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Podcast: 'What The Health?' Why Is It So Difficult To Control Drug Prices?

In this episode of “What the Health?” Mary Agnes Carey of Kaiser Health News, Sarah Karlin-Smith of Politico, Margot Sanger-Katz of The New York Times and Julie Appleby of Kaiser Health News discuss the recent extension of cost-sharing subsidies for millions of low-income beneficiaries on the Affordable Care Act’s marketplaces and the state of play on Capitol Hill and in the states concerning initiatives to lower prescription drug costs. (8/17)

Political Cartoon: 'Jack Of All Trades?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Jack Of All Trades?'" by Signe Wilkinson .

Here's today's health policy haiku:

CMS STEPS AWAY FROM NEW PAYMENT MODELS

Value-based payments
Too "complicated" for you?
Go back to piece work.

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:

Capitol Hill Watch

Congressional Clock Is Ticking On Efforts To Shore Up Obamacare Insurance Markets

Though some senators say they are cautiously optimistic, it is not yet clear if lawmakers will be able to reach agreement before a self-imposed mid-September deadline. Meanwhile, the outcome of the trial of Sen. Robert Menendez (D-N.J.) could have a serious impact on the Senate's balance of power and the outcome of major legislative battles, such as efforts to either repeal and replace the Affordable Care Act, or to fix it. News outlets also report on specific health policy positions of various senators and KHN's weekly "What The Health?" podcast reports on all the Capitol Hill health-policy goings on.

Morning Consult: Time Crunch Among Hurdles For Bipartisan Senate Push To Bolster ACA
The leaders of a key Senate committee say they are cautiously optimistic about reaching a deal to shore up the Affordable Care Act’s individual marketplaces, but even with a bipartisan effort, it is far from certain whether they can push out an agreement in time. The Senate Health, Education, Labor and Pensions Committee leaders of both parties have set a self-imposed mid-September deadline for a bipartisan agreement. To keep lingering animosity from the Obamacare repeal fight from seeping into negotiations, Chairman Lamar Alexander has made clear that what he’s seeking is far from comprehensive. (Reid, 8/18)

The New York Times: At Senator Menendez’s Trial, Stakes Are High For Democrats
If Mr. Menendez, a Democrat, is convicted and then expelled from the United States Senate by early January, his replacement would be picked by Gov. Chris Christie, the Republican governor of New Jersey and an ally of President Trump. That scenario — where Mr. Menendez’s interim replacement would more than likely be a Republican — would have immediate and far-reaching implications: The Republicans would be gifted a crucial extra vote just as the party remains a single vote shy in the Senate of advancing its bill to dismantle President Obama’s signature health care law. (Goldmacher, 8/17)

Iowa Public Radio: Sen. Ernst Supports Obamacare Payments As Insurance Premiums Increase
Sen. Joni Ernst says she wants the federal government to continue making payments for Obamacare subsidies to health insurance companies. President Trump has repeatedly threatened to stop making "cost-sharing reduction" payments. That uncertainty has led the only health insurance company left on Iowa’s exchange to propose a nearly 57 percent rate hike for 2018. (Sostaric, 8/17)

The Hill: Johnson Wants Details On Congressional ObamaCare 'Exemption' 
Sen. Ron Johnson (R-Wis.) wants information about why members of Congress and their staff receive an employer contribution toward their health coverage, which critics have dubbed an ObamaCare "congressional exemption." Johnson's request asks the Office of Personnel Management to preserve records related to the "exemption." (Roubein, 8/17)

Kaiser Health News: Podcast: ‘What The Health?’ Why Is It So Difficult To Control Drug Prices?
Mary Agnes Carey of Kaiser Health News, Sarah Karlin-Smith of Politico, Margot Sanger-Katz of The New York Times and Julie Appleby of Kaiser Health News discuss the recent extension of cost-sharing subsidies for millions of low-income beneficiaries on the Affordable Care Act’s marketplaces — as well as the state of play on Capitol Hill and in the states concerning efforts to lower prescription drug costs. (8/17)

House Democrats Push Pharmaceutical Companies To Explain High Costs Of MS Drugs

Two Democratic lawmakers, Rep. Elijah Cummings of Maryland and Rep. Peter Welch of Vermont, are pressing Bayer, Biogen, EMD Serono, Novartis, Sanofi, Teva, and Roche Pharmaceuticals for an explanation of the pricing strategies and whether companies were increasing prices as part of a coordinated effort.

Stat: Lawmakers Push Drug Makers To Explain Soaring Prices For MS Drugs
Two Democratic lawmakers are pressing major pharmaceutical companies to explain their pricing strategies for multiple sclerosis drugs. Reps. Elijah Cummings of Maryland and Peter Welch of Vermont wrote to Bayer, Biogen, EMD Serono, Novartis, Sanofi, Teva, and Roche Pharmaceuticals to request documents that reference pricing strategies. They also asked for information about corporate profits, expenses, patient assistance programs, and drug distribution systems. (Mershon, 8/17)

Health Law

Former HHS Sec. Sebelius Says Trump Administration Still 'Working To Engineer' ACA's Failure

In other news, Rhode Island regulators have approved health insurance premium rates for 2018.

KCUR: Trump Administration Still Sabotaging Affordable Care Act, Sebelius Says 
President Donald Trump and Republican congressional leaders came up short in their initial efforts to repeal the Affordable Care Act, but former Health and Human Services Secretary Kathleen Sebelius says they’re still working to engineer its failure. In a recent interview, Sebelius, who spearheaded implementation of the ACA, said she knows that the law isn’t perfect. But she said it would be working better if Republicans would stop undermining it. (McLean, 8/17)

The Associated Press: Rhode Island OKs Health Insurance Premium Increases
Rhode Island officials have approved health insurance premium rates for 2018, giving the OK to increases ranging from 5 percent to 12.1 percent. Marie Ganim, the state health insurance commissioner, said Thursday that approved rates were in some cases lower than the insurance companies had requested. She says that will save consumers nearly $17 million. (8/18)

Pharmaceuticals

Settlement Finalized Between Mylan, Feds Over Epipen Overcharges To Medicaid

The $465 million settlement announced Thursday by the Department of Justice resolves claims that Mylan avoided paying rebates to the government by improperly classifying the EpiPen as a generic drug. Mylan and its auto-injector product have been at the center of the national debate over prescription drug costs.

Bloomberg: Mylan Wraps Up $465 Million U.S. Accord Over EpiPen Rebates 
Mylan NV and the U.S. Justice Department finalized a $465 million settlement to resolve claims that the drugmaker defrauded taxpayers by misclassifying its allergy-shot EpiPen product as a generic drug. The settlement, announced by the Justice Department Thursday, resolves claims that Mylan was able to improperly avoid paying rebates owed to the government by classifying EpiPen as generic even though the company marketed it as a brand-name medicine. The drugmaker disclosed an agreement last year but government officials wouldn’t confirm it until now. (McLaughlin and Hopkins, 8/17)

Associated Press: EpiPen Maker Finalizes Settlement For Government Overcharges
EpiPen maker Mylan has finalized a $465 million government agreement settling allegations it overbilled Medicaid for its emergency allergy injectors for a decade — charges brought after rival Sanofi filed a whistleblower lawsuit and tipped off the government. It’s the second settlement with the Department of Justice that Mylan has made since 2009 for allegedly overcharging the government for its medicines. (Johnson, 8/18)

USA Today: Mylan $465M EpiPen Settlement Finalized
The drugmaker raised EpiPen prices by roughly 400% between 2010 and 2016, according to federal investigators. EpiPen is a disposable, pre-filled injector that administers epinephrine to counteract severe allergic reactions. (McCoy, 8/17)

Stat: EpiPen Maker Mylan To Settle On Claims It Overcharged Taxpayers
Lawmakers slammed the federal agencies on Thursday for letting Mylan get off the hook too easily with the settlement. Sen. Richard Blumenthal (D-Conn.) called it “completely insufficient,” and Sen. Chuck Grassley (R-Iowa) cast is as “disappointing” in statements. Mylan, meanwhile, called the settlement, “the right course of action,” and said that the product has been reclassified under Medicaid as of April 1. (Swetlitz, 8/17)

Modern Healthcare: DOJ, Mylan Finalize $465 Million EpiPen Medicaid Settlement
Medicaid requires pharmaceutical companies to provide their products at a discount to the government. Most branded drugs are either 23% less than the average manufacturer price, or the difference between that average price and the lowest price they sell anywhere, adjusted by inflation. Medicaid receives a 13% rebate on generic drugs from the average price. HHS' Office of the Inspector General estimated the misclassification cost Medicaid $1.27 billion in lost rebates from 2006 to 2016. (Lee, 8/17)

Pittsburgh Post-Gazette: Mylan Finalizes Settlement Over Medicaid Payments For EpiPen
Medicaid requires pharmaceutical companies to provide their products at a discount to the government. Most branded drugs are either 23% less than the average manufacturer price, or the difference between that average price and the lowest price they sell anywhere, adjusted by inflation. Medicaid receives a 13% rebate on generic drugs from the average price. HHS' Office of the Inspector General estimated the misclassification cost Medicaid $1.27 billion in lost rebates from 2006 to 2016. (Sabatini, 8/17)

FDA Issues New Approvals For Leukemia, Ovarian Cancer Medicines

The Food and Drug Administration approves a new Pfizer drug to treat a rare, fast-progressing form of leukemia. The agency also expands the use Lynparza, sold by AstraZeneca and Merck & Co, to treat recurrent ovarian cancer. In other pharmaceutical news, changes to 340B program are delayed and a biopharma executive encounters challenges when trying to fund his own project.

Reuters: FDA Expands Use Of AstraZeneca/Merck Ovarian Cancer Drug
The U.S. Food and Drug Administration on Thursday expanded the use of Lynparza, sold by AstraZeneca Plc and Merck & Co Inc, to include ongoing treatment of patients with recurrent ovarian cancer who have responded to platinum-based chemotherapy. The agency also approved a new two-tablet regimen for the drug, regardless of whether patients test positive for BRCA genetic mutations associated with high risk for the cancer. (8/17)

Modern Healthcare: Changes To 340B Drug Discount Rule Delayed Until July 2018 
A rule that would set new ceiling prices in the 340B drug discount program has been delayed until July 2018, HHS announced Thursday. The rule, which was supposed to take effect in April would also authorize HHS to levy fines against drug manufacturers that intentionally charge a hospital more than the ceiling price. The 25-year-old program requires drug companies to provide discounts to hospitals and clinics, with the goal of providing low-income patients greater access to medications. (Lee, 8/17)

Stat: A Veteran Biopharma Executive Tries To Fund His Own Product — And Sees Firsthand How Hard It Is
After two decades as an executive at well-known drug companies, he’s used to navigating the ups and downs of raising money on the public market. But Greg Mayes has never faced a fundraising challenge like this before. Galvanized by his teenage son’s epilepsy diagnosis, Mayes started a new company to try to shepherd a promising inhaler technology for epilepsy through a key clinical trial. Now, he’s racing against the clock to convince venture capital firms and private investors to help him move forward. He needs a total of $21 million by the end of this month — and he still has a third of the way to go. (Robbins, 8/17)

Marketplace

Trump's Mar-A-Lago Club Loses Fundraising Galas Of Cleveland Clinic And American Cancer Society

Both organizations announce that they will move fundraising events in Florida following events since the Charlottesville violence. The Cleveland Clinic's decision is a reversal after organization leaders resisted earlier calls to pull its annual gala from Donald Trump's resort.

Stat: Cleveland Clinic Reverses Course, Moves Fundraiser From Mar-A-Lago
The Cleveland Clinic and the American Cancer Society said they will not hold annual fundraising galas at President Trump’s Mar-a-Lago resort in Florida amid intense criticism over the president’s reluctance to denounce white nationalist groups. The announcements come as businesses have faced increasing pressure to distance themselves from Trump, who has been sharply criticized for his equivocal response to the deadly violence in Charlottesville, Va. The clinic’s decision, which was announced Thursday, was a reversal from its prior commitment to keep the event. (Ross, 8/17)

The Associated Press: Cleveland Clinic Will Pull Event From Mar-A-Lago Resort
A leading U.S. hospital pulled its annual fundraiser from Donald Trump’s Mar-a-Lago resort on Thursday, reversing course after initially resisting pressure from health professionals and others over the president’s support for repealing the Affordable Care Act and cutting federal budget dollars to medical research. (Carr Smyth, 8/17)

The Hill: Cleveland Clinic Will No Longer Hold Gala At Trump's Mar-A-Lago
The Cleveland Clinic will no longer hold its annual fundraising gala at President Trump’s Mar-a-Lago club in Florida. "After careful consideration, Cleveland Clinic has decided that it will not hold a Florida fundraiser at Mar-a-Lago in 2018," the hospital system said in a statement, according to Cleveland.com. "We thank the staff of Mar-a-Lago for their service over the years." (Lorenz, 8/17)

Public Health And Education

Post-Surgical Patients Are Rarely The Ones Who Start Long-Term Opioid Use

Its more common for those who receive their first prescription for back pain or “other ill-defined conditions” to go on to use painkillers for six months or more, according to new research. In other news related to the national epidemic, the Cherokee Nation asks a judge to allow its lawsuit against opioid distributors and retailers to be heard in the tribe's own court. And KHN reports that the public health crisis is taking a toll on the nation's foster care system.

Los Angeles Times: Don't Blame The Surgeons: Long-Term Opioid Use Rarely Starts With Surgery, Study Finds
Don’t blame the nation’s surgeons for an opiate-abuse crisis that now claims 142 lives daily in the United States. New research suggests that patients leaving the hospital after surgeries or inpatient procedures are rarely the ones whose long-term opioid use started with a doctor’s prescription. Instead, the patients who most frequently go on to use opioid medications for six months or more got their first prescription for some sort of back pain, or for pain described in medical code as “other ill-defined conditions,” according to a research letter published Wednesday in the journal JAMA Surgery. (Healy, 8/17)

The Associated Press: Cherokee Nation Says Opioid Lawsuit Belongs In Tribal Court
The Cherokee Nation is urging a federal judge to allow a tribal lawsuit against distributors and retailers of opioid medications to be litigated in the tribe’s own court. Cherokee Nation Attorney General Todd Hembree has filed written arguments with U.S. District Judge Terence Kern in a lawsuit that alleges the companies have contributed to “an epidemic of prescription opioid abuse” among the tribe’s citizens. The lawsuit alleges that six distribution and pharmaceutical companies have created conditions in which “vast amounts of opioids have flowed freely from manufacturers to abusers and drug dealers” within the tribe’s territory. (8/18)

Kaiser Health News: Opioid Crisis Strains Foster Care System; Programs Aim To Keep Kids With Mom
Data from the U.S. Department of Health and Human Services show that from October 2012 to September 2015, as addiction surged, the number of kids entering the foster system rose 8 percent. In recent years, experts suggest, the number has continued to climb, though data aren’t yet available to track that increase. Even before this epidemic, social systems struggled to meet demand. Now, the swell of kids needing care is putting new pressure on a network already stretched to capacity — both financially and in its ability to find homes and families that can take in displaced children. (Luthra, 8/18)

And in news from Indiana, New Hampshire, California and Missouri —

The Associated Press: Hospital In Drug-Troubled Indiana County Starting Detox Unit
A hospital in a rural eastern Indiana county hit hard by opioid abuse is planning to start a drug detoxification unit emphasizing treatment for those diagnosed with HIV. Fayette Regional Hospital in Connersville says the 46-bed unit will provide treatment for about a week for patients with severe intoxication or withdrawal problems and mental health disorders. The unit is meant to stabilize the patient before moving to another treatment program. (8/18)

New Hampshire Public Radio: N.H. Overdose Deaths Expected To Decline This Year, But Not By Much
The Office of the Chief Medical Examiner is projecting at least 466 people will die from drug overdoses by year’s end — not quite as many as last year’s record of 486, but close. Chief Forensic Investigator Kim Fallon says officials make those projections using a formula that accounts for both confirmed and pending cases, as well as the months left in a given year. (McDermott, 8/17)

Daily Pilot: H.B. And Costa Mesa Account For More Than 1,200 Opioid-Related ER Visits In 4 Years In O.C. Study
Emergency room visits stemming from opioid use increased by 141% in Orange County from 2005 to 2015, with large numbers of patients coming from Huntington Beach, Costa Mesa, Anaheim and Santa Ana, according to a study released this week by the Orange County Health Care Agency. More recently, between 2011 and 2015, 7,457 Orange County residents went to an emergency room for treatment of opioid addiction or overdose, according to the report. (Fry, 8/17)

Kansas City Star: Missouri Doctor's License Suspended After He Gave Drugs To Patient He Was Having Sex With
From March 2013 to August 2015, central Missouri physician Justin LaMonda gave a patient a long list of drugs she didn’t need — including painkillers, anti-depressants, anti-anxiety medications and sedatives — without keeping records. ...Those were the findings of the Missouri State Board of Registration for the Healing Arts in an order handed down earlier this month that suspended LaMonda’s medical license for three years. (Marso, 8/17)

Detroit Free Press: Oak Park Doc: I Peddled Pain Pills To Make Money
An Oak Park doctor is heading to prison after admitting she peddled more than $2 million in pain pills on the street so that she and her cohorts could make money, including two other doctors. Jennifer Franklin, 40, of Harrison Township, pleaded guilty Wednesday in U.S. District Court to writing prescriptions for oxycodone without any medical reason, admitting she made $200,000 in the scheme. She also acknowledged that the street value of the addictive painkiller she prescribed totaled more than $2 million. (Baldas, 8/17)

'DNA Surgery': Scientists Try Gene Editing In Human Embryos

NPR goes inside the lab that is working on embryonic research. In other public health news today are developments related to HIV, tuberculosis, Alzheimer's, maternal mortality and nicotine addiction.

NPR: A First Look: Inside The Lab Where Scientists Are Editing DNA In Human Embryos
Human eggs are the key starting point for the groundbreaking experiments underway in this lab. It's run by Shoukhrat Mitalipov, a biologist who's been on the cutting edge of embryonic genetic research for decades. Mitalipov and his international team electrified the world this summer when the group announced it had successfully — and seemingly safely — figured out how to efficiently edit the DNA in human embryos. (Stein, 8/18)

Bloomberg: How A Blue Pill Is Stopping The Spread Of HIV
Kyle, a 29-year-old Sydneysider, never knew a time when HIV wasn’t a persistent and pernicious threat — until he began popping a pill to prevent it. The blue, oval-shaped antiviral tablet, known as Truvada, that Kyle takes daily is the subject of a study in Australia’s New South Wales state that, in less than a year, has helped drive new cases of the AIDS-causing human immunodeficiency virus among gay and bisexual men to the lowest since 1985. ...Thirty-six years after a rare lung infection in gay men in Los Angeles heralded the start of the AIDS epidemic in North America, the deadly disease is firmly in retreat globally. For the first time, more than half of all people living with HIV are on virus-suppressing treatment that staves off symptoms and prevents transmission. (Gale, 8/17)

Stat: Genetic Tweaks To Tuberculosis Could Speed Up Discovery Of A New Vaccine
These minty bacteria are genetically engineered relatives of Mycobacterium tuberculosis, the bacterium that kills 1.5 million people each year. Thankfully this strain — Mycobacterium smegmatis — is harmless. But it’s a close enough cousin that scientists can use it as a proxy for the real thing. And though a mint-scented bacterium might seem like a silly achievement, it’s part of a serious strategy by a team of Harvard scientists to speed up discovery of a better tuberculosis vaccine. Their goal: to modify the germ so that it can be safely given to people to test a vaccine – and if the vaccine doesn’t work, that the participants can be cured. (Wosen, 8/18)

Stat: 'Beyond Amyloid': A Look At What's Next In Alzheimer's Research
It’s neuroscience’s oldest and most acrimonious debate. On one side, scientists who aver that blasting away toxic plaques called amyloid is the best path toward treating Alzheimer’s disease. On the other, frustrated skeptics ready to ditch the amyloid hypothesis once and for all. But a parade of failed clinical trials has seeded a growing middle ground of agnostics and stoked a bevy of new research efforts, as “the field in general — and our pharma colleagues — are recognizing that they need to think beyond amyloid,” said Dr. David Knopman, a neurologist at the Mayo Clinic. (Garde, 8/18)

The Philadelphia Inquirer/Philly.com: More U.S. Women Are Dying In Childbirth. What Can Be Done?
Safe Start, funded by the pharmaceutical giant Merck, is a small but innovative example of efforts to reverse a disturbing trend: While deaths as a complication of pregnancy have been falling around the globe, including in many poor countries, the U.S. maternal mortality rate has doubled since the 1990s. And Philadelphia’s rate is even higher than the national average. (McCullough, 8/17)

Guns Account For Higher Suicides Rates In Rural Areas Over Urban Ones, Study Finds

Suicides-by-firearm are 66 percent higher in thinly populated counties than in urban counties. There is little regional disparity in non-firearm suicide rates. In related news, experts target teens in suicide prevention efforts while the California prison system reports an increase in suicide attempts among women inmates.

The New York Times: Guns Play Oversize Role In Rural Suicides
Suicide rates are higher in rural counties, according to a new study, and the reason is firearm use by men. The report, in the American Journal of Public Health, used data on 6,196 suicides of Maryland residents over age 15. They found that the rate of firearm suicides was 66 percent higher in the most thinly populated counties than in metropolitan areas with populations greater than a million. Non-firearm suicide rates in rural and urban counties were roughly the same. (Bakalar, 8/17)

Kaiser Health News: Gun Sellers Join Forces To Curb Suicide-By-Firearm, Rampant In Rural Areas
John Yule, 53, manages Wildlife Sport Outfitters, a hunting and fishing supplies store on the edge of Manchester, N.H., and is “deeply involved in the Second Amendment community.” But six years ago, while listening to a public radio story, Yule heard about a way he could tackle a familiar problem — the high rates of suicide in rural areas like some nearby in his state ... Now he’s part of a team of people on the front lines, trying a simple but radical approach to curb rates of suicide, the nation’s 10th-leading cause of death. (Luthra, 8/17)

The New York Times: Preventing Teen Suicide: What The Evidence Shows
There are evidence-based ways to prevent suicide. The World Health Organization has a guide for how media professionals should talk about the subject. They should avoid sensationalizing it or normalizing it. They should be careful not to repeat accounts of suicide or to provide explicit descriptions as to how suicide might be attempted or completed. They should word headlines carefully, and avoid video or photos of suicides or the victims. (Carroll, 8/17)

Sacramento Bee: Suicide Spike Followed Merger Of CA Women's Prisons
California’s corrections department’s failure to prepare when it moved hundreds of high-security female inmates from a Central Valley prison to one in inland Southern California may have contributed to a recent spike in suicide attempts by women prisoners, according to a new state audit. Between 2013 and 2016, women made up 4 percent of the state’s prison population but accounted for 11 percent of the system’s suicides, according to the audit. (Ashton, 8/17)

Veterans' Health Care

Trump Signs Law To Aid WWII Vets Exposed To Mustard Gas

The legislation was advanced through Congress by Sen. Claire McCaskill (D-Mo.) and requires the Department of Veterans Affairs to reconsider denied disability benefits for those who claimed the testing caused health problems.

The Associated Press: Trump Signs Bill To Help Vets Exposed To Mustard Gas
World War II veterans exposed to mustard gas by the military will find it easier to receive help under legislation President Donald Trump has signed into law. The St. Louis Post-Dispatch reports that Trump on Wednesday signed the legislation that Democratic Sen. Claire McCaskill, of Missouri, pushed through Congress. It requires the Veterans Affairs Department to reconsider disability benefits denied to those who claimed the testing caused health problems. (8/18)

Atlanta Journal-Constitution: Atlanta VA Employees Reassigned After Racially Charged Messages
The VA reassigned the head of the agency’s national health enrollment office in Atlanta and another employee pending the outcome of an investigation into racially charged messages that included mention of sending people to “the ovens.” The move comes after a report by the Atlanta Journal-Constitution and Channel 2 Action News this week about the messages between HEC Director Angel Lawrence and program analyst Nathan Jaco. (Schrade, 8/17)

State Watch

Large Mass. Health Care System Drops Out Of Networks Being Planned For Medicaid

UMass Memorial Health Care said it will continue to care for MassHealth patients but it won't join in the accountable care organizations being formed as the state revamps Medicaid. Meanwhile, a California health care system is moving some of its Medicaid patients to clinics instead, and Utah formally submits a request to the federal government for a limited Medicaid expansion for some homeless people.

Boston Globe: UMass Memorial Pulls Out Of State Medicaid Overhaul
Central Massachusetts’ largest health care provider has dropped out of a program to redesign the way the state pays for and manages health care for poorer residents, saying the financial risks are too great. The move makes UMass Memorial Health Care the state’s only large network of doctors and hospitals that will not participate in the restructuring of the Massachusetts Medicaid program, called MassHealth. (Dayal McCluskey, 8/17)

Sacramento Bee: Sutter Shifting Medi-Cal Enrollees To Community Health Centers
In Sacramento and Placer counties, roughly 10,000 adult Medi-Cal enrollees with Anthem Blue Cross are learning this summer that Sutter’s primary-care doctors will no longer see them. Instead, those patients are being shifted to primary-care doctors at community health centers such as Sacramento’s WellSpace Health or Auburn’s Chapa-De Indian Health, said Dr. Ken Ashley, the medical director for primary care at Sutter Medical Group. He said the change in providers will allow the patients to access more services. (Anderson, 8/17)

The Associated Press: Utah Submits Medicaid Plan To Help With Homeless, Treatment
Utah asked the Trump administration this week to approve a limited Medicaid plan to help the homeless and those in need of mental health and drug addiction treatment. The plan is part of a state strategy to curb violence and drug trafficking in a Salt Lake City neighborhood near an overcrowded homeless shelter, but it’s a very limited alternative to expanding Utah’s Medicaid plans as offered under President Barack Obama’s health care law. (8/18)

Colorado Hospital President Resigns After Managing Transition To New Owner

News outlets look at hospital news across the country, including an analysis of how Tianqiao Chen's purchase of a large stake in Community Health Systems could affect that large chain.

Denver Post: Longmont United Hospital President Resigns As Part Of Centura Health Transition
The president and CEO of Longmont United Hospital is resigning, having completed a two-year management transition following the hospital’s purchase by Centura Health. Mitchell Carson, president and CEO of Longmont United, said in the news release that he had committed to leading the hospital through that changeover after Centura Health bought it in 2015. (Antonacci, 8/17)

Modern Healthcare: Chen's 22% CHS Stake Carries Clout - With Or Without A Board Seat 
Tianqiao Chen's 22.1% stake in Community Health Systems could give him enough influence to encourage hospital sales at lower prices than what CHS has been demanding to accelerate CHS's divestiture strategy. Chen, through his Singapore-based Shanda Group affiliates, roared back on the public scene less than a week ago by buying 9.8 million more shares of CHS to raise his equity stake from 13.7% to 22.1%. (Barkholz, 8/17)

Houston Chronicle: HHS Awards Nearly $4.8 Million To Texas Health Centers 
The U.S Department of Health and Human Services announced this week it is awarding nearly $4.8 million to 72 health centers across Texas to promote access to care, address disparity and maintain quality of care. Recipients included at least 10 centers or agencies in the Houston area. "Americans deserve a healthcare system that's affordable, accessible, of the highest  quality, with ample choices, driven by world-leading innovations, and responsive to the needs of the individual patients," said HHS Sec. Dr. Tom Price in a statement from the agency. (Deam, 8/17)

The Associated Press: Tennessee Health Centers Awarded $2 Million
Federal officials say 29 health centers in Tennessee are receiving a total of more than $2 million to further improve quality, efficiency and effectiveness. The centers are chosen based on high levels of performance in categories including improving quality of care, increasing access to care, enhancing delivery of high-value health care, addressing health disparities and achieving patient-centered medical home recognition. (8/18)

State Highlights: Conn. Medical Society Gets Impatient, Starts Own Health Information Exchange; Mo. Families Struggle With Home-Care Cuts

Media outlets report on news from Connecticut, Missouri, Ohio, Massachusetts, Pennsylvania, Illinois, Texas, California, New Mexico, Oregon and Tennessee.

The CT Mirror: While Waiting For A State Health-Records Exchange, Medical Society Launches One
Frustrated that after 10 years of effort the state of Connecticut has yet to launch a functioning health information exchange (HIE) allowing physicians, hospitals and other health care providers to share patient medical records, the Connecticut Medical Society is offering one of its own. Available to all clinicians in the state and called CTHealthLink, it is based on a system currently used in Kansas. (Werth, 8/18)

The Associated Press: Missouri Families Struggle With In-Home Care Cuts
Lawmakers approved a one-time funding fix aimed at avoiding cuts to the in-home care program in May, but it was vetoed by Gov. Eric Greitens. The bill passed the House with 83 votes — 26 votes shy of a two-thirds majority needed to override a veto. Without the $35 million funding fix, the $27 billion state budget approved by lawmakers and signed by Greitens changes eligibility requirements for Missourians to qualify for in-home and nursing care services through Medicaid. Essentially, people are now required to display more severe disabilities to get state-funded care, a change that could eventually affect more than 8,000 Missourians. (Hancock and Montgomery, 8/18)

Cleveland Plain Dealer: Language For Contentious Issue 2 Prescription Drug Measure OK'D For Ballot
The Ohio Ballot Board approved language Thursday afternoon for how a prescription drug proposal will be presented on the Nov. 7 ballot, with no conflict between the sides lined up for and against Issue 2. Issue 2, if passed, would require Ohio to obtain the same discounts on prescription drugs as the prices obtained by the U.S. Veterans Administration - affecting an estimated 4 million Ohioans who get drugs in a range of state programs, such as Medicaid and state employee and retiree health care. (Hancock, 8/17)

Boston Globe: So Far, Compromise Eludes Mass. Alcohol Task Force
Key members of the state’s alcohol industry are tempering expectations that a task force reviewing Massachusetts’ booze laws will deliver sweeping reforms to how beer, wine, and spirits are sold and distributed in Massachusetts, saying it’s more likely to result in modest tweaks. ... The list includes a number of highly controversial policy questions that have long divided businesses, health advocates, and policy makers. (Adams, 8/17)

The Associated Press: Wolf's Insurance Chief To Take Over At Human Services Agency
Gov. Tom Wolf will nominate his insurance commissioner, Teresa Miller, to lead Pennsylvania’s Department of Human Services while he waits to see whether lawmakers will approve its merger with the Department of Health. Wolf made the announcement in an email to employees Thursday, and said the change in duties takes effect Monday. Wolf’s current human services secretary, Ted Dallas, is on medical leave. Wolf’s office says Dallas will take an advisory role to the governor when he returns to work. (8/18)

The Associated Press: Bloomberg Funds $2 Million In Ads Backing Soda Tax
Former New York Mayor Michael Bloomberg is throwing his support behind a Chicago-area sweetened beverage tax by financing an ad campaign backing the levy. Bloomberg's charity announced Thursday that $2 million will be spent on television, radio and digital ads. The ads will contend the tax could help fight "the epidemic of childhood obesity and diabetes" and support Cook County hospitals and health programs. (8/18)

Cincinnati Enquirer: Training They Hope To Never Put To Use
Springfield Township is offering its residents a chance to get training so they would be ready to take care of neighbors and victims through the Community Emergency Response Team program. The training program trains volunteers to organize themselves and others at the disaster site, to provide immediate assistance to victims, and to collect disaster information to support responder efforts when help arrives. (Key, 8/17)

KCUR: Case Of Autistic Missouri Teen Who Was Tased After Stopping To Tie His Shoe Moves Forward 
A federal judge has given the go-ahead to a lawsuit filed by the parents of an autistic teenager who was shot multiple times with a Taser after he stopped to tie his shoe on the lawn of a Missouri Highway Patrol trooper. U.S. District Judge Fernando Gaitan this week denied dismissal motions filed by the five law enforcement officials named as defendants in the case by the parents of Christopher Kramer. (Margolies, 8/17)

Columbus Dispatch: Panel Briefed On Link Between Health And Academic Achievement
There is a strong link between education and student health, and Ohio is one of the least healthy states in the nation, representatives of the Health Policy Institute of Ohio told the Task Force on Education and Poverty, a panel designed to recommend ways to close a persistent achievement gap involving students in poverty. ... Neither state nor federal law requires schools to provide comprehensive health services to all students. (Siegel, 8/17)

The Washington Post: Elderly Couple Got ‘Deepest Wish’ — To Die Together — In Rare Euthanasia Case
In recent years, apparent double-suicides and murder-suicides have been capturing worldwide attention amid an emotional right-to-die debate — couples from Florida to Paris reportedly ending their lives together. Assisted suicide has summoned up deep religious and ethical concerns among critics. In the United States, the subject was widely debated in 2014, when a 29-year-old woman who had a fatal brain tumor moved from California to Oregon, where she could legally seek medical aid to end her life. California has since enacted its End of Life Option Act, joining a small number of states where it is legal. (Bever, 8/17)

Houston Chronicle: Houston Clinic Owner Sentenced In $17 Million Medicare Fraud Scheme 
The owner of a string of Houston home health care clinics was sentenced to 40 years in federal prison Thursday for a brazen scheme involving more than $17 million in fraudulent Medicaid and Medicare billing. "I'm not here to pass the buck," Godwin Oriakhi, who ran the five clinics, told U.S. District Judge Sim Lake before sentencing. "I never set out in any way to defraud the government." Defense lawyer Sean Ryan Buckley said prior to sentencing that Oriakhi did not live an opulent life but got caught up trying to pay expenses for his business. (Banks, 8/17)

NPR: Exclusive: Inside The Lab Where Scientists Are Editing DNA In Human Embryos
Mitalipov and his international team electrified the world this summer when the group announced it had successfully — and seemingly safely — figured out how to efficiently edit the DNA in human embryos. For the first time, they said, they had corrected a mutation that causes a potentially fatal heart condition. (Stein, 8/18)

St. Louis Public Radio: Secret Sedative: How Missouri Uses Pentobarbital In Executions
Missouri will use two of its 34 vials of the sedative pentobarbital on Tuesday when it executes Marcellus Williams, who was convicted in the 1998 killing of Felicia Gayle, a former St. Louis Post-Dispatch reporter. The state has enough pentobarbital for 17 executions, Williams’ included, according to a document obtained by St. Louis Public Radio. (Hunzinger, 8/18)

Los Angeles Times: Married Alhambra Couple Sues Employer, Saying Insurance Was Revoked Because They're Gay
An Alhambra couple has filed a federal discrimination lawsuit against a former employer, alleging the company refused to provide spousal health insurance coverage because of their sexual orientation and rescinded previous coverage, leaving them with tens of thousands of dollars in medical bills. Judith Dominguez, 59, began working as a loan originator for Colorado-based Cherry Creek Mortgage at a branch office in Diamond Bar in 2016 and enrolled herself and her wife, Patricia Martinez, 55, in the UnitedHealthcare plan offered by the company. The couple had been covered for most of the year when, in November, Dominguez submitted her annual re-enrollment “employee + spouse” forms. (Branson-Potts, 8/17)

The Associated Press: 61-Year-Old Farmington Man Dies From West Nile Virus
Farmington officials say a resident of the northwestern New Mexico city has died of the West Nile virus, making him the first human fatality of the mosquito-borne disease in the state this year. Officials say it’s not known how the 61-year-old man contracted the virus and the city says it has an aggressive mosquito control program that includes treatment of standing water and weekly spraying at night. (8/18)

The Associated Press: Lawsuit: Birth Control For Sentencing Breaks Violated Rights
A Tennessee sheriff and judge violated the constitutional rights of jail inmates by promising to reduce their sentences if they underwent birth control procedures, an ex-inmate says in a federal lawsuit. Christel Ward was among the misdemeanor-level White County Jail inmates who took the deal, according to the lawsuit. She said Thursday that she still has the unwanted birth control device in her arm that authorities injected in her. “I want this out of my arm, and I’m still not allowed to get it out until I pay,” Ward said at a news conference. “I can’t come up with $250 to get this out.” (Mattise, 8/18)

Health Policy Research

Research Roundup: Labor Force Participation After The ACA; Childhood Firearm Injuries

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

Health Affairs: Medicare Competitive Bidding Program Realized Price Savings For Durable Medical Equipment Purchases
In 2011 the Centers for Medicare and Medicaid Services (CMS) implemented a competitive bidding program to reduce spending on durable medical equipment and similar items. Previously, CMS had used prices in an administrative fee schedule to reimburse for these items. ... Our results suggest that the initial years of the program produced prices comparable to those obtained, on average, by large commercial insurers—sophisticated purchasers that presumably were able to negotiate prices with suppliers of durable medical equipment and similar items. (Newman, Barrette and McGraves-Lloyd, 8/1)

JAMA Internal Medicine: Inclusion of Demographic-Specific Information in FDA Studies of High-Risk Medical Devices
Women, the elderly, and minorities have been underrepresented in clinical trials. Risks and benefits of medical therapies, however, can vary based on these patient characteristics. ... Although the 2014 FDA Action Plan4 calls for examination of results by age, race and/or ethnicity, and sex, such analyses infrequently occur—fewer than 20% of all studies for original PMAs approved in 2015. (Dhruva et al., 7/24)

JAMA Psychiatry: Impact Of Reward Prediction Errors In Major Depression
In a neuroimaging study, depression was not associated with a reduced neural impact of reward prediction errors in a nonlearning context. Depression also was not associated with a reduced emotional impact of reward prediction errors in a laboratory behavioral study and in a smartphone study with 1833 participants. Meaning: In moderate major depression, impacts of reward prediction errors that are linked to dopamine, known to be attenuated in a learning context, are intact in nonlearning tasks. (Rutledge et al., 7/5)

The National Bureau of Economic Research: The Effects Of The Affordable Care Act On Health Insurance Coverage And Labor Market Outcomes
Our findings indicate that the majority of the increase in health insurance coverage since 2013 is due to the ACA. ... While labor market outcomes in the aggregate were not significantly affected, our results indicate that labor force participation reductions in areas with higher potential exchange enrollment were offset by increases in labor force participation in areas with higher potential Medicaid enrollment. (Duggan, Goda and Jackson, 7/1)

Pediatrics: Childhood Firearm Injuries in the United States
Fatal injuries were examined by using data from the National Vital Statistics System and nonfatal injuries by using data from the National Electronic Injury Surveillance System. ... Firearm-related deaths are the third leading cause of death overall among US children aged 1 to 17 years, surpassing the number of deaths from pediatric congenital anomalies, heart disease, influenza and/or pneumonia, chronic lower respiratory disease, and cerebrovascular causes. (Fowler et al., 7/1)

Editorials And Opinions

Perspectives On Health Reform: Trump Should Help The Health Law; GOP Isn't Living Up To Its Obamacare Promises

Opinion writers offer their thoughts on the issues facing the health law.

The Washington Post: Trump Needs To Stop Sabotaging Obamacare — Before It’s Too Late
Yet the administration has stoked more uncertainty than it has allayed, leaving the health system in peril. The White House has been deciding month-to-month whether to keep important subsidy payments flowing to insurance companies — payments that were simply assumed during the Obama administration. Without these payments, insurers would have to jack up premiums or leave Obamacare markets next year. The CBO estimated Tuesday that average premiums would jump by 20 percent next year if the Trump administration pulled them. Moreover, because of how the payments interact with other elements of the health-care system, the government would end up losing money — $194 billion over a decade. (8/17)

San Antonio Press-Express: Go Back To Work, Repeal Obamacare
Democrat obstruction is devastating for ordinary, hard-working Texans, making it difficult for government to function. However, after seven years of promises, I find it amazing and deeply disappointing that congressional Republicans are unable to govern in spite of holding both chambers of Congress. (Don Kirchoff, 8/17)

The Washington Post: All Of These Health-Care Plans Are So 20th Century
House and Senate GOP health-care plans, like Obamacare itself, have squawked loudly about subsidizing demand but said little about the supply of doctors, nurses and drugs. That is economic malpractice. It is also so 20th-century. ... An aging population is pushing up demand, and without more supply, prices will catapult higher. Doctors are aging, too: More than 30 percent are 60 or older. Forecasts project a physician shortage ranging from 46,000 to 90,000 by 2025, especially among specialists. Already, one quarter of the federal budget goes to Medicare and Medicaid. Taxpayers will find themselves frustrated with packed waiting rooms and higher taxes. So what can Washington do to help spark a supply-side shock in health care? (Todd G. Buchholz, 8/17)

Roll Call: ‘Medicare For All’ Is The New ‘Repeal And Replace’
Like repeal and replace, Medicare for All is catchy. It’s simple. It makes the incredibly complex problem of providing universal health insurance sound easy — Medicare for all! Like repeal and replace on the right, single-payer health care is also popular with the Democratic base and quickly getting more popular with time. ... But the fine print on Medicare for All is much more complex. For one thing, there is almost no fine print on congressional proposals to extend Medicare to the entire population. (Patricia Murphy, 8/17)

Forbes: New Research Shows Many In Middle-Aged, Middle Class Can't Afford ACA Policies In 2018
Those predisposed to like the Affordable Care Act are pointing to the dwindling number of counties in which no insurer is willing to sell insurance. The fear of numerous "bare counties" appears to have gone away. Their celebration is understandable: those predisposed to dislike the Affordable Care Act had cited the number of bare counties as evidence of Obamacare's implosion. But the argument over bare counties is only part of the story. ... Another sensible measure of ACA success is the affordability of the policies being sold. (Seth Chandler, 8/17)

Health Insurance Resource Center: Who Really Needs The Public Option? Trump Country.
ACA marketplaces may never work well in rural areas. Indeed some of the very same counties lack Medicare Advantage plans, and for some of the same reasons. These areas have too few people for real competition among insurers or among providers. These gaps are not a huge problem in Medicare. Why is that? Because Medicare has a powerful alternative to Medicare Advantage. It’s called traditional Medicare, but it might as well be labeled the public option. ... So here’s the irony: Trump Country really needs a way to bypass the ACA marketplaces entirely. So Democrats’ favorite policy option – the public option – would be most valuable in precisely the deep-red areas that went most fervently for Republicans and for the President. (Harold Pollack, 8/15)

Viewpoints: Californians Need Safe Water; A Simple Way To Save People From Overdosing

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

Los Angeles Times: Hundreds Of Thousands Of Californians Lack Access To Safe Drinking Water. Let's Fix That Once And For All
California’s wet winter eased the immediate water shortages that affected most of the state, giving lawmakers and water agencies a bit of a breather as they craft new policies and design new infrastructure to weather the next big drought (which, for all we know, may already be underway). But neither the rainfall nor the new projects and policies will help hundreds of thousands of Californians whose local water supply is contaminated. (8/18)

The New York Times: A Simple Move To Save Thousands Of Lives From Overdose
A vast majority of opioid deaths are preventable if the person overdosing is given naloxone, a safe, easy-to-use and relatively inexpensive drug that has successfully reversed tens of thousands of overdoses over the years. But this medicine is often not on hand when and where it is needed. Making it more readily available could save many lives. (Megan McLemore and Corey Davis, 8/18)

The Washington Post: This Is The Only Safe Way To Treat Opioid Users
“I’m detoxing.” This is the sort of news that delights the families of patients who are addicted to heroin. The promise of a seven-day detox solution is seductive. But detoxification is actually extremely dangerous. Nearly every addict who successfully completes a week-long detox program without further treatment relapses, and in a world with increasingly powerful synthetic drugs on the market, the risk of overdosing and dying during a relapse has become ever more threatening. (Michael Stein, 8/17)

The New York Times: Reset The Clock For Malpractice Suits
[O]verwhelming majorities in both chambers of the Legislature passed a bill [in June] called “Lavern’s Law.” Under it, cancer patients alleging malpractice would have twice as long to bring action: two and a half years. Critically, the clock would start running from the time they became aware of the misdiagnosis. By way of compromise, the legislators elected not to cover all instances of medical malpractice, just cancer cases (though that is a potentially large number). Now the question is whether Gov. Andrew Cuomo will sign the bill when it is formally sent to him. (8/18)

Des Moines Register: Reynolds' Medicaid Rhetoric Does Not Reflect Reality
The Doublespeak Award was established in 1974 and is given by the National Council of Teachers of English. The ironic, annual tribute recognizes individuals and entities using language that is, among other things, deceptive, evasive and confusing. ... Iowans should nominate Gov. Kim Reynolds for her misleading rhetoric on the Medicaid privatization experiment implemented by her former boss. Her statements deserve recognition. After handing over management of the $4 billion Medicaid program to three for-profit companies last year, Iowans have filed hundreds of complaints, including many about losing access to care. Health providers have closed their doors. Iowans with disabilities have filed a federal lawsuit against Reynolds, accusing the state of depriving thousands the right to live safely outside institutions. Yet the new governor continues to insist privatization is a great thing. (8/17)

Los Angeles Times: It Shouldn't Take Generous Strangers To Help Patients Cope With Drug Prices
The inherent goodness of people was made clear this week when a pair of readers offered to pay for a 75-year-old Encino man’s prescription meds after the drug maker imposed a $1,100 deductible to be eligible for financial assistance. Meanwhile, the warped priorities of our for-profit healthcare industry once again tumbled into the open as the drug company in question, Eli Lilly & Co., responded to this demonstration of humanitarian fellowship with a shrug of its corporate shoulders. (David Lazarus, 8/18)

Stat: Victorious Declarations Of Progress On HIV/AIDS Don't Hold True For Children
Several of these shortcomings affect a chronically underserved population: infants and children. While there has been tremendous progress in recent years toward preventing mother-to-child transmission of HIV, the report shows that global access to antiretroviral therapy (ART) for women with HIV who are pregnant or breastfeeding is plateauing at around 75 percent. That’s well below the level needed to eliminate infections before and soon after birth. A substantial number of children infected with HIV as infants are not brought for treatment until they reach adolescence, at which point many already suffer from HIV-related health problems. These include infectious diseases such as tuberculosis and malaria, which take advantage of weakened immune systems. (Charles Lyons, 8/16)