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First rule: Do no harm!
But care should have benefits …
Otherwise, it’s waste.

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Summaries Of The News:

Administration News

Trump's 'Skinny Budget' Puts Health Care On A Drastic Diet

The 2018 budget proposed by the president makes deep cuts across the health care industry, from cancer research and public health to infectious diseases and drug safety. Media outlets break down which agencies and missions will be affected the most.

Los Angeles Times: Cancer Research, Public Health And Worker Safety Would All See Steep Cuts Under Trump Budget
Under the heading “Putting America’s Health First,” the Trump administration’s 2018 budget blueprint includes a $5.8-billion cut for the National Institutes of Health, a move that would slash the medical research agency’s funding by just over 18%. It would reduce public health spending by the U.S. Centers for Disease Control and Prevention by $1.32 billion, a 17% decline from 2017 spending levels. And it would cut the Food and Drug Administration’s spending by $854 million, a 31% decrease cut from current funding levels. (Healy, 5/23)

NPR: Trump Administration Seeks Deep Cuts In Health Care, Medical Research
The NIH, which funds research into medical treatments and basic science, would see cuts of almost $6 billion, to about $26 billion. That would include a $575 million cut to the National Heart, Lung and Blood Institute and $838 million cut to the National Institute of Allergy and Infectious Diseases, which is involved in a wide range of diseases including AIDS and Zika. The National Institute of Diabetes and Digestive and Kidney Diseases would be cut by $355 million. (Kodjak and Stein, 5/23)

The Washington Post: Trump’s Budget Proposal Aims To Cut All Federal Funds From Planned Parenthood
President Trump’s 2018 budget proposal would bar Planned Parenthood and other abortion providers from receiving federal funds that help pay for health-care services for millions of Americans. The budget, the “New Foundation for American Greatness,” was released Tuesday, proposing to cut trillions of dollars in spending during the next decade. The budget is part of the Trump administration’s effort to follow through on a campaign promise to exclude “certain entities that provide abortions, including Planned Parenthood” from participating in any Department of Health and Human Services programs, according to a fact sheet from the White House. (Bever, 5/23)

The New York Times: Cuts To AIDS Treatment Programs Could Cost A Million Lives
At least one million people will die in sub-Saharan Africa and elsewhere, researchers and advocates said on Tuesday, if funding cuts proposed by the Trump administration to global public health programs are enacted. The United States currently spends more than $6 billion annually on programs that buy antiretroviral drugs for about 11.5 million people worldwide who are infected with H.I.V., the virus that causes AIDS. The Trump administration has proposed slashing those programs by at least $1.1 billion — nearly a fifth of their current funding, said Jen Kates, a vice president at the Kaiser Family Foundation. (Harris, 5/23)

Stat: Trump Plan To Have Industry Pay For All Product Reviews Will Likely Go Nowhere
True to its word, the Trump administration released its 2018 budget that includes a notable change for drug and device makers — they would face a stiff increase in so-called user fees that industry pays for to fund product reviews conducted by the Food and Drug Administration. And the higher fees, which are slated to nearly double to $2.4 billion, would be used to cover the entire cost of those reviews...The notion was widely anticipated after a May 15 letter, which written by US Health and Human Services Secretary Tom Price to the Senate Health, Education, Labor, and Pensions Committee, leaked out. (Silverman, 5/23)

Stat: The Trump Budget: 8 Ways It Might Affect Public Health
The budget outline released by the White House Tuesday contains sharp cuts to everything — from a $76 million reduction in global health funding that includes HIV programming to grass-roots community health grants. And while it’s not clear what cuts will survive the congressional budget process, the proposal reveals a White House that, for the most part, wants a leaner public health system, and less American money used overseas. (Facher, 5/24)

Denver Post: Trump Budget Stirs Unease In Boulder Science Community
The release of President Donald Trump’s $4.1 trillion spending plan for the fiscal year starting in October sparked concern on Tuesday in Boulder’s scientific community for its potential impact on the work that many see as critical to public safety in the face of a changing global climate. At the national level, much of the early focus has been on the budget’s slashing to Medicaid and anti-poverty efforts. But its cuts to scientific research are also being viewed warily at the local level. (Brennan, 5/23)

CQ Roll Call: Budget Proposal Aims Cuts At Heart Of Zika Response
The leaders of agencies responding to the spread of Zika virus told lawmakers Tuesday that theyneed consistent support to combat the disease, an appeal that came on the day the White House released its budget proposal that would strip billions of dollars from those same agencies and from public health systems strained by the effects of Zika. The Trump administration wants to cut $7 billion from the $34-billion National Institutes of Health in fiscal 2018, an amount that includes a $1.1 billion cut to the $4.9 billion National Institute for Allergy and Infectious Diseases, which is developing a promising vaccine to prevent the Zika virus. (Siddons, 5/23)

The Associated Press: Agency-By-Agency Look At Trump's Budget
The budget initiates deep cuts to health insurance programs for people with modest incomes, including coverage for children. Those cuts would go beyond the House GOP bill that repeals much of the Affordable Care Act, also known as "Obamacare," and limits future federal financing for Medicaid. (5/24)

Medicaid Cuts In Trump's Budget Would Be 'Just Awful,' Advocates Say

President Donald Trump is proposing $800 billion in cuts to the program, as well as deep trims to the Children's Health Insurance Program.

The Associated Press: Poor And Disabled Big Losers In Trump Budget; Military Wins
The poor and the disabled are big losers in President Donald Trump's $4.1 trillion budget proposal while the Pentagon is a big winner. Trump's plan for the budget year beginning Oct. 1 makes deep cuts in safety net programs, including Medicaid and the Children's Health Insurance Program. The proposal also includes big cuts in Social Security's disability program. (Ohlemacher, 5/24)

USA Today: Health Care Advocates Say The Trump Budget Plan Would Gut Medicaid
Advocates for low income people struggled to find the words to describe the likely effect of the proposed $800 billion in cuts proposed to Medicaid in the Trump administration's budget released Tuesday. Depending who you ask, it will be devastating or "just awful" to the lowest income Americans, especially children and those with chronic health conditions, mental illness or substance use disorder. (O'Donnell, Saker and Robinson, 5/23)

The Washington Post: Trump Budget Would Cut Health Benefits For Many Lower-Income Kids, Experts Fear
Lower-income children would have their federal health benefits cut sharply under President Trump’s proposed budget, which analysts say could reverse gains that have pushed uninsured rates for this vulnerable population below 5 percent. The shift stems from a combination of factors, including a plan to reduce Medicaid by $1.4 trillion over the next decade and a roughly 20 percent decrease in funding for the Children’s Health Insurance Program (CHIP), along with proposed changes to eligibility requirements and the way federal matching funds are calculated. (Eilperin, 5/23)

Politico: Trump Undermines Senate GOP’s Medicaid Backers
A group of Republican senators is fighting desperately to preserve health coverage for millions of low-income constituents who have benefited from Obamacare. And the president of their own party seriously undercut their negotiating position with his budget Tuesday. By proposing hundreds of billions of dollars in Medicaid cuts in combination with the House-passed health care bill’s more than $800 billion in Medicaid spending reductions, President Donald Trump is effectively throwing in with fiscal conservatives looking to constrain the program’s growth and wind down its coverage as quickly as possible. And that could be perilous for more than a dozen GOP senators who have been meeting for months over how to preserve the law's benefits. (Everett and Cancryn, 5/23)

PBS NewsHour: Why Schools Are Worried About Medicaid Cuts Hurting Special Education
Special education, which is hugely reliant on Medicaid, is one factor that didn't get much attention in the debate over the Republican health care bill. If the bill becomes law and triggers billions of dollars of cuts to Medicaid, how would it affect the millions of public school kids who receive special ed services? William Brangham talks to Sasha Pudelski of the American Association of School Administrators. (5/22)

Proposed Cuts Land With A Thunk In Congress: 'The Budget Was Dead Before The Ink Was Dry'

The severe cuts contained in President Donald Trump's proposed budget are meeting stiff bipartisan resistance in Congress.

The Washington Post: Even Some Republicans Balk At Trump’s Plan For Steep Budget Cuts
While some fiscally conservative lawmakers, particularly in the House, found a lot to praise in Trump’s plan to balance the budget within 10 years, most Republicans flatly rejected the White House proposal. The divide sets up a clash between House conservatives and a growing number of Senate Republicans who would rather work with Democrats on a spending deal than entertain Trump’s deep cuts. “This is kind of the game,” said Senate Majority Whip John Cornyn (R-Tex.). “We know that the president’s budget won’t pass as proposed.” (Snell, Paletta and DeBonis, 5/23)

The Wall Street Journal: Bipartisan Pushback Greets Trump’s Proposed Budget
“I hate to say it, but I would say the budget was dead before the ink was dry,” Rep. Don Young (R., Alaska), who opposes the budget’s elimination of two programs in his state. Payments to Medicaid, the federal-state health program for the poor, would be cut by more than $600 billion over a decade from levels projected under current law in addition to proposed Medicaid cuts under the House bill repealing and replacing much of the Affordable Care Act. (Davidson, Peterson and Andrews, 5/23)

The Associated Press: Icy Reception To Trump Budget From Fellow Republicans
Longtime GOP Rep. Hal Rogers of Kentucky declared proposed cuts to safety net and environmental proposals "draconian." "I don't think the president's budget is going anywhere," said Republican Sen. Bill Cassidy of Louisiana, asked if he's concerned about the message sent by slashing the Medicaid program for the poor and disabled. (Werner, 5/23)

The New York Times: Republicans Will Reject Trump’s Budget, But Still Try To Impose Austerity
Finally some good news for President Trump: His new budget stands absolutely no chance of being enacted by Congress. Moving forward with the cuts outlined in the $4.1 trillion spending plan created by the budget director, Mick Mulvaney, formerly one of the most determined fiscal hawks in Congress, would no doubt have major repercussions and compound the peril of Republicans already facing upheaval over their health care proposals. It would most likely hurt some of the very voters in rural and economically distressed corners of the nation who catapulted Mr. Trump to the White House and Republicans to control of the House and Senate. The effect on those constituents would be quickly felt. (Hulse, 5/23)

The Associated Press: Cabinet Members Head To Capitol Hill To Defend Trump Budget
Top officials in President Donald Trump’s Cabinet are heading to Capitol Hill to defend his plans to cut domestic programs and parry Democratic criticism of his tax proposals. Budget Director Mick Mulvaney appears Wednesday before the House Budget panel while Treasury Secretary Steven Mnuchin will testify at the tax-writing House Ways and Means Committee. The budget contains virtually no further detail on taxes beyond the cuts the administration proposed in a one-page outline last month. (Taylor, 5/24)

McClatchy: Trump’s Gift To At-Risk Republicans? A Budget They Can Bash
President Donald Trump may have handed Republicans leery of supporting him a great gift: a spending plan that calls for deep cuts to some of the country’s most popular programs – and one they can rail against. Indeed, it did not take long for congressional Republicans on Tuesday to distance themselves from the White House’s $4.1 trillion budget blueprint, promising their constituents they’d fight Trump’s ideas. (Clark, 5/23)

The administration's Medicaid proposals draw particular criticism from both sides of the aisle —

The Hill: GOP Senators Bristle At Trump's Medicaid Cuts 
GOP senators are balking at President Trump’s proposed steep cuts to the nation's healthcare system for the poor, worrying that it could leave millions without health plans. Trump’s budget proposal would gut Medicaid by $627 billion over the next decade, on top of the $839 billion that would be cut under the House-passed ObamaCare repeal-and-replace bill. Combined, Trump and House Republicans have proposed slashing $1.4 trillion from Medicaid. (Hellmann and Weixel, 5/23)

CQ Roll Call:  White House's Proposed Medicaid Cuts Draw Quick Protests
The OMB budget says Medicaid outlays would drop by $627 billion in the decade ending in fiscal 2027, falling to $4.70 trillion. This appears to largely reflect a Trump administration plan to reduce the flow of federal dollars to state Medicaid funds beyond the reduction proposed in the House GOP bill (HR 1628). OMB then has a separate placeholder item in its budget for $1.25 trillion in expected savings from Republican revisions to the 2010 health care law. (Young, 5/23)

Meanwhile, Hillary Clinton blasts the president's budget —

The Associated Press: Clinton: Trump Budget Shows 'Unimaginable' Cruelty
Hillary Clinton proclaimed Tuesday that President Donald Trump's budget shows an "unimaginable level of cruelty" for millions of Americans and children. The former Democratic presidential nominee, who recently declared herself part of the Trump resistance, lashed out at the Republican president's spending plan in aggressive terms after being honored in New York City by the Children's Health Fund, a nonprofit organization that helps provide health care to poor and homeless children. (Peoples, 5/23)

President's Blueprint Targets The Very People Who Helped Put Him Into Office

The proposed cuts are "a slap in the face," some voters say.

Reuters: Trump Budget Cuts May Stir Backlash In Rural America
President Donald Trump’s proposals to slash federal aid to the poor, the sick and people living in rural areas reflect conservatives' demands for a smaller federal government but target many of the very people who voted for him last November. In his first detailed budget submission to Congress on Tuesday, Trump requested major reductions to programs that help poor families afford groceries and poor and disabled people get healthcare. (Cowan, 5/23)

McClatchy: Trump Budget Seen As A 'Slap In The Face' To His Rural Voters 
Two of farmers’ most powerful Republican advocates in the Senate slammed President Donald Trump’s proposal Tuesday to slash crop insurance, warning those and other budget cuts would badly wound one of the president’s most loyal constituencies. Voters who live in rural areas gave Trump a 61-34 percent advantage over Democrat Hillary Clinton in November, according to network exit polls. (Wise and Lowry, 5/23)

Modern Healthcare: Trump Budget Targets Rural Hospitals, Minority Health Professional Education ​
Proposed cuts in President Donald Trump's 2018 budget for HHS would reduce funding for rural hospitals and hurt the supply pipeline for black and Hispanic healthcare professionals. The budget proposal targets several rural hospital grants in its projected cuts. The Rural Hospital Flexibility Grant, at $42 million, is proposed for elimination. The Obama administration previously had recommended cutting the program, saying it was duplicative. The new budget also zeroes out grants to state offices of rural health, a $9 million program. (Lee, 5/23)

San Antonio Press-Express: USDA Staffing Faces Steep Cuts Under Trump Budget Proposal 
More than 5,200 staffers would be cut from the agency that oversees food stamps, farm loans, animal and plant disease prevention, and other programs under the 2018 budget proposal President Donald Trump sent to Congress on Tuesday... While lawmakers on both sides of the aisle quickly proclaimed the spending plan overly aggressive and likely dead on arrival, Perdue during the call recalled getting through tough fiscal times as governor of Georgia and said he would lead the USDA amid any approved cuts. (Brezosky, 5/23)

Meanwhile, governors in California and Louisiana react to the budget —

New Orleans Times-Picayune: Louisiana Governor To Donald Trump: Your Budget Robs My State Of Coastal Restoration Money
[Gov. John Bel] Edwards said the budget proposal also threatens key health care services such as the Children's Health Insurance Program, which offers health care to 122,000 Louisiana children. He urged the state's congressional delegation to oppose Trump's budget, "including cutting federal funding for Medicaid patients and health care providers by eliminating Medicaid expansion coverage and cutting health care for elderly and disabled residents." (Shleifstein, 5/23)

Proposed Gutting Of Drug Czar's Funding Rolled Back To Just Trims After Vocal Outcry

A draft of the president's budget had shown a proposed 95 percent cut to the office in the middle of an opioid epidemic. But the released plan walks that back. Meanwhile, Food and Drug Administration Commissioner Scott Gottlieb is calling on his staff to increase efforts to fight the crisis sweeping the country.

Stat: After Outcry, Trump Budget Largely Preserves 'Drug Czar' Funding
After an outcry, the Trump administration has rolled back a proposed gutting of the Office of National Drug Control Policy, instead asking for relatively small trims to the office and largely preserving two main grant programs. President Trump’s 2018 budget — released Tuesday — is just a proposal; Congress actually allocates government spending. (Joseph, 5/23)

CQ Roll Call: Drug Office Cuts Rolled Back As FDA Examines Opioid Policies
Lawmakers in states where opioid abuse is rampant praised the Office of Management and Budget for not proceeding with the original cuts. “I’m happy to see OMB reversed course and included funding for the office in its budget,” said Sen. Shelley Moore Capito, R-W.Va., a member of the Appropriations Committee. "We still have a long way to go when it comes to the drug epidemic, and it is essential that we remain fully committed to fighting it. We need to be doing more — not less.” (Siddons, 5//23)

The Washington Post: FDA Commissioner Gottlieb Calls For ‘More Forceful Steps’ To Curb Opioid Epidemic
Food and Drug Commissioner Scott Gottlieb called on his staff Tuesday to explore “more forceful” efforts to curb the epidemic, including requiring training for doctors and ensuring patients aren't prescribed the medications for unnecessarily long periods that increase the risk of addiction. “Opioid prescriptions should be written only for appropriate patients and for appropriate durations,” Gottlieb said in his first interview since becoming commissioner. “No more 30-day supplies for tooth extractions” or uncomplicated hernia repairs. (McGinley, 5/23)

And in opioid news from the states —

WABE: What Is 'Gray Death,' And How Does It Kill? 
Amid Georgia’s opioid problem, a new drug has entered the market. “Gray death,” a cocktail of several opioids, was reported to have claimed its first death in Georgia last week. Despite efforts to curtail the spread of opioids in the Southeast, drugs are getting even stronger and more deadly, according to Georgia Bureau of Investigation public affairs director Nelly Miles. (Such, 5/23)

Health Law

Washington Waits With Bated Breath For CBO Score On GOP Health Plan

The politically bruised agency is expected to release the score Wednesday, which will determine whether the Senate can move forward with any plans to repeal and replace the Affordable Care Act.

The Associated Press: Budget Office To Gauge Health Bill Effect On Coverage, Cost
Congressional Republicans are about to learn more about whether their drive to dismantle President Barack Obama's health care law has been worth the political pain they've been experiencing. The Congressional Budget Office planned to release its estimate Wednesday of what impact the GOP's House-passed health care overhaul would have on coverage and premiums. (Fram and Alonso-Zaldivar, 5/24)

Politico: Republicans Gird For CBO Verdict On Obamacare Repeal
Republicans are bracing for a report Wednesday expected to say their Obamacare repeal plan would leave millions of Americans without health insurance, further complicating their efforts to pass legislation quickly. The CBO’s analysis of the bill comes three weeks after House Republicans rushed to vote on the legislation without an update on its cost, or its impact on the nation's uninsured. The agency's score will serve as the unofficial framework for Senate lawmakers negotiating their own version of repeal and will likely help those eager to make big changes. It's also expected to become a rallying point for Democrats critical of an effort that could strip health care from millions. (Cancryn and Ferris, 5/23)

A Plea To Congress From The Industry: Give Us A Short-Term Fix To Stabilize Marketplace

Hospitals, physician groups, health insurers and the U.S. Chamber of Commerce are all asking lawmakers to step in to make sure the marketplaces don't collapse amid the uncertainty around the Affordable Care Act and the Republicans' efforts to dismantle it. Meanwhile, there's growing pressure for the Senate to pass a version of the legislation before August recess. And CEOs are hiding behind big lobbying groups when it comes to wielding influence on the plan.

Los Angeles Times: With Healthcare In Turmoil, Senate Republicans Are Under Pressure To Buck Trump
Senate Republicans face increasing pressure to rescue health insurance markets and protect coverage for millions of Americans amid growing fears the Trump administration is going let the markets collapse. In recent days, leading hospitals, physician groups, health insurers and the U.S. Chamber of Commerce have pleaded with the Senate to step in, effectively going around the White House. (Levey and Mascaro, 5/23)

Roll Call: Republican Senator Seeks to Save Obamacare Before Dismantling It
Sen. Lamar Alexander has found himself in an uncommon position for most Republicans this year: Trying to save the shaky insurance markets created by the 2010 health care law before attending to a major overhaul of the law. The opinions of the Tennessee’s senior senator carry significant weight among his colleagues. He is a close confidant of Senate Majority Leader Mitch McConnell and also chairs the Health, Education, Labor and Pensions Committee. And while Alexander has been a near constant critic of former President Barack Obama’s signature domestic achievement, he is now one of the leading voices in the chamber for saving it, at least for 2018 and 2019. (Williams, 5/24)

CQ HealthBeat: McConnell Clamps Down On Health Care Leaks
Senate Majority Leader Mitch McConnell sent a warning to staffers last week amid growing frustration at the amount of information leaking from private Republican discussions on repealing the 2010 health law. At a May 16 meeting of his health care working group, the Kentucky Republican excused all non-leadership staffers after expressing annoyance over the number of leaks about the closed-door discussions, GOP senators and aides told Roll Call. He was particularly frustrated with a report that cited a verbatim conversation that took place during a prior meeting, according to one lawmaker who spoke on the condition of anonymity. (Williams and Mershon, 5/23)

The Hill: Senate Feels Pressure For Summer Healthcare Vote
Senate Republicans are under mounting pressure to pass an ObamaCare repeal-and-replace bill before the congressional recess in August. While Senate Majority Leader Mitch McConnell (R-Ky.) is wary of committing to a specific deadline after the House struggled to pass a bill, the White House wants the upper chamber to hit the gas. Health and Human Services Secretary Tom Price and House GOP lawmakers are publicly nudging the Senate to vote before lawmakers leave town at the end of July. (Carney, 5/24)

Modern Healthcare: Healthcare CEOs Have Zipped Their Lips On AHCA Politics 
House Republicans' Affordable Care Act repeal-and-replace bill is likely to undergo serious changes before the Senate votes on the legislation. But few healthcare CEOs are wielding their influence publicly to shape the legislation that will significantly affect their companies' bottom lines and customers. Insurer and provider executives are hiding behind industry lobbying groups, including America's Health Insurance Plans and the American Hospital Association, instead of using their power to influence lawmakers on the GOP's American Health Care Act. Their silence is a missed opportunity to serve their patients' best interests, some experts say. (Livingston, 5/23)

In other news on the American Health Care Act —

The Washington Post: Fact-Checking A Rosy Portrait Of The American Health Care Act
In a $2 million ad campaign to support the House GOP health plan, the right-leaning American Action Network (AAN) features a California woman named Elizabeth Jacinto who says she suffered under Obamacare and expresses enthusiasm for the American Health Care Act. The ACHA only narrowly passed the House and was greeted lukewarmly by the Senate, so a key part of the effort appears to assist 21 GOP lawmakers who cast a tough vote to support proposal. (Kessler, 5/24)

The Associated Press: Health Care Is Key Issue As Montana Fills US House Seat
Meagher County, Montana, may not be much different than the rest of the rural enclaves across America that voted overwhelmingly for Donald Trump last fall. The median annual household income is $38,000 — about 25 percent below the national average. Nearly 20 percent of its 1,800 residents live in poverty. And more than one in four people don't have health insurance. (5/23)

Concord Monitor: N.H. Legislators Push Bill To Let Regulators React To Health Insurance Upheaval
Facing a repeal of the Affordable Care Act and potential premium hikes next year, New Hampshire lawmakers are proposing to give state regulators broad authority to quickly respond...Under the measure, the state insurance department can work with the New Hampshire Health Plan to take steps meant to maintain coverage and stabilize prices in the individual market. Those could include reviving a high-risk pool or seeking waivers from the federal government to get money, officials said. Gov. Chris Sununu said in a letter that it is not his intent to waive requirements that insurers cover pre-existing conditions. Any changes would need a public hearing and sign-off from a legislative oversight committee. (Morris, 5/24)

Boston Globe: Study Finds That More Than 10 Percent Of Mass. Residents Would Be Uninsured If US House Health Care Bill Passes 
Massachusetts, the state with the highest rate of residents with health insurance, could see its uninsured rate jump above 10 percent if the sweeping health care bill approved by the US House becomes law, according to a new analysis. The bill known as the American Health Care Act, which is backed by House Republicans and President Trump, would repeal huge portions of former president Obama’s health care law. (Dayal McCluskey, 5/23)

WBUR: GOP Health Bill Would Hike Uninsured Rate In Massachusetts To 10.3 Percent, Report Finds 
For more than a decade, Massachusetts has had the lowest number of residents without health insurance in the nation. The rate dropped after the passage of a 2006 state coverage law and has remained low under Obamacare. But a study from the Urban Institute, a D.C.-based think tank that bills itself as independent, projects the state's uninsured rate would rise from 2.8 percent to 10.3 percent by 2022 — a nearly four-fold increase. (Bebinger, 5/23)

Moderate At Center Of House Health Bill Negotiations Gives Up Chairman Position

Rep. Tom MacArthur (R-N.J.), who worked with Rep. Mark Meadows (R-N.C.) to get the GOP health plan through a reluctant House, said his decision to quit his position as head of the Tuesday Group was because some of the members have "a very different view of governing."

The Associated Press: Congressman Quits Post In GOP Group Over Health Care Bill
A New Jersey Republican congressman who helped push the House health care bill to passage quit his post Tuesday as a chairman of the chamber's moderate Tuesday Group, criticizing colleagues for having "different objectives and a different sense of governing than I do." Rep. Tom MacArthur, a second-term congressman, announced his decision at a closed-door meeting of the group, which has roughly 50 members. (Fram, 5/23)

USA Today: Rep. Tom MacArthur Quits As Leader Of Moderate Tuesday Group
"I realized through the health care debates that people in my group wanted different things. They had a very different view of governing," MacArthur told reporters during a House vote Tuesday. MacArthur became co-chairman of the Tuesday Group at the beginning of this year. A former insurance executive now in his second term in the House, he was the first New Jersey Republican to support House leaders' bill to repeal and replace the Affordable Care Act, or Obamacare. (Jackson, 5/23)

The Washington Post: Q&A: Rep. Tom MacArthur And The Agony Of GOP Moderates In Trump’s Washington
MacArthur’s brief and uneasy turn under the national spotlight has been telling. Exchanges from his packed forum this month in deep-blue Willingboro — mostly of supporters of the Affordable Care Act fuming about his attempts to repeal and replace the law — have been replayed endlessly on cable news. And the centrists MacArthur once led are increasingly nervous about their reelection chances — and have groused that his eagerness to cut a deal with Freedom Caucus hard-liners is partly responsible for their vulnerability. (Costa, 5/23)


Review Of H-1B Visa Practices Imperils Efforts To Attract Foreign Doctors To Underserved Areas

The Trump administration has suspended the 15-day expedited process to obtain an H-1B visa. Those visas are often used by hospitals and medical groups to hire foreign-born workers in specialty fields.

Stateline: Changes To Visa Program Put Foreign-Born Doctors In Limbo
For parts of the country that have difficulty attracting American-born doctors, the uncertainty swirling around the H-1B program is already creating problems, with doctors tied up in legal uncertainty rather than treating patients. ... Hospitals in distressed urban neighborhoods also rely on foreign-born medical school graduates to fill medical residencies that might otherwise go vacant. (Ollove, 5/23)


Some States, Facing Tight Budgets, Working To Recertify Medicaid Enrollees' Eligibility

Missouri, Wyoming and Mississippi have enacted laws to scrutinize whether Medicaid or food stamp recipients are eligible, and several other states are considering such measures. News outlets also report on Medicaid news from Oregon, Iowa, Indiana and Kansas.

Stateline: What Happens When States Go Hunting For Welfare Fraud
Now, faced with growing Medicaid enrollment and tight budgets, Republican lawmakers in several ... states are taking ... steps to ensure that people receiving welfare benefits are eligible for them. Under their proposals, which are modeled on legislation drafted by a national conservative group, recipients would face tougher and more frequent eligibility checks. And the checks could be conducted by private contractors who are motivated to justify their hiring by knocking as many people as possible off the rolls. (Fifield, 5/23)

The Oregonian: Health Authority Estimates 32,000 Medicaid Recipients Could Be Ineligible 
Oregon Health Authority officials told a legislative committee Tuesday that the agency might have provided Medicaid benefits to some 32,000 people who no longer qualified for them. If historical trends hold true, as the state processes a backlog of 115,000 Medicaid renewals, 28 percent of them could be deemed ineligible because they make too much money. But Lynne Saxton, director of the health authority, flatly rejected the idea that the lingering questions about the state's Medicaid rolls poses a financial risk for the state. The questions come just as state lawmakers consider a new tax on health care providers. At the federal level, the Trump administration continues to push for the repeal of the Affordable Care Act and the sweeping Medicaid changes that came with it. (Manning, 5/23)

Des Moines Register: Privatized Medicaid Appears To Be Saving Iowa Money. But Is It Real?
Iowa will spend $600 less on each Medicaid recipient this year compared with before private companies were hired to manage the program, according to a projection from the nonpartisan Legislative Services Agency. ... The data does not account for millions of dollars in losses the private companies hired to manage the program have accrued in the current fiscal year, losses Iowa has agreed to at least partially repay in 2018. Those losses won’t show up in the current year’s budget. (Clayworth, 5/23)

Modern Healthcare: Indiana Medicaid Director Moser Steps Down
Joe Moser, a key architect of Indiana's alternative Medicaid expansion program has stepped down from his role as the state's Medicaid director. Moser was appointed by then-Gov. Mike Pence in 2013 and oversaw the care of more than 1.5 million Medicaid and Children's Health Insurance Program enrollees. Moser told Modern Healthcare he has no plans to work with the Trump administration, but would be open to that possibility. He decided to leave Indiana's Medicaid agency in order to pursue new opportunities. (Dickson, 5/23)

Kansas City Star: Federal Officials Accept Plan To Fix Kansas Medicaid Program 
Federal officials have accepted a corrective action plan for Kansas’ privatized Medicaid program, an important hurdle in ensuring the program can continue to operate next year. The federal Centers for Medicare & Medicaid Services had rejected the state’s request to extend its KanCare program through 2018 in January after finding that the program was “substantively out of compliance” with federal regulations. (Lowry, 5/23)

Public Health And Education

Who Should Be Punished When A Child Dies From An Accidental Gunshot? The Answer Varies State To State

A series by USA Today and The Associated Press offers a look at gun safety and children in different states.

USA Today/The Associated Press: States Rejecting Bills Intended To Keep Guns Away From Kids
In state after state, proposals that would create or toughen laws intended to keep kids from getting ahold of unsecured guns have stalled — caught up in a debate over whether they are effective prevention measures or just government overreach. Child access prevention laws allow prosecutors to bring charges against adults who fail to safely store their loaded guns, especially when they are obtained by minors and used to harm. (Foley and Penzenstadler, 5/24)

In related news —

KCUR: Kansas Committee Advances Bill To Keep Gun Ban At Some Health Facilities 
The Kansas Senate Ways and Means Committee on Tuesday advanced a bill that would allow public health care facilities to continue to ban concealed guns. A state law taking effect July 1 will allow people to carry concealed guns into any public building that is not secured by armed guards and metal detectors. The bill that advanced Tuesday would allow guns to be banned at state-run psychiatric hospitals, publicly owned medical facilities and the University of Kansas Health System. (Koranda, 5/23)

Teaching Hospitals Have Lower Death Rates For Older Patients Than Less Costly Community Hospitals

Researchers found that the 30-day mortality rate at major teaching facilities was 8.3 percent, compared with 9.5 percent at non-teaching ones. Today's other public health stories cover child fatalities from car crashes, near-death experiences, botulism in California, and the heart benefits of chocolate.

Stat: Pricey Teaching Hospitals Have Lowest Death Rates For Older Patients
At a time when insurers are steering patients away from expensive academic medical centers, a new study counters the idea that the quality of care is consistent across hospitals, concluding that major teaching hospitals have lower mortality rates for older patients than community hospitals. Using millions of Medicare records, researchers found that the 30-day mortality rate — the percentage of patients who died within 30 days of hospitalization and one common way to gauge quality — was 8.3 percent at major teaching hospitals, compared with 9.2 percent at minor teaching hospitals and 9.5 percent at non-teaching hospitals. The figures accounted for differences in patient populations and hospital characteristics. (Joseph, 5/23)

NPR: One Fifth Of Children In Fatal Car Crashes Were Improperly Restrained
A new study found that 20 percent of children who were in a fatal car crashes were not buckled in properly, or were not wearing a seat belt at all, and that child fatality rates in deadly car crashes vary widely by state. The results add evidence to the argument that state regulations and public information tactics can affect motor vehicle safety for kids. The Centers for Disease Control and Prevention has noted that, for example, seat belt use across all age groups is higher in states with more stringent seat belt enforcement laws. (Hersher, 5/23)

Cronkite News: 'Everybody Wants That Miracle': Survivors Of Near-Drownings Face Tough Road To Recovery
The state’s constant warm climate keeps pools open year-round, the most common environment for drownings involving toddlers; in fact, toddlers in the Grand Canyon state are far more likely to drown compared with rates of childhood drownings from around the nation  —  and authorities say they’re nearly all preventable. For those who survive, recovery could last a lifetime. (Souse, 5/23)

The New York Times: Why Chocolate May Be Good For The Heart
Eating chocolate has been tied to a reduced risk of heart disease. Now scientists have uncovered one possible reason. Using data from a large Danish health study, researchers have found an association between chocolate consumption and a lowered risk for atrial fibrillation, the irregular heartbeat that can lead to stroke, heart failure and other serious problems. The study is in Heart. (Bakalar, 5/23)

WHO's Next Director-General Will Be First To Come From Africa

Former Ethiopian health minister Tedros Adhanom Ghebreyesus has been elected to head the World Health Organization, the United Nations agency responsible for coordinating international responses to infectious disease epidemics like Ebola and Zika.

The New York Times: W.H.O. Elects Ethiopia’s Tedros As First Director General From Africa
Tedros Adhanom Ghebreyesus of Ethiopia was voted director general of the World Health Organization on Tuesday, the first African ever to head the agency. The election was the first conducted by the W.H.O. under more open and democratic rules. After nearly two years of public campaigning, originally by six candidates, the voting took place in a closed-door session in which the health ministers of 186 countries cast their ballots in secret. (McNeil and Cumming-Bruce, 5/23)

The Washington Post: WHO Picks Tedros Adhanom Ghebreyesu Of Ethiopia To Lead The Global Health Agency
During the third and final round of balloting in Geneva, members of the World Health Assembly voted 133 to 50 to pick Tedros, as he is known, to be the next director-general, according to unofficial tallies. Cheers broke out, observers said, as he beat out David Nabarro, a 67-year-old physician and longtime United Nations official from Britain, and Sania Nishtar, a 54-year-old cardiologist from Pakistan. It was the first time member states took part in a secret ballot that gave each member state an equal vote. In the past, leaders were chosen by an executive board and voting took place behind closed doors. Nishtar was eliminated during the first round of voting. (Sun, 5/23)

State Watch

State Highlights: Contract Dispute In Ariz. Leaves Many Out Of Network At Dignity Health Hospitals; Texas Lawmakers OK Maternal Health Bills

Media outlets report on news from Arizona, Texas, California, Minnesota, Georgia, Colorado and Florida.

Sacramento Bee: Health Care For Illegal Immigrants Proposed By California Senator
State Sen. Ricardo Lara doesn’t only want to reconstruct the way health care is delivered and paid for in California. As the debate around publicly funded universal health care heats up in the Capitol, Lara is also seeking to expand the state’s low-income health program to undocumented adults up to age 26. (Hart and Miller, 5/23)

Georgia Health News: State AG Backs Wider View Of Records In Hospital Court Fight 
The state’s attorney general has urged the Georgia Supreme Court to reverse a lower court opinion that barred access to Northside Hospital’s financial records. Chris Carr, in office since late last year, said in a Monday court filing that the Georgia Open Records Act is broader in its applications than what Northside Hospital has argued. (Miller, 5/23)

Atlanta Journal Constitution: GA Attorney General Weighs In On Northside Hospital Open Records Case 
Georgia law requires open government even when a private party is carrying out the public’s work, Attorney General Christopher Carr argued in a brief filed Monday in the Northside Hospital open records case before the Georgia Supreme Court... The Georgia Supreme Court asked the Attorney General’s office to file an opinion in the hotly-contested case that started when attorney E. Kendrick Smith requested documents from Northside under the state’s sunshine law. (Teegardin, 5/23)

Texas Tribune: Grieving Mom “Humbled” And “Relieved” After Senate Passes Autopsy Bill 
As the Texas Senate passed a bill on Tuesday that would ensure parents can view their deceased child's body before an autopsy is conducted, a grieving mother shed tears from the gallery... Currently, parents need permission from a justice of the peace or medical examiner to see their deceased child if his or her death occurs outside a hospital or health care institution. (Mansoor, 5/23)

Austin American Statesman: Texas Senate Approves Bill Aimed At Identifying Postpartum Depression
The Texas Senate on Tuesday approved a bill aimed at increasing identification of postpartum depression among mothers participating in federally backed health care programs for low-income families. Under House Bill 2466 by Rep. Sarah Davis, R-West University Place, mothers who bring their kids in for checkups can get screened for postpartum depression by their children’s pediatricians. (Collins Walsh, 5/23)

Denver Post: New Leadville Hospital Dealt Major Setback After Feds Withhold Loan 
Lake County’s only hospital, St. Vincent in Leadville, has put plans to build a new facility on hold after financial projections came up shorter than expected, indicating the small hospital has recovered from the financial brink but still needs to improve its balance sheet before a much-needed building upgrade. In 2014, the hospital announced it would be shutting down because of critical building repairs and declining revenues, but service cuts and a partnership struck several months later with Centura Health — which also runs St. Anthony Summit Medical Center in Frisco — kept the 138-year-old hospital open. (5/23)

Sacramento Bee: Abortion Reversal Therapy Grows More Popular Despite Doubts
Several California clinics advertise the therapy, claiming to be able to undo the effects of the first dose containing mifepristone, which blocks progesterone production and causes the uterine lining to shed. The second set of pills contains misoprostol, which makes the uterus contract and initiates bleeding and cramping. More than 350 providers nationwide perform abortion reversal therapy, according to proponents of the treatment. (Caiola, 5/23)

Kansas City Star: Kansas Records: Several Hotline Calls Still Didn’t Save Adrian Jones 
The head of Kansas’ child welfare agency said earlier this month that social workers’ last contact with the family of Adrian Jones was in February 2012. But records obtained by The Kansas City Star on Tuesday show that social workers with the Kansas Department for Children and Families investigated a hotline call 10 months later, in December 2012. (Baurer and Woodall, 5/23)

Kansas City Star: Missouri Hospital And Clinic Settle Medicare Fraud Suit 
A Missouri hospital, clinic and infusion center have agreed to pay $34 million to settle a federal lawsuit that alleged they defrauded Medicare. The suit alleged that Mercy Hospital Springfield and its affiliate, Mercy Clinic Springfield Communities, had an improper financial agreement that provided kickbacks to oncologists based on the value of their chemotherapy referrals to the infusion center. (Marso, 5/23)

KQED: Valero Outage Prompts Benicia To Consider Industrial Safety Ordinance 
City officials would have greater oversight over the Valero refinery under a proposal set to be unveiled at the Benicia City Council meeting on Tuesday—a potential reform prompted by the major outage at the facility earlier this month. Mayor Elizabeth Patterson is proposing the city develop regulations similar to those in Contra Costa County, home to several refineries. That county’s industrial safety ordinance, considered to be one of the strongest in the country, requires oil refining facilities to undergo safety audits and have risk management plans. (Goldberg, 5/23)

Miami Herald: John Morgan ‘Prepared To Invest $100M’ In Medical Marijuana 
John Morgan spent nearly $7 million pushing two statewide ballot initiatives to expand medical marijuana throughout the state of Florida. But that’s a drop in the bucket compared to what the wealthy Orlando attorney and possible gubernatorial candidate says he’s prepared to invest in the industry now that it’s about to explode. (Smiley, 5/23)

Prescription Drug Watch

With Little Federal Progress Being Made, States Step Up Own Efforts To Curb High Drug Prices

Bills in California and Nevada reflect a growing trend across the country. Outlets report on news out of Ohio, Texas and New York, as well.

FiercePharma: Nevada Bill Could Force Sanofi, Novo And Lilly To Reveal Their Insulin Pricing Secrets
As a variety of states weigh measures targeting pharmaceutical pricing, Nevada’s Senate has passed a tough new bill that would publicly spotlight insulin makers' price hikes and profits. Approved by the Nevada Senate on Friday, the bill would force diabetes drugmakers to disclose information on their insulin pricing, profits, costs and more, and would require the state government to publish the information publicly on the internet. (Sagonowsky, 5/22)

Columbus Dispatch: Broad Coalition Anchored By Drug Makers Opposes Ohio Ballot Issue
Opponents of a ballot issue aimed at lowering prescription drug prices today announced a broad coalition to fight the proposal Ohioans will see in the Nov. 7 election. The group Ohioans Against the Deceptive Rx Ballot Issue formed to oppose the Ohio Drug Price Relief Act, an initiated statute that, if passed, would require the state government to pay no more for prescription drugs than the lowest price paid by the U.S. Department of Veterans Affairs. (Johnson, 5/23)

Columbus Dispatch: High-Powered, Bipartisan Team Lined Up To Push Drug Price Vote
The Ohio Drug Price Relief Act will have a high-profile bipartisan campaign team working to pass the ballot issue in the Nov. 7 election. Financed in part by the AIDS Healthcare Foundation, the act would require state agencies to pay no more for prescription drugs than the lowest price paid by the U.S. Department of Veterans Affairs. Supporters say that could lower prices by 40 percent or more and cause a ripple effect for Ohio consumers. (Candisky, 5/16) Former Ohio Medicaid Directors Oppose Drug Price Ballot Issue
Three former Ohio Medicaid directors say a November ballot measure intended to lower prescription drug prices would have the opposite effect for most Ohioans. "The money's going to come from some place and this is not the way to do it," John McCarthy, former Medicaid director under Gov. John Kasich, said in a Tuesday phone call with reporters. The call was organized by opponents to the measure, Ohioans Against the Deceptive Rx Ballot Issue, which launched their campaign earlier in the day. (Borchardt, 5/23)

Texas Tribune: Scientists Wary As Texas Mulls Allowing Sale Of Unproven Drugs 
A group of scientists and medical professionals is sounding the alarm in the final days of the Texas legislative session about a little-noticed bill that would allow manufacturers of unproven drugs to sell their products to dying patients. Supporters of House Bill 3236 by state Rep. Kyle Kacal, R-College Station, say it could help incentivize drugmakers to get promising, experimental drugs onto the market and into needy patients’ hands. (Walters, 5/23)

Kaiser Health News: New York State Wants Its Prescription Drug Money Back — Or Else
New York Medicaid regulators aim to use the threat of imposing increased scrutiny of prescription drugs — such as eyeing their relative effectiveness and their profit margins — to coax additional discounts from drugmakers. The rules, signed into law in mid-April as part of the state’s budget, don’t go as far as the surcharge that Democratic Gov. Andrew Cuomo originally sought to control the “skyrocketing costs of prescription drugs,” but they retain elements guaranteed to get under a pharmaceutical executive’s skin. (Appleby, 5/22)

Amazon Mulls Entering PBM Field, Even As These Middlemen Bear Brunt Of Blame Over High Drug Costs

News outlets report on stories related to pharmaceutical pricing.

Stat: Can Amazon Win As A Pharmacy Benefits Manager?
What kind of impact could Amazon have if the ubiquitous company enters the mysterious and complicated world of pharmacy benefit managers? The online retailer is reportedly exploring the pharmacy business and, as part of the plan, may build an internal PBM for its own employees, but later roll this out to the world at large. The possibility is intriguing because it comes at a time when these middlemen — which negotiate with drug makers for favorable insurance coverage — are under varying degrees of financial and political pressure. (Silverman, 5/18)

Stat: US Drug Prices Are So High That Canada Wants Other Countries As Reference Points
How high are drug prices in the US? So high that the Canadian government may remove the US from its long-standing list of countries that are used as a guide for determining whether prices are excessive. In a proposal issued last week, Health Canada said it wants to overhaul the framework used by the Patented Medicine Prices Review Board, which assesses therapeutic benefits and sets ceiling prices. Right now, this is accomplished, in part, by benchmarking prices against what drug makers currently charge in seven other countries — the US, France, Germany, Italy, Sweden, Switzerland, and the UK. (Silverman, 5/22)

The Wall Street Journal: How The FDA Approved A $300,000-A-Year Drug Its Own Experts Didn’t Believe Worked
Jennifer McNary, a stay-at-home mother, was desperate to find a medicine that might spare her two sons an early death from a rare form of muscular dystrophy. Chris Garabedian, the chief executive of a pharmaceutical firm, was desperate to find a profitable drug that would reverse his company’s slow fall. They met in June 2012 at a conference on Duchenne muscular dystrophy and joined forces, often behind the scenes and with little public disclosure, in a yearslong mission to push the government to approve a drug to treat DMD, as it is known. (Pulliam and Mullins, 5/19)

Stat: Generic Hepatitis C Meds Really Are Cost Effective: Study
For the past three years, various governments and patient advocacy groups have clamored for lower-cost hepatitis C medicines, given the high cure rate for these pricey new drugs. Now, a new study finds that upfront treatment with cheaper generic versions can offer a substantial payback. Using a mathematical model for patients in India, researchers found that copycat versions costing around $300 would increase life expectancy by more than eight years and reduce lifetime health care costs by more than $1,300 per person. (Silverman, 5/18)

The Wall Street Journal: FDA Approves Merck’s Keytruda To Treat Cancers With Genetic Defects
The U.S. Food and Drug Administration on Tuesday approved Merck & Co.’s Keytruda drug to treat tumors with a certain genetic defect—the first time the agency has cleared a cancer drug for a use not tied to the site of a tumor. The FDA approved Keytruda to treat tumors with genetic defects known as “microsatellite instability” or “mismatch repair” deficiencies, which are present in an estimated 4% of cancers. Studies showed the drug shrank tumors in a significant number of patients with colorectal and 14 other cancer types that had the genetic defect. (Loftus, 5/23)

CQ Roll Call: House GOP Tries Last-Minute Push For FDA Marketing Change
Republicans are attempting to address a major priority of the drug and medical device industries as part of a bill to fund the Food and Drug Administration, but in so doing risk injecting a controversial issue into what was supposed to be a smooth bipartisan negotiation. The makers of drugs and devices want the FDA to loosen the regulations governing how they can discuss and promote uses of their products that haven’t been explicitly approved. Approved uses are typically identified on a product’s label, but the practice of using drugs or devices in a so-called “off-label” way is common in some areas of medicine where treatment options may be limited, such as for cancer patients or pediatric populations. (Siddons, 5/24)

Stat: FDA Leaps Into Precision Medicine — With Caveats
The many proponents of precision medicine have long promised a world where terms like “lung cancer” and “melanoma” are rendered quaint by the awesome power of genomics. And the FDA, with its latest approval, just endorsed that vision of the future. The agency cleared Merck’s blockbuster cancer drug Keytruda to treat any solid tumor with one of two genetic abnormalities, marking the first time the FDA has granted such an agnostic approval. There are, of course, caveats — the mutations are rare, and Keytruda can be used only after a prior treatment has failed — but it’s a milestone approval nonetheless, and one that will be heartening to some forward-thinking biotech companies. (Garde, 5/23)

Stat: UK Regulator Says Merck Broke Competition Laws Over Biosimilars
The UK antitrust regulator accused Merck of illegally offering discounts for the Remicade biologic medicine in order to block lower-cost biosimilar versions. In a brief statement, the Competition and Markets Authority said it found that the drug maker “provisionally” broke the competition law and was “abusing its dominant position” in the market with its discount scheme. Remicade is used to treat chronic inflammatory diseases such as rheumatoid arthritis. (Silverman, 5/23)

Reuters: India's Drug Pricing Regulator Clamps Down On Drug Cocktails
India's drug pricing regulator has demanded explanations from 65 domestic and global drugmakers for selling new forms of essential diabetes and antibiotic drugs without its approval. The move could bring penalties for the drugmakers, among them Abbott Laboratories, Sanofi, Novartis and Indian firms such as Sun Pharmaceutical Industries and Lupin, the National Pharmaceutical Pricing Authority (NPPA) said on its website. (Siddiqui, 5/18)

Reuters: UK Competition Watchdog Accuses Merck Of Obstructing Biosimilars
Britain's competition watchdog has accused Merck & Co of operating an unfair discount scheme for its medicine Remicade that it said was designed to restrict competition from so-called biosimilar copies. The Competition and Markets Authority (CMA) said on Tuesday it had provisionally found the U.S. company's European unit, Merck Sharp & Dohme, had abused its dominant position through the scheme, opening it up to potential financial penalties. (Hirschler, 5/23)

Stat: Former Lilly Employee Wins An Ironic Lawsuit Over Disability Benefits
A federal appeals court ruled last week that Eli Lilly should not have ended disability benefits to a former human resources director who claimed she was unable to continue working because she suffered from fibromyalgia, a chronic neurologic condition. Yet at the same time the former employee was fighting in court to have those benefits restored, the drug maker was marketing a medicine in the US to treat the condition, which one of its own consultants had described as “very disabling,” according to court documents. (Silverman, 5/22)

Stat: How A Drug Ad Made Its Way Into 'General Hospital'
[Anna] Devane is a soap opera character, as you might have guessed, appearing for the last 32 years on “General Hospital.” And her dramatic diagnosis is brought to you by Incyte Corp., a biotech company that happens to market a drug for her on-screen disease, the rare blood disorder polycythemia vera. The scene, which aired in February, is a novel twist on what’s called unbranded advertising, in which drug companies detail the symptoms of a disease but refrain from mentioning the names of any drugs. (Garde, 5/18)

FiercePharma: Drama And Diagnosis On Soap Opera Set Troubles Cancer Doctors, Puts Incyte In Hot Seat
Soap operas often include medical mysteries and miracles, but a couple of real-life doctors are concerned about Incyte's connection to the latest drama on General Hospital. Writing in JAMA, oncologists Sham Mailankody and Vinay Prasad question the ABC soap opera's rare-disease plot enabled by a partnership with the biopharma company Incyte. In the General Hospital storyline begun in February, leading character Anna Devane is diagnosed with a rare blood cancer called polycythemia vera (PV). The show doctors explain to the character, who is played by Incyte spokesperson Finola Hughes, that PV is part of a group of rare blood cancers called myeloproliferative neoplasms, and that there are treatments, but no cure. (Bulik, 5/22)

Stat: This Company Admitted Failure — And The Stock Market Rewarded It
Rather than shunning the company, investors embraced it. Only a small number of them cashed out their shares. (The coauthor of the paper who took responsibility for the error returned the stock, but made the shares a donation.) The IPO, delayed by a few weeks, went forward. And within a few years WntResearch stock went on a surge that to date has left it up nearly 500 percent over 6 1/2 years. In other words: Openness was a risk in the short run but a long-term boon for the company. (Oransky and Marcus, 5/23)

Perspectives: FDA Wades Into Pricing Controversy, But Doesn't Have Authority To Actually Fix It

Read recent commentaries about drug-cost issues.

Morning Consult: Is The FDA Digging Its Own Hole On Drug Pricing And Opioids?
The Food and Drug Administration may be digging a huge hole for itself by singling out drug pricing and opioid abuse for priority and focused attention. These two highly-visible and highly-charged issues have been pushed into the political arena. The FDA has, unwisely, agreed to take them on. Both issues are mission impossible for the FDA, which has neither the authority nor the resources to solve either problem. The agency is setting itself up to be perceived as having failed. (Wayne Pines, 5/22)

Bloomberg: A Bipartisan Way To Lower Drug Prices
White House budget director Mick Mulvaney has floated an idea to bring down drug prices that's both promising and -- if other Republicans can be persuaded to go along -- bipartisan. At a recent health-care forum, Mulvaney proposed that drugmakers be required to pay rebates to the government on drugs sold to Medicare beneficiaries, as they do with drugs sold to Medicaid patients. ... In an ideal world, the secretary of Health and Human Services would negotiate on behalf of the 41 million people enrolled in Medicare's Part D prescription drug plan. That kind of purchasing power -- accompanied by the right not to cover a drug it deems too expensive -- would give the department great leverage. Unfortunately, Congress not only forbids such negotiation, it requires that Medicare pay for all medicines approved by the Food and Drug Administration. (5/22)

Stat: Clinical Trial Participants Should Have A Say In New Drug Pricing
People who volunteer to participate in clinical trials of new drugs provide a valuable service to pharmaceutical companies and to the rest of us. In return, I think that they should have a say in how much these drugs will cost when they hit the market. Not only would that honor their service, but it would also provide a patient-centered mechanism to lower the price of new drugs. (Spencer Phillips Hey, 5/18)

Bloomberg: Amgen Can Shrug Off Its Bone-Drug Risks
With promising trial results and an FDA approval seemingly near, Amgen Inc.'s osteoporosis drug Evenity was expected to contribute at least something to the company's top line this year. But Amgen on Sunday evening reported the drug raised unexpected heart-safety concerns. Now the best hope is that its FDA approval will only be pushed to next year and that its commercial opportunity will merely be limited, not eliminated. Otherwise, it may not be worth the effort to keep seeking approval. (Max Nisen, 5/22)

Forbes: New Taxes Won't Lower Drug Prices
Prescription drug prices continue to be a hot political issue, with the Trump administration preparing to release an action plan as soon as repeal and replace legislation clears Congress. Mick Mulvaney, who heads the White House budget office and is participating in the talks, floated an idea last week that should quickly be crossed off the list of policy ideas. (Grace-Marie Turner, 5/18)

Stat: Will PhRMA's New Membership Criteria Help?
Earlier this month, PhRMA — the trade group representing innovator pharmaceutical companies — announced a set of new membership criteria. Going forward, PhRMA members will need to meet certain standards regarding their investment in R&D. PhRMA may have felt it needed to take action to restore public confidence in the industry and to constrain the bad press its members have been receiving on the drug pricing front. In my view, the new rules miss the mark. (Rachel Sachs, 5/22)

Bloomberg: Amazon's Long Shadow Falls On Pharmacies
It's hard to think of an industry Inc. isn't currently trying to conquer, or at least thinking of conquering. Pharmacies might be next. According to a CNBC report, Amazon is considering a leap into the prescription-drug business. It wouldn't be easy, but the industry and its investors shouldn't dismiss the threat. (Max Nisen, 5/17)

JAMA: Pharmaceutical Marketing For Rare Diseases
The US Food and Drug Administration (FDA) draws a distinction between direct-to-consumer advertising of specific drug products, which it regulates, and advertisements intended to create disease awareness, which it does not. Other nations, including the United Kingdom and the Netherlands, that ban direct-to-consumer marketing permit disease awareness efforts. Challenges arise when disease awareness efforts are made for conditions for which only 1 approved drug product is available; in this case, awareness will boost the sales of a specific drug, and several nations, include the United States, selectively regulate this type of advertising. Recently, a novel form of disease awareness promotion, through a daytime soap opera, raised questions about the role and regulation of this form of marketing. (Sham Mailankody and Vinay Prasad, 5/18)

CityBeat Cincinnati: November Ballot Issue Leaves Lower Drug Prices Up To Ohioans
This November, Ohio voters will decide on a referendum that sounds like a sure thing for passage: lower drug prices. No, this isn’t a follow-up to last year’s marijuana measure, which failed anyway. The discount would only apply to drugs purchased by state employees and retirees and through state programs like Medicaid. An estimated 3.7 million Ohioans, close to a third of the state’s population, would directly benefit. (James McNair, 5/22)

Editorials And Opinions

Different Takes On Doing The Math: Trying To Add Up 'Trumponomics;' The Trump Budget's 'Best New Idea'

Opinion writers take a hard look at how health and safety net programs fare in the Trump administration's proposed budget plan.

Los Angeles Times: Surprise, Surprise: Trump's Budget Punishes The Sick And The Poor While Rewarding The Wealthy
One factor holding back economic growth is that too many working-age Americans have fallen out of the labor force. The administration’s proposed budget for the fiscal year that begins Oct. 1 tries to tackle that problem, as well it should. But rather than grapple with some of the challenges underlying the disappearance of millions of Americans from the workforce — in particular, the technological changes and globalization that have caused so many blue-collar and middle-class jobs to evaporate, and the gap between the education and training Americans have received and the skills demanded by today’s employers — the Trump budget seeks to force people back into the workforce by making it harder to obtain or keep food stamps, Medicaid and Social Security disability benefits, while reducing federal support for welfare and children’s health. (5/23)

The Washington Post: Trumponomics: The Philosophy That It Doesn’t Suck Enough To Be Poor
For months, pundits and political advisers have tried to figure out what “Trumponomics” really stands for. Even President Trump himself struggled to characterize it, saying, “It really has to do with self-respect as a nation.” Now that we have the president’s budget in hand, we have a more definitive answer: Trumponomics — like Ryanonomics — is based on the principle that living in poverty doesn’t suck quite enough. That is, more people would be motivated to become rich if only being poor weren’t so much fun. (Catherine Rampell, 5/23)

The New York Times: Trump’s Budget Doesn’t Make Sense
Yes, Republicans have a blind spot when it comes to acknowledging that revenues must be a part of the fix. But to their credit, many Republicans — including, notably, Paul Ryan, the speaker of the House — have made the case for why we have to reform our largest entitlement programs, including Social Security and Medicare (though there has recently been a disquieting silence on the topic). And many Republicans are taking the responsible position that tax reform should at least be revenue neutral. Democrats, many of whom too often act as demagogues on entitlement reform, are clear that taxes must increase (though they also must stop pretending it is just millionaires who will be affected). They also have been admirable in their commitment to the pay-as-you-go principle in recent major legislation, which at least keeps us from digging the hole deeper. (Maya MacGuineas, 5/23)

The New York Times: Why Work Requirement Became A Theme Of The Trump Budget
The new White House budget proposal is built on a deep-rooted conservative belief: The government should help those who are willing to work, and cull from benefit rolls those who aren’t. That emphasis on work underlies deep cuts and proposed changes to food stamps, cash assistance and health benefits for the poor in a budget that boosts spending for the military and border security. Expect the poor to work in exchange for aid, the White House argues, and antipoverty programs will work better while costing the government less. (Emily Badger, 5/24)

USA Today: Trump Budget's Best New Idea
Since the passage of the Family and Medical Leave Act in 1993, American parents working for companies with at least 50 employees have had a right to 12 weeks of unpaid leave after the birth or adoption of a child. But many don’t take advantage of that option for the simple reason that they can’t afford to go that long without a paycheck. The Trump administration, at the urging of first daughter Ivanka Trump, has included in its budget released Tuesday a plan for paid medical leave of up to six weeks. (5/23)

USA Today: Trump's Parental Plan Will Hurt
President Trump’s budget includes a proposal for six weeks of mandated paid family leave for new parents. Despite its superficial appeal, this idea is likely to harm families more than it helps. The initial Trump proposal, floated in September, would have limited mandated leave to mothers, thereby likely engaging in unconstitutional sex discrimination. Key aspects of the new plan are still unclear. But it avoids legal problems by covering fathers, too. Yet it has serious flaws, nonetheless. (Ilya Somin, 5/23)

Bloomberg: Trump's DOA Budget Has Two Silver Linings
It also breaks Trump's campaign commitments to spare Social Security and Medicaid from budget cuts. Budget Director Mick Mulvaney explained this problem away (with Trump in Israel) by asserting in a Monday night briefing that proposals in the plan to cut Social Security disability benefits don't count because they're not retirement payments. (Albert R. Hunt, 5/23)

The Kansas City Star: Trump Budget Replicates Disastrous Kansas Approach. This Won’t End Well.
But tax cuts were only one half of the [Gov. Sam] Brownback experiment. Aided by conservatives in the Legislature, Kansas eviscerated the state’s social safety net: privatizing Medicaid, imposing new restrictions on welfare benefits, insisting on a tough food stamp work requirement. Humiliating the poor seemed to be a particular focus. For a time, the state told welfare recipients they could withdraw only $25 at a time from an automated teller machine, a decision that prompted anger and derision across the nation before it was repealed. (5/23)

Viewpoints: The Rule Of Law And Subsidies; Anticipating CBO's Score On The GOP Health Plan

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

Bloomberg: Rule Of Law Actually Applies To Democrats, Too
Yes. Congress can mandate subsidies without also mandating a funding source. Medicaid is another example. This is crazy, but there it is. For once the Constitution is admirably clear on how the executive branch should handle this quandary: “No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law; and a regular Statement and Account of the Receipts and Expenditures of all public Money shall be published from time to time.” The law appropriated no money for these cost-sharing reduction payments. But the Obama administration went ahead and paid them anyway. (Megan McArdle, 5/23)

The New York Times: How To Read The C.B.O. Score Of The Health Bill Like An Expert
Today, the Congressional Budget Office will issue important numbers about the House-passed version of the American Health Care Act, the Republican bill to repeal and replace portions of the Affordable Care Act. Although the budget office had analyzed an early version of the bill, the House on May 4 took the unusual step of voting before the budget office could gauge how several last-minute amendments might affect the deficit or the number of uninsured. (Margot Sanger-Katz, 5/24)

RealClear Health: Why Nutrition Standards And Policies Should Continue
The U.S. Department of Agriculture said recently it will delay the implementation of school lunch rules aimed at lowering the amount of sodium and raising the whole grain content of meals served to kids. At the same time, the Food and Drug Administration announced it will delay for one year the implementation of Obama administration rules to require calorie labels on menus and prepared food displays. (Deborah A.Cohen, 5/24)

WBUR: America's Food Access Problem Starts On The Farm 
Given that we’re tangled in knots over how to pay for health care, it’s remarkable that food and farm policy isn’t more in the public’s mind. Heads of hunger programs and food banks have begun to grasp the obvious; as one told WBUR, “food is medicine, food is health,” with good health impossible in the absence of nutritious eating. (Rich Barlow, 5/23)

San Jose Mercury News: Single-Payer Detracting From Big Medi-Cal Fight
Sen. Ricardo Lara’s single-payer legislation was a non-starter in California from day one, even before it was given an eye-popping $400 billion price tag. ... It’s merely an exercise in politics, which is all well and good except that it detracts from a far more important California health care issue: Can the state fight off President Trump’s inhumane effort to slash the nation’s Medicaid budget by more than $880 billion through 2026? (5/23)

Stat: Risk Scores For Preventing Heart Disease, Stroke Must Take The Long View
Back in 1998, researchers with the legendary Framingham Heart Study created the first heart risk calculator. Using answers to questions about age, cholesterol and blood pressure levels, tobacco use, and the presence of diabetes, it estimated an individual’s risk of having a heart attack or stroke over the next 10 years. Since then, this calculator has been revised and many others have been developed, including ones that extend the time horizon out to an individual’s lifetime. Yet much to our surprise, the use of these single-point-in-time risk calculators does little to reduce the risk of heart attack or stroke compared with not using such calculators. ( Kunal N. Karmali and Mark Huffman, 5/23)

On the Ground: Our Teeth Are Making Us Sick
The left side of Jacquelyn Garcia’s face throbbed fiercely. She had tried taking Tylenol and Excedrin for the pain, but threw them up. On a Monday morning straight after working the night shift as a custodian, she rushed to the N.Y.U. emergency dental clinic. Here a student delivered the verdict: decay so deep it had reached the nerve. The tooth needed to be pulled. (Zoe Greenberg, 5/23)