individuals, saying the move "represents a radical invasion of the federal bureaucracy into a doctor’s medical judgment." Texas, along with Wisconsin, Nebraska, Kentucky and Kansas sued on behalf three medical organizations, two of which are affiliated with Christian groups. (Herskovitz, 8/23)

Politico: States Sue To Block Obamacare's Transgender Protections
The lawsuit challenges a section of the Affordable Care Act that prohibits discrimination on the basis of race, color, national origin, sex, age or disability in health care programs. In May, HHS issued final regulations, which prevent insurers from having blanket bans on coverage of gender reassignment services and forbids providers from refusing care to transgender patients, among other protections. (Pradhan, 8/23)

The Wall Street Journal: U.S. Sued Over New Transgender Health-Care Regulation
The lawsuit marks religious conservatives’ growing engagement in the fight over transgender rights, which has rapidly emerged as one of the most explosive social debates of the Obama administration. The suit comes just one day after a Texas judge temporarily suspended new federal guidelines intended to expand bathroom access for transgender students at public schools. (Lovett and Radnofsky, 8/23)

The Texas Tribune: Texas Leading Suit Over Federal Transgender Health Policy 
Ramping up its fight over the rights of transgender people, Texas filed a lawsuit Tuesday against the federal government over a regulation prohibiting discrimination against transgender individuals in some health programs. Texas, on behalf of religious hospital network Franciscan Alliance, and four other states are claiming the new federal regulation would force doctors to perform gender transition procedures on children and requested the court to block the federal government from enforcing the regulation. The federal rule on nondiscrimination in health care prohibits denying or limiting coverage for transgender individuals, including health services related to gender transition. (Ura, 8/23)

The Associated Press: States File Another Lawsuit Over Obama Transgender Rules
The lawsuit is the second in recent months in which conservative states have sued over federal efforts to defend transgender rights. Social conservatives claimed victory Sunday when a federal judge in Texas halted an Obama administration directive requiring public schools to let transgender students use bathrooms consistent with their gender identity. Now they're asking that same court to block new regulations intended to ban discrimination by doctors, hospitals and insurers against transgender persons. (Weber, 8/23)

Capitol Hill Watch

EpiPen's Price Hikes Draw Intense Scrutiny, Raise Ire Among Lawmakers

News outlets report on how the maker of the emergency allergy medicine came to raise the treatment's price tag by so much, how this move fits into the broader story of U.S. drug pricing policy and how the ensuing controversy will now play out both in the marketplace and on Capitol Hill.

The Associated Press: How EpiPen's Maker Raised Prices, And Hackles, So Much
Sky-high price hikes for EpiPen, the injected emergency medicine for severe allergic reactions to foods and bug bites, have made its maker the latest target for patients and politicians infuriated by soaring drug prices. The company, Mylan, has a virtual monopoly on epinephrine injectors, potentially life-saving devices used to stop a runaway allergic reaction. Mylan N.V., which has headquarters in Hertfordshire, England, and Pittsburgh, has hiked prices as frequently as three times a year over the past nine years, pushing its list price for a package of two syringes to more than $600. (Johnson, 8/23)

USA Today: EpiPen's Steady Price Increases Masked Until Deductibles Rose
The prices insurers and employers negotiate with Mylan are up about 150% since 2009, according to Rx Savings Solutions, which represents businesses and insurance companies. The average wholesale price has increased nearly 500% in that time, says Michael Rea, a pharmacist and CEO of Rx Savings Solutions. As outrageous as the EpiPen increases seem, Rea says they aren't that unusual and are getting attention now because parents are stocking up before back to school and are increasingly facing higher out-of-pocket costs due to higher deductibles and cost sharing. (O'Donnell, Singer and Rudavsky, 8/23)

Vox: EpiPen’s 400 Percent Price Hike Tells Us A Lot About What’s Wrong With American Health Care
The story of Mylan’s giant EpiPen price increase is, more fundamentally, a story about America's unique drug pricing policies. We are the only developed nation that lets drugmakers set their own prices, maximizing profits the same way sellers of chairs, mugs, shoes, or any other manufactured goods would. In Europe, Canada, and Australia, governments view the market for cures as essentially uncompetitive and set the price as part of a bureaucratic process, similar to how electricity or water are priced in regulated US utility markets. (Kliff, 8/23)

CNN: EpiPen Cost Soars, But It's Not The Only Drug To
Prescription drugs also cost about twice as much in the United States compared to other advanced nations. In other words, EpiPens are not the only prescription drugs with steep price hikes. For instance, when Turing Pharmaceuticals increased the cost of Daraprim, a drug used by some cancer and AIDS patients, from $13.50 to $750 last year, it sparked outrage. The pharmaceutical company's former CEO was Martin Shkreli, known as "pharma bro." (Howard, 8/23)

Stat: Controversial CEO In The Hot Seat Over EpiPen Price Hikes
Drug company CEO Heather Bresch affectionately describes the humble EpiPen as her “baby,” a once-middling product that she turned into a blockbuster. With aggressive advertising — and even more aggressive price hikes — Bresch has fostered the EpiPen into a bestseller that brings in more than $1 billion a year in revenue for Mylan Pharmaceuticals. But the growing furor over drug pricing threatens to turn Mylan’s biggest asset into a liability. And it has forced Bresch into an unwelcome spotlight, as anxiety over the rising cost of medicine has drug industry critics seeking out the next Martin Shkreli. (Garde, 8/24)

The Fiscal Times: Epi-Pen Maker Enters The Pharmaceutical Industry’s Hall Of Shame
Mylan’s sales from the sale of EpiPens reached $1.2 billion in 2015, according to Bloomberg. The price hike has generated a national uproar in recent days, and nearly 63,000 people have signed a petition demanding that Congress investigate “the oppressive price increases.” The petition notes that many families have been forced to turn to manual syringes as a cheaper alternative to the EpiPens, although that makes it harder and more time consuming to get the right dosage. ... As prices of EpiPens went up, so did the company stock, which tripled from $13.29 in 2007 to a high of $47.59 this year, as well as executives’ salaries. (Pianin, 8/23)

The Washington Post: U.S. Lawmakers Demand Investigation Of $100 Price Hike Of Lifesaving EpiPens
EpiPen maker Mylan has become the new boogeyman of the pharmaceutical industry. Following complaints from consumers that the company had hiked the price of the emergency auto-injector by $100 in recent months for no obvious reason, members of Congress are calling for an investigation. ... The medication itself isn't expensive. Analysts calculate that the dosage contained in a single pen is worth about $1. It's the company's proprietary pen injector that makes up the bulk of the cost. (Cha, 8/23)

The Associated Press: Lawmakers Demand Information On EpiPen Price Increase
Two other senators, Democrats Mark Warner of Virginia and Richard Blumenthal of Connecticut, also wrote the company about the high prices. Warner said in a letter Tuesday that the issue is personal for him. "As the parent of a child with severe allergies, I am all too familiar with the life-or-death importance of these devices," Warner wrote.Rep. Grace Meng, D-N.Y., on Tuesday asked the House Oversight and Government Reform Committee to hold a hearing on the issue. She is a co-chair of the Congressional Kids Safety Caucus. (Jalonick, 8/23)

The Star Tribune: Klobuchar, Others Call For FTC To Investigate Increases In EpiPen Prices
U.S. Sen. Amy Klobuchar of Minnesota has asked the Federal Trade Commission (FTC) to investigate whether a drug company violated antitrust laws by steeply increasing the price of a product that treats people suffering from severe allergic reactions. After hearing from constituents, Klobuchar, whose daughter has nut allergies, questioned Mylan pharmaceutical’s decision to push the price of a dual pack of EpiPens from $100 in 2008 to $500-$600 in 2016. (Spencer, 8/23)

The Hill: Dem Wants Hearing On EpiPen Price Hikes
Rep. Grace Meng (D-N.Y.) is calling for a full committee hearing on the cost of EpiPens, lifesaving injections for people suffering from a severe allergic reaction. In a letter to the chairman and ranking member of the House Oversight and Government Reform Committee on Monday, Meng expressed her concerns about the dramatic increase in the cost of EpiPens. (Wheeler, 8/23)

Stat: EpiPen Goes For The Gold: Drug Maker Blitzed Olympics With Ads
Mylan Pharmaceuticals, which has been in the hot seat for hiking the price of its EpiPen anaphylaxis treatment beyond the reach of some patients, ran dozens of ads during NBC’s Olympics coverage to raise awareness of food allergies and push patients to talk to their doctors about treatments. The ad doesn’t mention EpiPens — but since EpiPens are, by far, the dominant anaphylaxis treatment, it’s a safe bet they’d be the first option for many physicians. And the ad drives consumers to an allergy awareness website that links in just a few clicks to the EpiPen site. (Tedeschi, 8/23)

For more news on high drug costs, check out our weekly feature, Prescription Drug Watch, which includes coverage and perspectives of the issue.

Politicians Continue To Play Blame Game As Localities Scrape Together Funds For Zika Fight

Discussions over how to pay for efforts to battle the mosquito-borne virus remain contentious.

Politico: Top Senate Candidates Pointing Fingers At 'Poison Pill' In House Bill For Failed Zika Funding
As the number of Zika virus cases grows in Florida, the leading candidates in the state’s nationally-watched U.S. Senate race have seized on the public health crisis to attack each other for not doing enough to fight the problem. At the heart of the messaging battle is a $1.1 billion Zika funding bill crafted by the House. Under that plan, the feds would have directed funding to hospitals and other health care facilities, but not women’s health clinics like Planned Parenthood. Senate Democrats blocked the bill because they said the language was an untenable “poison pill.” Both campaigns in Florida’s heated Senate race are using the failed legislation to portray their opponent as the poster child for congressional obstructionism. (Dixon, 8/23)

Morning Consult: Murphy Hits Rubio For Being ‘Ineffective’ On Zika
Rep. Patrick Murphy slammed Sen. Marco Rubio Tuesday for supporting GOP-backed Zika bills and not convincing his party’s leadership to return to D.C. to pass a funding bill to respond to the outbreak. The Florida Democrat, who is running for Rubio’s Senate seat, told reporters Rubio doesn’t hold the clout he claims to have with top congressional leaders, as he hasn’t been able to convince Senate Majority Leader Mitch McConnell or House Speaker Paul Ryan to call lawmakers back from recess to pass a funding measure. (McIntire, 8/23)

Health News Florida: Miami-Dade Gets $5 Million For Zika Fight 
Gov. Rick Scott said Monday the state is sending $5 million to Miami-Dade County to help in the ongoing effort to stem an outbreak of the Zika virus. As part of $26.2 million in emergency state funding authorized by Scott, the governor said Miami-Dade would receive the money for additional mosquito-control staff, mosquito spraying and community outreach. The state Department of Health has identified parts of two Miami-Dade communities, Miami Beach and the Wynwood neighborhood, where locally transmitted cases of Zika are occurring. (News Service Of Florida, 8/23)

Florida Reports New Zika Cases, Including One In Pinellas County Near St. Petersburg

The patient in Pinellas County had not traveled internationally so officials are trying to determine if the illness was caused by a mosquito transmission.

Miami Herald: Four More Local Zika Cases In Wynwood — And First One In Pinellas County
Florida Gov. Rick Scott on Tuesday announced the first local case of Zika outside of South Florida — in Pinellas County — along with four more in Wynwood. ... A total of 42 local Zika infections have reportedly been contracted in four Florida counties this year, with one each in Broward, Palm Beach and now Pinellas, and the remainder in Miami-Dade — where health officials have identified two zones where mosquitoes are actively transmitting the disease: Wynwood and Miami Beach. (Chang, 8/23)

The Washington Post: Florida’s Zika Outbreak Is Spreading, With New Case In St. Petersburg Area
Florida state officials have reported five new cases of Zika, four in the Wynwood neighborhood of Miami, where the first locally transmitted cases in the country were reported, and the fifth on the other side of the state in Pinellas County. It’s that last case that’s the most worrisome because it might signal that mosquitoes infected with the virus are spreading. But it’s too soon to know, and Florida Gov. Rick Scott (R) and the Centers for Disease Control and Prevention have yet to issue a travel advisory indicating there is active local transmission in that area. (Cha, 8/23)

The New York Times: Florida Investigates New Zika Cases On Gulf Coast And In Miami
When Florida announced a new case of the Zika virus on Tuesday, this time in Pinellas County, which includes St. Petersburg, it raised an urgent question: Had local mosquitoes in yet another part of the state started to spread the virus? The short answer is probably not, scientists say. The announcement of the case in Pinellas, on the other side of the state from the current danger zone in Miami-Dade County, may sound scary, but the reality is that single cases are usually one-offs and do not necessarily mean that the virus is starting to spread in a new area. (Tavernise, 8/24)

Health News Florida: Pinellas Has First Case Of Non-Travel-Related Zika 
Tampa Mayor Bob Buckhorn, whose city sits across the bay from Pinellas County, said Tuesday that he isn't waiting for federal, state or county officials to act. Buckhorn said he's authorized city officials to buy 4,000 mosquito "dunks," or small, doughnut-shaped pellets. Code enforcement officers will comb the city, looking for abandoned or foreclosed homes with pools and drop the dunks into the water. The pellets kill mosquito larvae for up to 30 days. (Ochoa and Miller, 8/23)

NBC News: New Zika Outbreak Found In Florida's St. Petersburg
Florida's got a third outbreak of Zika virus, this one on the Gulf coast, state officials said Tuesday. At least one person has been infected locally in Pinellas County, which includes St. Petersburg and Clearwater, Gov. Rick Scott said. And the state reported four more cases in Wynwood, an area north of Miami where the first continental U.S. Zika outbreak was seen. (Fox, 8/23)

Health News Florida: Gov. Scott, Miami-Dade Officials Spar Over Timing Of Zika Information Release
Florida Gov. Rick Scott has two goals when it comes to releasing information on locally transmitted cases of Zika. Make the information "accurate" and make it "timely." Scott's reiterated this message, using these exact words, numerous times at press conferences over the past week. But on Monday, Miami Beach and Miami-Dade County officials confronted the governor, saying he failed to meet the goal of timeliness. They're irked Scott waited until a press conference on Friday afternoon to let them know the Department of Health had confirmed five locally transmitted cases of Zika in Miami Beach. (8/23)

In Miami, where the first travel advisory was placed —

Stat: Zika Anxiety Leading Some Pregnant Women To Flee Miami
But all the advice the first-time parents have gotten sums up to one simple yet terrifying maxim: “Don’t get bit.” [Rishi] Sehgal and his wife, Brittany, are among a small number of expecting parents who have decided that’s not enough — and are looking to leave for safer grounds. There has been no official recommendation that pregnant residents relocate, but the federal Centers for Disease Control and Prevention has encouraged outsiders to avoid nonessential travel to Miami-Dade if they are pregnant or trying to conceive. (Wessel, 8/23)

The Washington Post's graphic updates all reported cases of Zika from around the nation —

The Washington Post: All The Reported Cases Of Zika In The United States
There are 10,314 confirmed Zika cases in the U.S., according to the Centers for Disease Control and Prevention and the Florida Department of Health. This includes 2,279 cases in the continental U.S. and 8,035 cases in the U.S. territories of Puerto Rico, the U.S. Virgin Islands and American Samoa. The first local spread of Zika virus through infected mosquitoes in the continental U.S. occurred in Miami, Florida in late July. (Stamm and Cameron, 8/24)

Wrenching Images Of Zika Babies Hint That Virus May Cause More Damage Than We Think

Fetal brain scans and ultrasounds show the damage caused by Zika to 45 babies in Brazil.

The Washington Post: Heartbreaking Images Of How Zika Destroys Babies’ Brains
Much of the public alarm about Zika has focused on the dramatic, heartbreaking pictures of children with microcephaly, a condition characterized by an abnormally small head. But a paper published Tuesday from the epicenter of the epidemic in northeastern Brazil shows that the damage to a baby’s brain may be far more extensive and diverse than has been previously known. (Cha, 8/23)

The New York Times: Brain Scans Of Brazilian Babies Show Array Of Zika Effects
A study of brain scans and ultrasound pictures of 45 Brazilian babies whose mothers were infected with Zika in pregnancy shows that the virus can inflict serious damage to many different parts of the fetal brain beyond microcephaly, the condition of unusually small heads that has become the sinister signature of Zika. The images, published Tuesday in the journal Radiology, also suggest a grim possibility: Because some of the damage was seen in brain areas that continue to develop after birth, it may be that babies born without obvious impairment will experience problems as they grow. (Belluck, 8/23)

ABC News: Devastating Effects Of Zika Virus Seen In New Fetal Brain Scans 
The devastating effects of the Zika virus on the brains of fetuses go beyond microcephaly, according to a new study published today in the medical journal Radiology. Researchers evaluated brain scans of fetuses and infants with suspected Zika infection and found that in addition to microcephaly there were severe abnormalities in 94 percent of infants. The researchers studied 17 babies and fetuses with confirmed Zika diagnosis and 28 with suspected Zika infection. Viral infection of a pregnant woman has been linked to increased risk of microcephaly in the fetus, but researchers are still learning how the virus affects brain development. (Mohney and Ghodadra, 8/23)

In the U.S. —

CNN: Zika: Baby Born In US With Complications From Virus
Micaela (Mendoza)  is among the first babies to be born in the United States with Zika-related complications. Doctors are learning that some problems, such as having microcephaly, or a very small head, are relatively easy to spot during pregnancy or shortly after birth. But other, more subtle problems such as brain calcifications can be more difficult to catch.And it's hard to know what these more subtle complications will mean for a child later in life. (Cohen, 8/23)

Medicare

Tax Credits For Seniors' Home Modifications Could Save States Medicaid Funding

Virginia and some other jurisdictions are offering residents tax advantages to help pay to retrofit a home, for example widening doorways to accommodate wheelchairs or adding ramps. Also, a look at how for-profit companies are moving into a Medicare program designed to keep people in their homes.

Stateline: Tax Credits For Ramps, Grab Bars To Help Seniors Stay At Home
Most seniors and aging baby boomers want to remain in their homes as they grow older. But to do that, many will have to retrofit their homes to accommodate them if they become frail or disabled — and that can be prohibitively expensive. It can cost $800 to $1,200 to widen a doorway to accommodate a wheelchair, $1,600 to $3,200 for a ramp, and up to $12,000 for a stair lift. ... Virginia and at least three counties in the U.S. have approved tax credits for residents who make their homes more accessible. ... For states, giving tax credits to allow people to stay in their homes may be a money-saver, since it’s much more expensive for Medicaid. (Bergal, 8/24)

Kaiser Health News: As The For-Profit World Moves Into An Elder Care Program, Some Worry
But this is no linoleum-floored community center reeking of bleach. Instead, it’s one of eight vanguard centers owned by InnovAge, a company based in Denver with ambitious plans. With the support of private equity money, InnovAge aims to aggressively expand a little-known Medicare program that will pay to keep older and disabled Americans out of nursing homes. Until recently, only nonprofits were allowed to run programs like these. But a year ago, the government flipped the switch, opening the program to for-profit companies as well, ending one of the last remaining holdouts to commercialism in health care. The hope is that the profit motive will expand the services faster. (Varney, 8/24)

Women’s Health

Texas Analysis: When It Comes To Pregnancy-Related Deaths, Black Women Face Greatest Risk

Meanwhile, in other women's health news, an anti-abortion group leads an effort to compile more demographic data about women who have abortions.

Dallas Morning News: Texas Finds Black Women Most At Risk Of Pregnancy Deaths, And Drug Overdose Is A Leading Overall Cause 
Black Texas women are more than twice as likely as white women to die within a year of their pregnancies ending, a new report shows. Though black women delivered only 11.4 percent of babies in Texas from 2011 to 2012, they accounted for 28.8 percent of pregnancy-related deaths. A task force commissioned by state lawmakers in 2013 to study pregnancy-related deaths and complications recently released its first report detailing the leading causes of maternal death and offering recommendations for legislators to consider next year. (Martin, 8/23)

Politico Pro: Anti-Abortion Group Outlines Effort To Collect Data
A key anti-abortion group is encouraging states to compile statistics on abortion and demographic information on women who get them, the latest in a growing effort among abortion opponents to compile more data. The Charlotte Lozier Institute, the education and research arm of the Susan B. Anthony List, on Wednesday plans to release a report identifying which states compile the most thorough abortion statistics. The report will also outline model requirements that states could follow. The goal is to encourage all states — but Lozier Institute President Chuck Donovan is hoping for about 25 to 30 — to enact laws or regulations to compile statistics on abortion rates. (Haberkorn, 8/24)

Where Women Live Factors Into Puzzle Over Stagnant Life Expectancy, Researchers Find

In another report related to mortality rates, cancer surpasses heart disease as the leading cause of death in 22 states.

The New York Times: New Clues In The Mystery Of Women’s Lagging Life Expectancy
It is now a grim fact that the life expectancy of American women is stagnant, but the reason for this remains a mystery. A team of researchers has now come up with an important clue: Where women live matters just as much as who they are. In fact, in a study to be published this week in SSM Population Health, they found that many common demographic traits — whether a woman is rich, poor, unemployed, working, single or married — might not be as important as the state in which she lives. (Tavernise, 8/23)

Stat: Why Cancer Hasn't Overtaken Heart Disease As America's Top Killer
Cancer deaths have been on pace to outnumber deaths from heart disease in the United States for some years now — but once again, in new data from the Centers for Disease Control and Prevention, they didn’t. Heart disease has ticked upward in deaths since 2010, and it remains the number one killer of Americans. Over the last three decades, the US has seen rising mortality from cancer and falling mortality for heart disease. Those lines had been projected to cross in recent years. (Samuel, 8/24)

Medicaid

Alabama Lottery Bill To Fund Medicaid Misses Deadline For November Ballot

If the legislature, which is meeting in a special session, eventually goes forward with the proposal favored by the governor, the vote will have to take place in a special election. Also in Medicaid news, Arkansas officials report that more than 300,000 people are signed up for the state's expanded Medicaid program.

AL.com: Alabama Lottery Bill Won't Make It On November Ballot
The Alabama House of Representatives today blocked a committee meeting that was necessary for Gov. Robert Bentley's lottery proposal to get on the ballot in the Nov. 8 general election. That means that if lawmakers still approve a proposed constitutional amendment to allow a lottery during the special session, a special election would be required to place it on the ballot for voters. Bentley, who proposed the lottery as a way to boost funding for the state General Fund and Medicaid, said this evening he was not giving up, even though it would now require a special election. (Cason, 8/23)

Arkansas Online: 307,878 Listed On Expanded Medicaid Rolls
The number of Arkansans who had completed enrollment in the state's expanded Medicaid program reached 307,878 at the end of last month, exceeding by more than 50,000 state officials' initial estimate of those who would be eligible. The number covered under the program as of July 31 could be even higher because the enrollment total didn't include applicants who had been deemed eligible but who had not yet completed enrollment. (Davis, 8/24)

Marketplace

Companies Keep Paying Doctors As Experts, Even If They Have Been Disciplined For Misconduct

ProPublica analyzed the disciplinary records for doctors in five states -- California, Texas, New York, Florida and New Jersey -- and then checked those records against data released by the Centers for Medicare & Medicaid Services on companies' promotional and advisory payments to doctors.

ProPublica: Drug And Device Makers Pay Thousands Of Docs With Disciplinary Records 
Pharmaceutical and medical device companies are continuing to pay doctors as promotional speakers and expert advisers even after they’ve been disciplined for serious misconduct, according to an analysis by ProPublica. One such company is medical device maker Stryker Corp. In June 2015, New York’s Board for Professional Medical Conduct accused orthopedic surgeon Alexios Apazidis of improperly prescribing pain medications to 28 of his patients. The board fined him $50,000 and placed him on three years’ probation, requiring that a monitor keep an eye on his practice. Despite this, Stryker paid Apazidis more than $14,000 in consulting fees, plus travel expenses, in the last half of 2015. (Huseman, 8/23)

In other news, hospitals are beginning to pay attention to the well-being of medical residents, hospitalists are gaining momentum and nurses have insights into the development of medical devices --

Chicago Tribune: A Look At The Growing Specialty Of Hospitalist 
A hospitalist is a doctor who focuses on work in the hospital, caring for patients and navigating an increasingly complex medical institution. Rather than focusing on an organ or a disease, the work revolves around the physical setting of care. Although hospitalists have been around in one form or another for years, the term "hospitalist" was coined in 1996 by Dr. Robert Wachter, chairman of the department of medicine at the University of California at San Francisco, who has taken a lead in developing and promoting this evolving and growing specialty. (Sadick, 8/23)

KQED: When It Comes To Medical Device Design, Nurses Are Doing It For Themselves (Video)
Anna Young is the CEO of MakerHealth and co-founder of MakerNurse, organizations dedicated to the idea that the most apt tools for treating patients are sometimes developed on the front lines, by those who work directly with patients. For generations nurses have been raiding hospital supply closets, modifying and repurposing standard equipment to better suit the needs of patients, Young says in a recently released TEDMED presentation. (McClurg and Brooks, 8/23)

No Uptick In Hysterectomy Complications Since Power Morcellator Use Declined

In pharmaceutical industry news, Pfizer acquires AstraZeneca's antibiotics business and the pay package of Valeant's new CFO is revealed.

The Wall Street Journal: Pfizer Buys Part Of AstraZeneca’s Antibiotics Business
Pfizer Inc. has agreed to buy part of AstraZeneca PLC’s antibiotics business for up to $1.575 billion plus royalties in a move the U.S. company said would boost the stable of older products it sells, some of which have lost patent protection. Under the terms of the deal Pfizer will pay Astra $550 million upfront plus an unconditional $175 million in January 2019. Then, depending on the progress and commercial success of the drugs in question, it will pay a further $850 million plus royalties. (Roland, 8/24)

The Wall Street Journal: Valeant Pays Up For New CFO Herendeen
Valeant Pharmaceuticals International’s new chief financial officer, Paul Herendeen, is getting a big pay bump as part of his move from animal healthcare company Zoetis, according to regulatory filings. The executive will be paid a base salary of $1 million, and is eligible for a bonus as high as $2.4 million as part of his deal with Valeant. (Monga, 8/23)

Public Health And Education

Limit Children's Sugar Intake To Six Teaspoons A Day, American Heart Association Advises

Daily diets for those aged 2 to 18 should not exceed six teaspoons of added sugar -- the equivalent to about 100 calories or 25 grams. In related news, the soda tax in Berkeley, California appears to be achieving its goal of cutting sugar consumption.

Reuters: U.S. Heart Group Sets Limit On Sugar For Kids And Teens
The vast majority of children and teens should have less than six teaspoons of added sugar in their diet each day, according to the American Heart Association. Until age 2, children should consume no added sugars at all, and between ages 2 and 18 they should limit added sugars to 25 grams per day, the organization says. (Seaman, 8/24)

CNN: Sugar Recommendation: No More Than 6 Teaspoons Per Day For Kids
Children, ages 2 to 18, should consume no more than about six teaspoons of added sugars in their daily diets, according to new recommendations from the American Heart Association. Researchers called limiting a child's added sugar consumption to six teaspoons -- equivalent to about 100 calories or 25 grams -- "an important public health target" in a paper published in the journal Circulation on Monday. The paper outlines the new recommendations. (8/23)

CBS News: American Heart Association Issues Strict New Guidelines For Added Sugars Intake 
Children in the United States currently consume an average of 19 teaspoons of sugar a day. But the American Heart Association wants families to focus on taming that sweet tooth.In its first-ever guidelines on added sugar, the American Heart Association calls for a daily limit of less than six teaspoons for children between ages 2 and 18, and none at all for kids younger than 2 years old. (8/23)

NPR: Berkeley's Soda Tax Appears To Cut Consumption Of Sugary Drinks
The nation's first "soda tax" on sugar-sweetened beverages, which went into effect in Berkeley, Calif., last year, appears to be working. According to a new study, consumption of sugary drinks — at least in some neighborhoods — is down by a whopping 20 percent. (Charles, 8/24)

Los Angeles Times: Berkeley Sees A Big Drop In Soda Consumption After Penny-Per-Ounce ‘Soda Tax’
Five months after the city implemented its penny-per-ounce tax on all manner of sugar-sweetened beverages, lower-income residents had reduced their consumption by 21%, compared to the pre-tax days. Meanwhile, their counterparts in neighboring Oakland and San Francisco increased the amount of sugary drinks consumed by 4% during the same period, according to a study published Tuesday in the American Journal of Public Health. (Kaplan, 8/23)

The Wall Street Journal: Soda Consumption Falls After Special Tax In California City
Consumption of soda and other sugary drinks fell by more than a fifth in low-income neighborhoods of Berkeley after the California city became the first in the U.S. to introduce a special tax last year, according to a study published Tuesday. The peer-reviewed research is the first to measure the impact of the penny-per-ounce tax. It found that consumption declined 21% and many residents switched to water after the tax went into effect in March 2015, according to the study published online in the American Journal of Public Health. (Esterl, 8/23)

CDC Declares That Sepsis Should Be Treated As A Medical Emergency

Doctors and nurses miss opportunities to catch the fast-moving disease, the agency warns. Meanwhile, at Massachusetts hospitals, preventable medical errors jumped 60 percent last year.

Boston Globe: Medical Errors Persist, Despite Increased Scrutiny 
Preventable medical errors reported by full-service hospitals in Massachusetts grew 60 percent last year, a rise partly attributed to problems detected in a single hospital’s dialysis unit. Hospitals disclosed 1,313 errors that harmed or threatened patients in 2015, including 26 cases when the wrong surgery or procedure was done on a patient; 51 instances when a medication error seriously injured or killed a patient; and 446 cases of contaminated drugs, devices, or biologics. This last category, which accounted for only 37 reports in 2014, constituted most of the overall increase in reported errors. (Kowalczyk, 8/24)

'It’s Unethical. It’s Borderline Criminal:' Addiction Treatment Centers Use Aggressive Tactics To Lure Away Clients

In other news on the substance abuse epidemic, a mother's raw and emotional Facebook post breaks taboos on openly discussing drug issues. And news outlets cover developments in Texas and North Carolina.

The New York Times: How Staten Island’s Drug Problem Made It A Target For Poaching Patients
At drug treatment centers on Staten Island, the calls disturb the daily routine. The solicitations interrupt meals, counseling sessions and support groups. Sometimes, staff members say, the callers make explicit offers: thousands of dollars to refer a person with a heroin or pain-pill addiction and good insurance. Other offers are more subtle — a recurring donation or a contract. (Jula, 8/23)

The Washington Post: ‘To My Daughter’s Drug Dealer’: A Distraught Mother’s Viral Facebook Post
[Tina] Louden’s honest, raw confession is just the latest in a string of online posts and even death announcements that have dared to talk about topics long-held as taboos: addiction, drugs, mental illness. For decades in obituaries, mourners were expected to fill in blanks. “Died suddenly” or “passed away at home” became code phrases for “overdose” or “suicide.” But a new wave of parents, like Louden, are harnessing the Internet to turn their children’s deaths into something meaningful. (Mettler, 8/23)

Houston Chronicle: Deadly Drug Now Showing Up In Houston 
A powerful opioid blamed for hundreds of overdose deaths on the East Coast appears to have made its way to Houston. Drug analysts at the Houston Forensic Science Center found fentanyl 10 times this year in fake pharmaceuticals and powders, according to a news release issued early Tuesday. Fentanyl is a potent opioid used in numerous pharmaceutical drugs that is estimated to be 50 times as potent as pure heroin. (Barned-Smith, 8/23)

North Carolina Health News: Help For Mental Health And Substance Abuse Clients In Rural WNC Counties 
One day this June, Wilkes County Sheriff Chris Shew found 22 patients with mental health and substance abuse problems crowding the local hospital’s emergency department, waiting for treatment, transportation or other help. This situation has played out frequently across North Carolina in recent years, but a partial solution is coming within the next year for people in mostly rural Wilkes, Ashe, Alleghany, Watauga and Avery counties. Daymark Enterprises, a service provider contracting with the Smoky Mountains LME-MCO, will open a 16-bed facility-based crisis center in North Wilkesboro. (Goldsmith, 8/24)

Public Health Roundup: Growing Number Of Young Stroke Victims; Roadblocks In Mental Health Care

News outlets also report on parents' attitude toward the HPV vaccine, how job satisfaction impacts health later in life, the connection between online devices and sleep quality as well as the latest on two transplant procedures.

Kaiser Health News: Hidden Stroke Victims: The Young
[Jamie] Hancock is among a growing number of younger adults who’ve had strokes, which occur when blood flow to the brain is blocked or a vessel in the brain bursts. Because strokes are most often associated with old age, symptoms in younger adults may be overlooked, according to patients, advocates and physicians. And their need for rehabilitation — to return to active lives as parents and employees, for instance — can be underestimated. (8/24)

KQED: Sorry, The Therapist Can't See You — Not Now, Not Anytime Soon
More than 43 million Americans have depression, anxiety, or another mental health condition. But more than half never get help. Recent laws were supposed to make it easier for Californians to access treatment, but many still face roadblocks, even with insurance. In this special series by KQED's The California Report and State of Health we travel across the state to find out why it’s so difficult to get mental health care. (Dembosky, 8/23)

Stat: Parents Remain Leery Of Schools That Require HPV Vaccination
A decade after first becoming available, the HPV vaccine is still a hard sell. A new study finds that only 21 percent of parents believe that a law requiring vaccination for attending school is a good idea, and 54 percent disagreed with the notion of such a requirement for school entry altogether. What might make them change their minds? Well, 57 percent reported that they could live with the requirement, but only if there is an opt-out provision. (Silverman, 8/23)

The Washington Post: Loathe Your Job In Your 20s Or 30s? That May Hurt Your Health By Your 40s.
Actually, it looks like the consequences of your unhappiness with your work may affect your physical and mental well-being — and perhaps sooner than you might think. An analysis by Ohio State University’s Jonathan Dirlam and Hui Zheng, presented this week at the American Sociological Association’s annual meeting, shows that job satisfaction in your late 20s and 30s appears to be linked to your health in your 40s. (Cha, 8/23)

KQED: The Online Life, As Both Liberation And Imprisonment
A study has recently suggested that our sleep hormones are being blanched from the light of our various nighttime screens. As a result we may sleep less well, and wake up more tired. Our phones are black on the bedside table, sleeping the sleep of the just, but their light swirls on behind our closed eyes, so the survey says. ... Fearing the toxicity of our gadgets is not a new pastime. (Scott, 8/23)

CBS News: Face Transplant Recipient Patrick Hardison, One Year Later 
For 14 years, Hardison battled pain, stares from strangers and a loss of hope, all from his disfigured appearance.But in August of 2015, doctors at New York University’s Langone Medical Center transplanted another face onto Hardison’s head. The donor, 26-year-old David Rodebaugh, died in a cycling accident.The surgery lasted 26 hours, and Hardison was only given a 50 percent chance of surviving. (Lapook, 8/23)

CBS News: Zion Harvey, First Child With Double Hand Transplant, Shows Amazing Progress One Year After Surgery 
One year after receiving a double hand transplant, 9-year-old Zion Harvey is -- to steal an old baseball metaphor -- batting a thousand. Last summer, doctors at Penn Medicine and Children’s Hospital of Philadelphia transplanted donor hands and forearms onto Harvey in the first operation of its kind ever performed on a child. Harvey had lost his hands and feet at the age of 2 due to a serious infection that also led to organ failure and a kidney transplant. (Marcus, 8/23)

State Watch

State Highlights: Calif. Weighs Experimental Drugs; Conn. Privatization Of Group Homes Worries Parents Of Kids With Disabilities

Outlets report on health news from California, Connecticut, Wisconsin, Florida, New Hampshire, Pennsylvania, Minnesota, Missouri, Tennessee, Ohio and Maryland.

Los Angeles Times: Gov. Jerry Brown To Again Weigh Access To Experimental Drugs For The Terminally Ill
For the second consecutive year, Gov. Jerry Brown will have to decide on a measure that would allow gravely ill patient access to experimental drugs. The Assembly on Tuesday gave final legislative approval to Assemblyman Ian Charles Calderon's so-called "right-to-try" legislation, which authorizes drug and medical device manufacturers to make their products available to terminally ill patients, even if the products have not yet been cleared by the federal Food and Drug Administration. (Mason, 8/23)

The CT Mirror: Parents Of Disabled Urge Malloy To Scrap Privatizing Group Homes 
Parents of intellectually disabled adults expected to be transferred from state-run group homes to private care reacted Tuesday with a mix of anger and appeals for compassion. About three dozen parents, unionized caregivers and their clients argued at SEIU 1199 headquarters in Hartford that the planned privatization of 40 state-run homes would weaken care and shatter the bonds formed between workers and clients. ... Critics of the private, nonprofit group homes for the developmentally disabled say they receive insufficient state funding to provide comparable care. They struggle with employee turnover rates that typically exceed 20 percent — which is a big problem given the close bonds clients seek to form with their caregivers. (Phaneuf, 8/23)

Kaiser Health News: California Court Helps Kids By Healing Parents’ Addictions
Hearing Officer Jim Teal sounded his gavel. “This is the time and place set for Early Intervention Family Drug Court,” he began, gazing sternly at the rapt faces of parents who sit before him. “Graduation from this court is considered a critical factor in determination that the children of participants will be safe from any further exposure to the danger and destructive impact of parental substance abuse.” Substance abuse is a factor in up to 80 percent of cases in which a child is removed from home. Recently, the number of children entering the foster care system has surged after years of decline. Roughly 265,000 kids entered foster care last year — the highest number since 2008, according to a recent government report. And there are signs that the opioid epidemic may be to blame. (Gold, 8/24)

Milwaukee Journal Sentinel: Medical Residency Programs Expanding
The best hope for averting a projected physician shortage in Wisconsin is starting new residency programs in rural areas and filling them with graduates from the state's medical schools. That’s one of the key points in a report to be released Tuesday by the Wisconsin Council on Medical Education and Workforce, a coalition that includes the Wisconsin Hospital Association, the state’s two medical schools and other organizations. (Boulton, 8/23)

ABC News: Teen Is The 4th Person To Survive Brain-Eating Amoeba In 50 Years
A Florida teen has become only the fourth person in the last 50 years to survive an infection by Naegleria fowleri, commonly known as the brain-eating amoeba. Sebastian DeLeon, 16, continues his recovery after contracting the infection earlier this month.He was taken to Florida Children's Hospital in Orlando, Florida, with a severe headache on Aug. 7. Doctors believe the teen, a camp counselor, was exposed to the amoeba at a freshwater lake a few days earlier. (Mohney, 8/23)

New Hampshire Public Radio: Executive Council To Vote On Staffing Contract For Psychiatric Care In N.H.
The Executive Council Wednesday is scheduled to vote on a more than $36 million contract with Dartmouth-Hitchcock to provide psychiatric services at New Hampshire Hospital. The decision of whether to extend this contract has been delayed for months due to ongoing labor disputes. The Executive Council pushed back final approval of the contract earlier this summer and instead opted for a contract extension through October. Now the council will decide whether to continue the contract through 2019.  (Sutherland, 8/23)

The Philadelphia Inquirer: Suburban Docs Form Groups To Coordinate Care
PMA Medical Specialists L.L.C., a group of 54 physicians with offices in Chester, Delaware, Montgomery and Philadelphia Counties, has applied with a Maryland company to form an Accountable Care Organization with 7,800 Medicare beneficiaries, the group said Tuesday. Accountable Care Organizations, or ACOs, are designed to improve care and reduce costs by emphasizing coordination. Typically, Medicare and the ACO share the savings, if there are any. (Brubaker, 8/23)

Minnesota Public Radio News: Allina, Nurses Resume Talks As Strike Threat Raises Stakes
With the threat of an open-ended strike looming, Allina Health and its union nurses plan to hold contract talks Tuesday. Nearly 5,000 nurses walked off their jobs earlier this summer, and the nurses have authorized another strike, which this time would be open-ended. They must give Allina 10 days' notice of a strike.Allina and the Minnesota Nurses Association have been engaged in a months-long battle, primarily over generous nurses-only health plans. The company has wants the nurses to move to its corporate plans which have higher out-of-pocket maximum costs. (Moylan, 8/23)

St. Louis Public Radio: Four VA Employees Test Positive For Higher-Than-Average Lead Levels 
Four employees who work in a Veterans Affairs records office in north St. Louis have tested positive for higher than average levels of lead in their blood, though officials stressed that the measurements still fall within the range that is normal for U.S. adults.  The results come after a federal safety regulator cited the Goodfellow Federal Center complex for high levels of lead dust in a file room occupied by the Veterans Affairs Records Management Center. (Bouscaren, 8/23)

Nashville Tennessean: Challenges Persist As Nashville Seeks To Be Health Tech Leader
Nashville is poised to emerge as a national leader in the area of health care information technology but needs to harness its existing expertise to build its reputation as a technology epicenter. A new report by Brookings Metropolitan Policy Program outlines the city's strengths and weaknesses in establishing itself as an epicenter of health care information technology, or HIT. (Fletcher, 8/24)

Cleveland Plain Dealer: West Nile Virus Detected In Five Cuyahoga County Communities
Mosquitos caught in traps set by the Ohio Department of Health in five Cuyahoga County communities have tested positive for West Nile Virus. The Cuyahoga County board of health said Tuesday it was notified by the state that infected mosquitoes were found in traps in Bentleyville, Brooklyn, Parma, South Euclid and Strongsville.  (Higgs, 8/23)

Minnesota Public Radio: Bottled Water For 80 Wash. County Homes After Contamination Alert
Minnesota health officials are ordering bottled water for 80 homes in southern Washington County after determining perfluorochemical levels in the well water of those homes now exceeds a new federal health advisory level. Residents were told this week about the contamination and will receive the bottled water at no cost until carbon filter systems can be installed in their homes, the Minnesota Department of Health said Tuesday. (8/23)

Columbus Dispatch: Crypto Cases Top 250; End Of Pool Season Should Help
There must be something in the water — still — because local cases of a waterborne diarrheal disease continue to climb, surpassing 250 by Tuesday. That number, which exceeds the cases in Franklin and Delaware counties combined in the past five years, probably will keep rising over the next few weeks before it levels off, health officials say. (Tate, 8/24)

Oakland Tribune: Judge Dismisses Bay Area Cities' Suit Against Monsanto For Polluting Bay With PCBs 
A judge has tossed a lawsuit filed against Monsanto Co. by the cities of San Jose, Oakland and Berkeley claiming that the St. Louis-based business is just as responsible as them for cleaning up harmful polychlorinated biphenyls, or PCBs, in San Francisco Bay. U.S. District Court Judge Edward J. Davila, however, left the door open in his ruling Monday for the cities to amend and re-file the complaint. ... PCBs are known to cause a number of health issues, including cancer, in humans, and destroy populations of fish, birds and other animal life. Finally banned by Congress in 1979, the chemical was used in a variety applications, such as paint, sealants and lubricants. (Green, 8/24)

The Baltimore Sun: Raw Sewage Has Been Leaking Into Baltimore's Harbor For Five Days, City Says 
Untreated wastewater has been flowing from a hole in an East Baltimore sewer for at least five days, leaking more than 10,000 gallons of raw sewage into the harbor, while the city Department of Public Works continues to search for the cause, officials said Tuesday. The overflow, discovered Thursday in the 21-inch sewer in the 1500 block of N. Chapel St., has been spilling untreated wastewater at an intermittent clip of 10 gallons per minute, public works spokesman Jeffrey Raymond said. (Campbell, 8/23)

Prescription Drug Watch

Drugmakers' Patents And Unique Role In Setting U.S. Prices Contributes To Soaring Costs, Study Finds

Researchers examine thousands of studies to determine why prices for medications have climbed and what might be done about it.

Boston Globe: Drug Prices Inflated By Exclusivity Rights, JAMA Article Says
The doctors are seeking to influence the growing debate on how to contain the surging costs of prescription therapies. Many drug industry critics have proposed giving Medicare, the largest US health insurer, the power to negotiate prices with drug makers -- a proposal that has been echoed by presidential candidates Hillary Clinton and Donald Trump. But the JAMA article contends that empowering Medicare, while potentially helpful, is only part of the solution. (Weisman, 8/23)

Kaiser Health News: Government-Protected ‘Monopolies’ Drive Drug Prices Higher, Study Says
The “most important factor” that drives prescription drug prices higher in the United States than anywhere else in the world is the existence of government-protected “monopoly” rights for drug manufacturers, researchers at Harvard Medical School report today. The researchers reviewed thousands of studies published from January 2005 through July 2016 in an attempt to simplify and explain what has caused America’s drug price crisis and how to solve it. They found that the problem has deep and complicated roots and published their findings in JAMA, the journal of the American Medical Association. (Lupkin, 8/23)

NPR: Drug Manufacturers Use Patents To Protect High Prices
The U.S. could rein in rising drug prices by being more selective about giving patents to pharmaceutical companies for marginal developments, a study concludes. That's because brand-name drugs with patents that grant exclusivity account for about 72 percent of drug spending, even though they are only about 10 percent of all prescriptions dispensed, according to the study, published Tuesday in JAMA, the journal of the American Medical Association. (Kodjak, 8/23)

Politico Pro: JAMA Paper: Limiting Patents Could Help Curb Drug Pricing, Increase Innovation
Tightening standards for so-called secondary patents for pharmaceuticals could help reduce drug prices and spur more medical innovation, according to a new JAMA paper that reviews more than a decade of health policy literature on U.S. pharmaceutical pricing. The most important factors that allows companies to set high drug prices is market exclusivity protected by patents and monopoly rights awarded by FDA approval, the paper says. The authors argue that the U.S. Patent and Trademark Office should only grant new patents to existing drugs if improvements are made to a product's safety or effectiveness — and not for trivial changes. (Karlin-Smith, 8/23)

Modern Healthcare: More Stringent Patent Laws Needed To Lower High Drug Costs, Study Says
Pharmaceutical firms have often justified the need to set high prices for their products by arguing that they offset the costs incurred for research and development, which they have contended can take hundreds of millions of dollars. Any requirement to lower drug prices could disrupt the pipeline for innovative breakthroughs.But the study rebuts that argument, pointing out that drugmakers invest between 10% and 20% into research and development and even less when it comes to the development of innovative products. (Johnson, 8/23)

UPI: Americans Pay More Than Double What Other Nations Pay For Drugs
As of 2013, per capita spending on prescription drugs in the United States was more than double that of 19 other industrialized nations -- $858 per year in the United States, compared to an average of $400 per year everywhere else. Overall, prescriptions occupy about 17 percent of U.S. healthcare services, the researchers estimate. (Feller, 8/23)

High Cost Of Risky Cancer Therapies Force Patients, Doctors To Make Tough Calls

News outlets report on more stories related to pharmaceutical drug pricing.

Stat: Cancer Therapy Holds Great Promise — But At Great Cost
(Karen) Koehler was undergoing a promising — and terrifying — experimental therapy that her oncologists hoped could rid her body of cancer entirely. It’s called CAR-T therapy, and it works by engineering the patient’s own immune cells to attack cancer. ... The treatment induces such sudden and severe side effects that it can take a small army of top specialists to keep patients alive while their newly engineered immune systems attack their cancer cells. The result: CAR-T remains so risky, so complex, and so difficult to manage that experts warn it’ll be years before it’s available to most patients who would stand to benefit — even though two drug makers, startup Kite Pharma and pharmaceutical giant Novartis, are racing to get their versions of the therapy approved by the the Food and Drug Administration as early as next year. (Keshavan, 8/23)

Stat: Do 'Step Therapy' Policies Save Money, Or Hurt Patients?
As science makes once-unthinkable treatments available, patients are increasingly facing a harsh reality: Insurance companies are forcing them to try older, less expensive therapies for months before covering pricier ones. Insurers have long relied on a cautious approach to control costs and spare patients from expensive medications they might not need. But in more than a dozen interviews with doctors and patients, a picture has emerged of insurers growing more aggressive as they respond to financial pressures. (Tedeschi, 8/22)

Perspectives On Drug Costs: The Role Of Patents; EpiPen Outrage Just One Example Of Pricing Problems

Recent commentaries about drug-cost issues.

Bloomberg: The Real Reason Drugs Cost Too Much 
The Food and Drug Administration and the U.S. Patent Office together give new drugs monopoly rights that last anywhere from eight and a half to 15-plus years. This helps explain why brand-name drugs account for 72 percent of drug spending in the U.S. even though they represent only 10 percent of prescriptions. Since 2008, prices for the most commonly used branded drugs have risen 164 percent -- far faster than other medical costs. The U.S. spends more than twice what other industrialized countries spend on drugs. (8/23)

Los Angeles Times: Another Reason To Hate Mylan, Which Jacked Up The Price Of Life-Saving EpiPens: It's A Tax Dodger
The pharmaceutical company Mylan has been taking on a boatload of vituperation — and rightfully so — for jacking up the price of its lifesaving EpiPen injector, which reverses allergic reactions, by 500%.But there’s another reason to detest this remarkably amoral corporation: It’s also a tax dodger. Mylan is one of the leading exploiters of the technique known as inversion, in which a U.S. company cuts its tax bill by acquiring a foreign firm and moving its tax domicile to the acquired company’s homeland. (Michael Hiltzik, 8/23)

The New York Times' The Upshot: The EpiPen, A Case Study In Health Care System Dysfunction
Three times in the last two weeks, people — a patient, a colleague and my wife — told me stories about how out of control the price of EpiPens were. Monday, my New York Times colleagues recounted in detail how expensive the devices have become in recent years. All tell the tale of how much even basic health care can cost in the United States. But by digging a bit further, the story of EpiPens can also explain so much of what’s wrong with our health care system. (Aaron E. Carroll, 8/23)

CNBC: EpiPen Prices Are Out Of Control! Here’s How We Fix The Problem
It's important to understand exactly what people are paying for when they buy the EpiPen. The cost of the life-saving epinephrine drug itself is minimal. Epinephrine has been around for more than 100 years and is easy to produce. The real costs come in connection to the EpiPen's auto-injector which delivers the drug to people who need it in a much easier fashion than a traditional needle and syringe. Mylan's patent on that auto-injector is the key to everything. And it's the government's protection of that patent that lies at the root of the price hikes that are leaving a lot of families struggling to meet the costs. (Jake Novak, 8/23)

Everett Herald: EpiPen Price Jump Points To Drug-Pricing Problem
When even “pharma bro” Martin Shkreli compares your company to vultures and wonders what drives its moral compass, you may have an image problem. Shkreli is the CEO of Turing Pharmaceuticals, the hedge fund posing as a drugmaker that last winter jacked the price of a drug used to treat malaria and HIV patients by 5,000 percent. Shkreli directed his comments late last week at Mylan, the makers of the EpiPen. (8/23)

Huffington Post: TPP And The Dire Threat To Affordable Drug Prices
In effect, the TPP would give drug companies wide latitude to jack up prices and costs of medications with their expanded monopoly rights and keep lower cost generics off the market. Its rules could not be altered without consensus by all signatories to the agreement. (John Greyman, 8/23)

Business Insider: Why The Price Of Prescription Drugs In The U.S. Is Out Of Control
Despite all the public outcry over certain drugs with high prices, none of those drugs have come down on their list price, instead choosing to offer a variety of discounts. So why not lower the list price, even a bit, to get the public off your back? "The answer is, you don't want to be the first one who caves," Ameet Sarpatwari said. "They're worried that it will start a chain effect." (Lydia Ramsey, 8/23)

Editorials And Opinions

Viewpoints: Public Option Would Boost Obamacare; Disturbing Trend Of Diagnosing Clinton And Trump's Physical And Mental Health

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

The New York Times: A Public Option Would Greatly Improve Obamacare
The Affordable Care Act is certainly sustainable. In fact, it has performed far better than expected. Even as health costs have grown at historically low rates, the law has reduced the number of Americans without health insurance by more than 40 percent. Still, the law could use improvements — and right now, the most critical of them is to add a “public option,” available in all parts of the country, that would allow Americans buying coverage through the Obamacare "exchanges" to enroll in a public insurance plan modeled after Medicare. (Jacob S. Hacker, 8/24)

The New York Times: Hillary Health Shocker!
Although she has gone to extraordinary lengths to distract and deceive American voters, the truth is finally coming out: Hillary Clinton has an 11th toe. I don’t have the medical records. She refuses to release them. But just try to come up with some other explanation for why she’s so infrequently photographed in sandals or flip-flops; why she seldom appears barefoot in public; why, during debates, she keeps her legs, especially the lower halves, tucked carefully behind the lectern. She’s covering something up, and it’s that freakish, disqualifying digit. (Frank Bruni, 8/23)

The Hill: Clinton Health Questions: Off Limits Or Legitimate Issue? 
Hillary Clinton is 68 years old. She's been diagnosed with cerebral venous thrombosis; head trauma, pregnancy, cancer, brain infection, autoimmune diseases and inborn clotting abnormalities are all predisposing factors, per The Washington Post. She's currently taking blood thinners. Four years ago, Clinton fainted, hit her head and suffered a concussion. She's also the odds-on favorite to assume one of the most strenuous jobs on the planet as president of the United States. But lately many in the media have become outraged that Clinton's health is being broached at all. And what are the primary two words associated when Donald Trump, a Trump surrogate or conservative media bring up Clinton's medical condition? "Conspiracy theories."  (Joe Concha, 8/23)

Los Angeles Times: A Professional Opinion: You Don't Need A Psychiatrist To Know There's Something Wrong With Donald Trump
Like many Americans, I have been personally appalled by much of Trump’s indecorous behavior as a candidate. He comes across as cantankerous, vain, impulsive, demeaning and ill-informed. I understand why people have raised questions about his mental health. It can be tempting to describe his behavior in familiar psychopathological terms. But there are several reasons why we should resist using a psychiatric framework to describe Trump. (Matthew Goldenberg, 8/23)

Chicago Tribune: Diagnosing Donald Trump And Hillary Clinton
This presidential campaign has been odd in many ways, but among its wretched excesses is the penchant of experts and nonexperts to issue categorical judgments about the mental and physical health of the two major party candidates. This year, it's not enough to say, in the standard colloquial manner of expressing distaste, that "Donald Trump is nutty" or "Hillary Clinton is sick." This year, more literal claims are being made. And we find the trend unhealthy, in a strictly nonmedical sense. (8/23)

The Washington Post: Zika Is Spreading In Florida, But Congress Still Hasn’t Approved Cash To Fight It
Ground zero for the Zika virus in the United States is now South Florida. The virus, which can cause severe fetal birth defects and other neural disorders, is spreading in a 20-block area of Miami Beach and another section of Miami known as Wynwood. The Centers for Disease Control and Prevention has issued a warning to pregnant women to avoid both areas and to people more generally to be aware of the risks. Zika is a mosquito-borne virus that can also be transmitted through sex and blood. Although the symptoms may be mild in most people, a new report suggests that it may also affect adult brain cells. (8/23)

Tampa Bay Times: Abortion Is Not The Answer To Zika
The arrival of the Zika virus and its ability to cause severe microcephaly in infants born to some infected pregnant women has once again pushed the issue of abortion back into the public spotlight. The debate isn't surprising, but what is surprising and what should deeply disturb everyone is the cavalier suggestion that abortion should be the default option for a pregnant woman infected with the Zika virus. (Richard Corcoran, 8/22)

St. Louis Post-Dispatch: D.A. Henderson And The Triumph Of Science
At a time when Hillary Clinton gets applause by declaring, “I believe in science,” it’s worth taking a moment to remember the life and achievements of Donald Ainslee Henderson. All he did with science was eradicate smallpox. Dr. Henderson died Friday at age 87 in Towson, Md., not far from the Johns Hopkins University Bloomberg School of Public Health in Baltimore, where he had been dean emeritus. In the early 1960s, while working for the Centers for Disease Control, he and his team began an ambitious program to eliminate smallpox in 18 African countries. (8/23)

The Wall Street Journal: Pay Bone-Marrow Donors, Save Lives
Doug Grant wants to save lives. Thousands of them. And he wants to do it better, faster and for less money than anyone else. But Mr. Grant and his health-care startup, Hemeos, are suspended in a bureaucratic limbo—their fate in the hands of federal regulators who haven’t made a decision after nearly three years of dithering over a proposed rule.Hemeos is aimed at one of the most pressing problems in medicine: the shortage of bone-marrow donors to combat deadly blood diseases. Thousands of Americans are waiting for a lifesaving donor, and thousands more have died waiting. (Rowes and McNamara, 8/23)

The New York Times: The Underused HPV Vaccine
You’d think that when parents are told of a vaccine that could prevent future cancers in their children, they’d leap at the chance to protect them. Alas, that is hardly the case for a vaccine that prevents infections with cancer-causing human papillomavirus, or HPV. The vaccine, best given at age 11 to 12, is currently the most underutilized immunization available for children. (Jane E. Brody, 8/22)

The Des Moines Register: Branstad Remains Clueless About Medicaid Woes
Last year, Gov. Terry Branstad’s spokesman told The Des Moines Register the governor believed Obamacare “is unaffordable, unsustainable and creates too much uncertainty for Iowans. The implementation of this law has been flawed from the very beginning.” Oh, the irony. Iowans currently are mired in the disaster of the Medicaid privatization plan Branstad foisted upon the state this spring. (8/24)

Bloomberg: Health Care Is A Business, Not A Right 
“The health of Americans should not be a profit center. Health care is a right. Full stop.” That comes from the Twitter feed of personal finance writer Helaine Olen. But it could have issued straight from the heart of any progressive in the land.  Subjecting health care to the sordid whims of the marketplace strikes many people as simply immoral. (Megan McArdle, 8/23)

Modern Healthcare: Tales From The Healthcare Shopping Front: Good Luck Finding A Cheaper MRI
Some policymakers and theorists say price transparency is the silver bullet that will help solve the nation's healthcare cost growth problem. Consumers will use information about the price and quality of services offered by different providers to get the best deal, saving themselves and the country lots of money, they argue. But my personal experience over the past year trying to find a lower price for an MRI shows that shopping for a healthcare service based on price and quality is very hard, even for someone with above-average knowledge about how the system works. (Harris Meyer, 8/22)

Los Angeles Times: Another Reason To Hate Mylan, Which Jacked Up The Price Of Life-Saving EpiPens: It's A Tax Dodger
The pharmaceutical company Mylan has been taking on a boatload of vituperation — and rightfully so — for jacking up the price of its lifesaving EpiPen injector, which reverses allergic reactions, by 500%. But there’s another reason to detest this remarkably amoral corporation: It’s also a tax dodger. Mylan is one of the leading exploiters of the technique known as inversion, in which a U.S. company cuts its tax bill by acquiring a foreign firm and moving its tax domicile to the acquired company’s homeland. (Michael Hiltzik, 8/23)

The Wichita Eagle: Disabled Services Face Funding Crisis
Here is another reason the Legislature needs to revisit its tax cuts: Providers of community-based services to Kansans with intellectual and developmental disabilities are struggling to pay bills and keep employees. It’s been eight years since the state has increased reimbursement rates to I/DD service providers. Yet costs continue to increase. (8/24)

The Philadelphia Inquirer: More Professors Needed To Teach Nursing Students
The country is on the brink of a crisis that has the potential to affect the care of patients - in the hospital, at the doctor's office, in schools - just about anywhere there should be a nurse. The need for nurses has created record enrollments in nursing schools nationwide, which has contributed to an increased need for academic nurse faculty. Unfortunately, a national shortage of doctorally prepared faculty threatens society's access to a workforce of competent nurses delivering patient care. (Barbara Patterson, 8/24)

Houston Chronicle: Pay People To Save Money On Their Health Care
Different providers can charge a ridiculous range of prices for the exact same service, but that fact is almost never revealed to the patient, who assumes the insurance company will take care of it. That assumption, and the patient's decision not to shop for a good price from a quality provider, costs Americans $600 billion a year, according to research published in the Journal of the American Medical Association. If Americans took the time to shop for the best value, they could shave up to 20 percent off the nation's annual medical bill, but only if they could figure out the prices. (Chris Tomlinson, 8/23)

Cincinnati Enquirer: First Responders Need Support System
Health care professionals and emergency responders confront the brutality of injury and illness on a daily basis. Too often we assume these heroes can block out the horrors and heartbreak of their jobs – that they are superhuman. But the idea that doctors, nurses, officers and EMTs are impervious to mental illness is untrue. Studies show health care and emergency professionals suffer from immense psychological and emotional distress related to their jobs. (Janie Heath and Jan Findlay, 8/24)