KHN Morning Briefing

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Summaries Of The News:

Health Law Issues And Implementation

Obamacare Premiums To Spike 25% On Average, But HHS Says Subsidies, Shopping Will Help

The Obama administration says customers buying insurance from the exchanges will still be able to find plans for less than $100 a month with help from federal subsidies. Republicans, however, pounce on the news of the premium increases as another sign the Affordable Care Act is failing.

NPR: Rates Rise Again For Obamacare Health Plans, But So Do Subsidies
"We think they will ultimately be surprised by the affordability of the premiums, because the tax credits track with the increases in premiums," said Kevin Griffis, assistant secretary for public affairs at the Department of Health and Human Services. During a media briefing Monday, Griffis said the 2017 rates are roughly at the level the Congressional Budget Office forecast when the law was proposed. "The initial marketplace rates came in below costs," he said. "Many companies set prices that turned out to be too low." (Kodjak, 10/24)

The Washington Post: Average Premiums For Popular ACA Plans Rising 25 Percent
The figures, announced by federal officials Monday, injected a new round of uncertainty into the future of the insurance exchanges that are a core feature of the 2010 health-care law. Health policy experts said the rising prices and shrinking insurance options add tumult to the coming ACA enrollment season. The data immediately touched off a fresh round of criticism among the ACA’s persistent Republican congressional opponents. (Goldstein, 10/24)

The Hill: Feds: Most States To See Steep ObamaCare Rate Hikes 
The White House’s report was released the same day as data from the Kaiser Family Foundation, which found that the cost of a benchmark plan will rise 145 percent in Phoenix, Ariz., to $507 per month for an average 40-year-old person. That same plan will increase 71 percent in Birmingham, Ala., and Oklahoma City, Okla. (Ferris, 10/24)

Politico: Key Obamacare Premiums To Jump 25 Percent Next Year
The Department of Health and Human Services report, released just two weeks before Election Day, is sure to provide fresh fodder for Donald Trump and Republicans in down-ballot races to attack the law. Democrats, who have increasingly warned about the escalating costs of Obamacare coverage in some areas, have pushed for Republicans to give up on repeal and work on fixes to the law. (Pradhan, 10/24)

Morning Consult: Republicans Raise Concerns About Obamacare Subsidies
House Republicans are questioning how much taxpayer money is going into federal subsidies meant to make insurance coverage more affordable for low-income Americans. Reps. Fred Upton (R-Mich.), Joseph Pitts (R-Pa.) and Tim Murphy (R-Pa.), all leaders of the Energy and Commerce Committee, sent a letter Monday to Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services, requesting information about the amount of taxpayer money that will go toward Obamacare subsidies next year. (McIntire, 10/24)

Morning Consult: Enrolling People In Obamacare Means Talking About Cost
The Affordable Care Act has put the nation’s uninsured rate to a historic low, but there are still roughly 24 million uninsured people in the United States. Of that group, the Department of Health and Human Services estimates that 10.7 million will be eligible for financial assistance this year. Officials expect about one-third of that group to sign up for an Obamacare plan during the three-month open enrollment period beginning Nov. 1. HHS is countering news of median 16 percent premium increases for silver-level plans with messages about the subsidies that may make coverage affordable for a majority of marketplace consumers. (McIntire, 10/24)

States Face Double-Digit Premium Increases

Media outlets report on insurance rate news out of Minnesota, Illinois, Texas, New Jersey, Tennessee and Connecticut.

Pioneer Press: Minnesota Has 4th-Highest Increase Of Insurance Premiums Nationwide
Minnesota’s 59 percent premium increases on its individual health insurance market have been shocking consumers and politicians alike, but they’re not even the highest in the country. ... Among the 43 states with available data, Minnesota has the fourth-highest premium increase, behind Tennessee, Oklahoma and the 116 percent increase in Arizona. All three states use Despite Minnesota’s huge increase, it’s not among the states with the highest 2017 premiums, though it is now above-average in costs. (Montgomery, 10/24)

Chicago Tribune: Illinois Obamacare Premiums Rise By Double-Digits For 2017 Plans 
The wait is over: People who want to buy health insurance on the state's Obamacare exchange can go online to see their options and prices, but they may not like what they find. The plans unveiled online Monday contain far fewer choices and significantly higher prices, and arrive toward the end of a presidential campaign in which Republican candidate Donald Trump has called for the repeal of the Affordable Care Act and Democratic candidate Hillary Clinton has said she wants to fix it. (Schencker, 10/24)

Houston Chronicle: ACA Exchange To Offer Fewer, And More Expensive, Plans Locally 
Houstonians who purchase health insurance through the Affordable Care Act's exchange will have dramatically fewer options in 2017, with half the number of carriers participating as last year. And premium prices will rise by more than $200 per month for some plans. With a week to go before the fourth enrollment season opens on Nov. 1, the website on Monday publicly previewed a slimmer array of plans that will be available for next year. The plans are generally more expensive, too. The national average increase of 25 percent in benchmark silver-plan premiums. (Deam and Najarro, 10/24)

The Philadelphia Inquirer: Modest Rate Increases For Some Affordable Care Act Plans In N.J.
Price increases for many Affordable Care Act health insurance plans sold on New Jersey's exchange won't be as steep as those announced last week for Pennsylvania, U.S. Department of Health and Human Services data showed. Two insurers, Horizon Blue Cross Blue Shield of New Jersey and AmeriHealth New Jersey, a unit of Independence Blue Cross, are still selling health insurance on the state's ACA exchange. (Brubaker, 10/24)

Nashville Tennessean: Healthcare.Gov Offers Window Shopping, With Doctor Filter, Prior To Nov. 1
People with individual insurance plans can browse options on in advance of open enrollment — which is encouraged for any one who may have to switch physicians because their insurance carrier is leaving the market. Open enrollment begins Nov. 1 but is having a window shopping period that allows people to look at potential out-of-pocket costs, likely tax credits and additional cost savings features for some. Perhaps the most critical feature in the window shopping period is the ability to filter by physician or facility. (Fletcher, 10/24)

The CT Mirror: What You Need To Know For The 2017 Obamacare Open Enrollment 
If you buy health insurance on your own, or plan to, your chance to sign up for 2017 coverage starts next week. This year’s open enrollment period is coming after several months of turmoil for the state’s health insurance exchange, including the departure of two insurance companies, big price hikes and a major change in the availability of insurance agents and brokers who have helped many people pick health plans in the past. Here’s what you need to know about the open enrollment period, in two parts: What’s new this year and, for those new to the process, the basics on buying insurance. (Levin Becker, 10/25)

Obama Administration Asks Appeals Court To Overturn Health Law Ruling

Also in news related to the health law's implementation, marketplace reports on how accountable care organizations have led to changes in how care is delivered.

Politico Pro: Administration Asks Court To Overturn Obamacare Ruling
The Obama administration on Monday asked a federal appeals court to overturn a lower court ruling that found the White House was funding an Obamacare program that Congress never paid for. The Justice Department told the U.S. Court of Appeals for the District of Columbia that the health law properly funded Obamacare’s cost-sharing subsidies and that the dispute between the legislative and executive branches shouldn’t be resolved by the courts anyway. (Haberkorn, 10/24)

Marketplace: Doctors Cut Costs By Getting To Know Their Patients
In the past six years, we’ve seen the rise of Accountable Care Organizations, now numbering more than 800, where doctors or hospitals work together to streamline care. For physicians that means they now get some compensation through contracts that reward improving health and controlling costs, as opposed to simply making money for every service provided regardless of the outcome or expense. There are now an estimated 28 million Americans enrolled in these ACOs, and that means, at least for some, their care looks radically different than even just a few years ago. That’s particularly true for some of the sicker people in the country. (Gorenstein, 10/24)


Medicare Temporarily Stops More Insurers From Automatically Enrolling Beneficiaries

In the "seamless conversion" process, insurers switch marketplace customers to Medicare Advantage plans as the customers reach the age of 65 and become eligible for Medicare. But advocates complain that some seniors would rather be in traditional Medicare or may not know that they have been switched. Also in Medicare news, a federal audit finds problems in payments to chiropractors, Iowa officials say two Medicare supplement companies misled potential customers and federal officials find problems with Medicare Advantage online directories.

Modern Healthcare: CMS Halts Auto-Enrollment Proposals From Medicare Advantage Plans 
The CMS has temporarily stopped accepting new proposals from health insurance companies seeking to automatically enroll their commercial or Medicaid patients into their Medicare Advantage plans. The federal agency also disclosed that 29 Medicare Advantage companies—including Aetna, UnitedHealth Group and several Blue Cross and Blue Shield insurers—can move consumers who had been enrolled in a regular plan into their Medicare Advantage products once the consumers turn 65 years old. (Herman and Livingston, 10/24)

North Carolina Health News: Medicare Suspends 'Seamless Conversion' Practice, Allows For Re-Enrollment 
The Centers for Medicare and Medicaid Services is backing away from a controversial “seamless conversion” policy, suspending the practice and allowing those enrolled under it to re-enroll in other plans including traditional Medicare. Under seamless conversion, an insurance company was allowed to notify a beneficiary approaching 65 that the person had been automatically enrolled in a company’s private “Medicare Advantage” plan instead of traditional Medicare. The person who was notified — often as part of countless mailings from Medicare-related providers — had to take an active step to opt out of the Medicare Advantage coverage. (Goldsmith, 10/24)

The Fiscal Times: Medicare Paid Chiropractors Bone-Chilling Millions For Bogus Billings
An astounding 82 percent of Medicare payments for chiropractic services totaling hundreds of millions of dollars did not comply with Medicare rules and requirements, according to a new report from the Department of Health and Human Services Office of Inspector General. The report released last week found that lax oversight by Medicare auditors in ferreting out improper payments for chiropractic services during 2013 resulted in a loss to the government of $358.8 million of the $439 million in total payments, according to the IG’s report. (Pianin, 10/24)

Des Moines Register: Medicare Supplement Letters Allegedly Misled Iowa Seniors
Two out-of-state companies could face fines for misleading Iowa seniors about their Medicare options, regulators said Monday. The Iowa Insurance Division has filed administrative charges against the two companies, the Robert Stillwell Agency, based in Pennsylvania, and Senior Direct, based in Texas. The charges against the Pennsylvania insurance agency and its president, Cynthia J. Fitzgerald, said it sent about 30,000 misleading letters to Iowans who buy Medicare supplement insurance. Medicare supplement plans cover costs not covered by the public insurance program for the elderly and disabled. (Leys, 10/24)

Kaiser Health News: Feds Find Doctor Listings Often Wrong In Medicare Advantage Directories
Provider directories for private Medicare Advantage plans are riddled with errors, according to the government’s first in-depth review. The results made public Monday, arriving amid the annual enrollment period through Dec. 7, validate gripes long made by seniors and consumer advocates. The level of errors still surprised regulators, said officials from the Centers for Medicare & Medicaid Services who disclosed their findings at an industry conference in Washington. (Galewitz, 10/24)


FDA Plan To Remove Generic Status From ADHD Medication Faces Opposition From Drugmakers

Meanwhile, news outlets cover other pharmaceutical news from Novartis, GlaxoSmithKline and Merck.

Stat: Generic Drug Makers Challenge FDA Plan To Withdraw Their ADHD Pills
Two drug makers — Mallinckrodt and Lannett — are fighting the US Food and Drug Administration over a plan the agency announced last week to withdraw their generic versions of the Concerta pill for attention deficit disorder. Mallinckrodt is trying to contest the move in court, while Lannett plans to seek a hearing in hopes of convincing the agency to change its mind. The agency took this step after determining the generic drugs were not equivalent to the brand-name pill, an issue that actually arose two years ago and prompted the FDA to downgrade regulatory ratings for the copycat drugs. (Silverman, 10/24)

The Wall Street Journal: Merck Drug Gets FDA Approval As A First-Line Lung Cancer Treatment
Merck & Co.’s immunotherapy cancer drug Keytruda received U.S. Food and Drug Administration approval as a first-line treatment for certain lung cancer patients. The approval is for patients with metastatic non-small cell lung cancer whose tumors have high PD-L1 expression, with no EGFR or ALK genomic tumor aberrations. The new indication means Keytruda can be an initial treatment instead of chemotherapy for these patients. (Beckerman, 10/24)


Dignity, Catholic Health Mull Megamerger To Become Nation’s Largest Nonprofit Hospital System

The deal would combine 103 hospitals owned by Catholic Health Initiatives, based in Englewood, Colo., with 39 hospitals operated by San Francisco-based Dignity Health.

The Wall Street Journal: Catholic Health Initiatives, Dignity Health In Merger Talks
Hospital operator Catholic Health Initiatives, which has struggled after rapid expansion and a foray into health insurance, is in merger talks with Dignity Health to create one of the nation’s largest nonprofit hospital systems by revenue. Catholic Health Initiatives and Dignity Health said in a statement they are in talks regarding “aligning their organizations.” A person familiar with the matter said the talks involve a merger. (Evans, 10/24)

Modern Healthcare: Dignity Health And Catholic Health Initiatives Are In Merger Talks 
Dignity Health and troubled Catholic Health Initiatives are in merger talks, the health systems announced Monday. The not-for-profit giants have signed a nonbinding agreement to evaluate “an alignment” between the systems, according to a release. A full merger would create the nation's largest not-for-profit hospital company with combined revenue of $27.6 billion ahead of the $20.5 billion posted by Catholic-sponsored Ascension. (Barkholz, 10/24)


The Catch-22 Of Sinks In Hospitals: Crucial For Infection Control But A Breeding Ground For Bacteria

Experts are stuck in a bit of a "you can't live with them, you can't live without them" scenario when it comes to sinks in hospitals. In other hospital safety news, The Washington Post offers a look at what patients should know about the deadly infection linked to medical devices used in heart surgery.

Stat: How Hospital Sinks Became A Health Problem
In a devilish case of unintended consequences, sinks have been linked to a number of outbreaks of serious infections in hospitals from Baltimore to Shanghai and many places in between in recent years. In one notable case, a hospital in the Netherlands took sinks out of the patient rooms in its intensive care unit in a bid to slow the spread of bacteria. (It worked.) At a time when concern is mounting about antibiotic resistance, and when the specter of untreatable infections threatens the advances of modern medicine, finding ways to slow the development and spread of drug-resistant bacteria is a major preoccupation of infection control teams. As a result, evidence that hospital sinks could exacerbate the problem presents health care specialists with a quandary. (Branswell, 10/25)

Public Health And Education

AARP Suit Adds Fuel To Simmering Debate Over Employee Wellness Programs

AARP argues that the programs violate anti-discrimination laws aimed at protecting workers’ medical information, a worry that underscores the new rush to offer financial incentives to improve employee health.

The New York Times: AARP Sues U.S. Over Rules For Wellness Programs
Employers have raced to offer workers a hefty financial incentive to sign up for programs meant to improve their health, submitting personal medical details in the process. But as these programs have spread, so has resistance from employees dubious about sharing that information with employers. On Monday, that tension erupted in a federal lawsuit against the government agency that handles the rules on these so-called wellness programs. (Abelson, 10/24)

In other news on aging —

Kaiser Health News: For Seniors, Teeth Need Care — But Insurance Coverage Is Rare
Aging can take a toll on teeth, and for many seniors paying for dental services is a serious concern because they can’t rely on their Medicare coverage. Low-income seniors, in particular, are struggling. More than a third with incomes below 200 percent of the federal poverty level (about $23,000 annually) had untreated tooth decay between 2011 and 2014, according to an analysis of federal data by the American Dental Association. (Andrews, 10/25)

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

All Eyes Are On Zika But A Far More Common Threat To Babies Lurks In Shadows

Experts say cytomegalovirus -- which causes hearing loss, microcephaly, intellectual deficits and vision abnormalities -- affects more people than Zika, but no one is talking about it. In other news, a study lays out the importance of well-child visits.

The Wall Street Journal: New Reasons Not To Miss A Well-Child Visit
Is your child up-to-date at the pediatrician’s office? Regular well-child visits during the first three years of childhood are critical to identify health, behavioral and developmental problems that could have long-lasting effects into adulthood. But parents don’t always follow the recommended schedule, which includes about a dozen appointments by the time children turn 3. And children who miss out on visits are more likely to be admitted to the hospital with preventable problems, studies show. (Landro, 10/24)

Nearly 30 Percent Of Cancer Deaths Linked To Smoking

The report offers suggestions -- such as implementing a higher cigarette tax -- "to avert many more premature deaths."

In other news —

NPR: The FIT Test Measures Up For Noninvasive Colon Cancer Screening
Not so very long ago, colonoscopy was the gold standard for colon cancer screening. But times are a-changing. Last month when I went in for a checkup, my primary care doctor handed me a FIT test, a colon cancer test you can do at home without the unpleasantness and risk that turn people off to colonoscopy. The FIT test, or fecal immunochemical blood test, is a newer and more accurate way to test for blood in stool, which can be a symptom of colon cancer. (Shute, 10/24)

Georgia Health News: Why Are Childhood Cancer Rates Rising? 
Just one of every 100 new cancer diagnoses in the United States is a childhood case. Still, the National Cancer Institute (NCI) says there has been a significant increase in the overall rate of childhood cancers in recent decades — up 27% since 1975 in kids under age 19, according to data collected by the NCI’s Surveillance, Epidemiology, and End Results (SEER) Program. The news comes as the overall incidence of adult cancers has fallen. (Miller and Goodman, 10/24)

Cleveland Plain Dealer: Joe Biden Talks Cancer Moonshot At Cleveland Clinic Innovation Summit 
Vice President Joe Biden opened this year's Cleveland Clinic medical innovation summit with a talk about what he deemed "the only bipartisan thing left in the United States of America"-- the fight against cancer. Speaking about his Cancer Moonshot initiative, launched in January, Biden told a roomful of doctors, healthcare executives and entrepreneurs that for millions of people across the country affected by cancer, this work is urgent. (Zeltner, 10/24)

A Snowball Effect: How Our Brains Become Desensitized To Feeling Bad About Lying

What starts as a little fib can often become a whopper of a lie, and scientists wanted to know why.

Stat: Brain Study Shows Why Lying Becomes Easier The More You Do It
When people tell small fibs, she and her colleagues reported on Monday in Nature Neuroscience, their brain becomes desensitized to the emotional twinge that dishonesty usually causes. Lying becomes easier and telling ever-bigger self-serving whoppers becomes more likely, they found: that may be why nickel-and-diming on tax returns sometimes balloons into massive fraud, why spousal white lies become deeper secrets, and why scientific misconduct escalates from “losing” data to faking findings. Neuroscientists who have studied the neural basis for moral decisions and were not involved in this research generally praised it, but questioned how well it described the real world. (Begley, 10/24)

Los Angeles Times: Neuroscientists Show How Tiny Fibs Snowball Into Big Lies
A little dishonesty goes a long way. Scientists who studied the brain activity of people who told small lies to benefit themselves found that these fibs appeared to pave the way to telling whoppers later. The findings, published in the journal Nature Neuroscience, demonstrate how self-serving lies can escalate and offer a window into the processes in the brain at work. (Khan, 10/24)

Women’s Health

Virginia Board Of Health Ditches Strict Regulations On Abortion Clinics

The decision to do away with hospital-style building codes for the clinics follows the Supreme Court ruling that struck down similar regulations in Texas.

Reuters: Virginia Health Board Lifts Contested Rules On Abortion Clinics
Virginia's Board of Health voted on Monday to remove contested regulations on abortion clinics that included meeting hospital-like building standards, a spokeswoman said. The 11-4 vote lifted restrictions imposed under a 2011 law that the board found were an undue burden on abortion providers, the spokeswoman said. (Simpson, 10/24)

Richmond Times Dispatch: Virginia Board Of Health Votes To Remove Contested Regulations On Abortion Clinics
The Virginia Board of Health voted Monday to remove contested regulations on abortion facilities that board members deemed an undue burden on abortion access. The 11-4 vote repealed regulations that required facilities that provide five or more abortions a month to meet hospital-like building standards, among other restrictions. Proponents argue that the standards keep women safe. Opponents claim they limit abortion access for women. (Demeria, 10/24)

State Watch

Mental Health Courts Can Offer A Successful Exit From Revolving Jailhouse Doors

The Kansas Health Institute offers a series looking at how mental health courts play a role in helping those with an illness instead of sending them off to jail.

Kansas Health Institute: U.S. Research Points To Potential Of Mental Health Courts
[Mary] Giliberti, chief executive officer of the National Alliance on Mental Illness, said 2 million people with serious mental illness were booked into U.S. jails each year. Half receive no treatment in jail, she said. The experience of most of those people in the criminal justice system, she said, ought to shock the conscience...The growth of mental health courts designed to provide an alternative to incarceration has inspired academic research into the unconventional attempt to slow jailhouse revolving doors for the mentally ill. Research by the U.S. Department of Justice indicated prison and jail inmates with mental health problems were more likely to have co-occurring drug or alcohol addictions, to have a background of physical abuse and homelessness, and to be involved in fights or be disciplined for rule violations while incarcerated. (Carpenter, 10/25)

Kansas Health Institute: Minnesota Mental Health Court A Model 
Few Kansas counties have tried to establish their own mental health courts. But Hennepin County provides lessons for others that might try in the future: To successfully keep people with mental health issues in treatment and out of jail, it takes partnerships with organizations outside the judicial branch and dedicated case workers. Everyone [Judge Kerry] Meyer saw in her courtroom that morning had been diagnosed with a severe and persistent mental illness, a traumatic brain injury or an intellectual and developmental disorder — including the college student who stole the vitamins. Instead of going to criminal court, the student had agreed to abide by a treatment plan and check in regularly with Meyer and a probation officer for a set amount of time. (Marso, 10/25)

Kansas Health Institute: Advocates Of Kansas Mental Health Courts Say Lives Improved, Taxpayer Dollars Saved
In a handful of Kansas cities — Topeka, Lawrence, Kansas City and Wichita — there are independent movements to sculpt judicial programs channeling low-level offenders diagnosed with an illness of the mind to a separate court docket. It’s a recognition that old-school punishments often fell short. The objective in alternative courts has been to help people step beyond an adversarial process into a program to improve access to services for those with mental illness, promote participation in treatment and reduce recidivism. Ingredients of change range from medication and therapy to housing and vocational rehabilitation. The judge regularly meets behind closed doors with lawyers and mental health staff to talk about the status of each case before meeting participants in open court. (Carpenter, 10/25)

Federal Officials Seeking Public Feedback On Kansas' Medicaid Disability Policies

The federal effort comes after Kansas sought to make changes to several disability support policies as the state moved to managed care companies to run Medicaid. Also, Arizona is restricting opioid prescriptions for Medicaid enrollees and state employees.

Kansas Health Institute: Federal Officials Question Kansas Disability Support Policies
Federal officials Monday opened their regional office in Kansas City to take feedback on several changes to disability support policies in Kansas — including one they’ve instructed state officials to put on hold. The Centers for Medicare and Medicaid Services told leaders of the Kansas Department of Health and Environment and Kansas Department for Aging and Disability Services earlier this month they cannot implement a change to the “capable person” policy — one of two changes to home and community-based disability support services made in May to help balance the state budget. Federal officials also have instructed the state to provide more information about the elimination of a waiting list for Kansans with physical disabilities who requested such services. (Marso, 10/24)

The Associated Press: Ducey Limits Medicaid, State Insurance Opioid Prescriptions
Arizona Gov. Doug Ducey on Monday ordered the state's employee insurance plan and its Medicaid plan to limit narcotic painkiller prescriptions in an effort to cut future drug addiction. The order signed by the Republican governor limits the initial prescription of opioid drugs for adults to a 7-day supply. Children are not prescribed more than a 7-day supply unless they have cancer, other chronic disease or a traumatic injury. (10/24)

State Highlights: Minn. Nurses Settlement Could Give Hospitals More Labor-Relations Muscle; Legal Fees Grow In Kansas Planned Parenthood Case

Outlets report on health news from Minnesota, Kansas, Maine, Massachusetts, Georgia, Florida, New Hampshire, Ohio and California.

Minnesota Public Radio: Allina Nurses Settlement Could Embolden Hospitals 
The recently concluded Allina Health nursing strike could be the start of a change in hospital labor relations nationwide. Allina took a hard line saying there would be no deal unless the nurses accepted give-backs on health benefits. The nurses' 37-day walkout ended only after the rank and file reluctantly agreed to give up their generous union-only health insurance and transition to Allina's still generous, but less-expensive corporate health plans. (Benson, 10/24)

Kansas Health Institute: Legal Fees Mount In Case Challenging Kansas Effort To Defund Planned Parenthood
The state of Kansas incurred nearly $300,000 in legal fees in just three months to defend a lawsuit brought by Planned Parenthood challenging the state’s decision to boot the organization from the Medicaid program. Invoices obtained by KCUR show that outside law firms representing the state billed it $282,477 in legal fees and $2,725 in expenses between May 29 and Aug. 31. The invoices were provided by the Kansas Department of Health and Environment in response to a Kansas Open Records Act request. KDHE Secretary Susan Mosier is the defendant in the lawsuit, which seeks to overturn her decision in May to block Medicaid payments to Planned Parenthood. (Margolies, 10/24)

Stateline: As Rural America Ages, Volunteers Give A Hand
Across Maine, volunteers are stepping up to help rural seniors like [Dianna] Haller who want to remain in their homes as they age. Some work with local governments or nonprofits. Others have simply gotten together to offer a hand. Many of them are seniors themselves. And what they are doing can be emulated by the rest of the nation, as the number of people 65 and over is projected to explode from 48 million to 77 million between now and 2035. Maine’s rural population is older than that of most other states. Demographers project that a third of the state’s population will be 65 and over by 2032. And the challenges confronting Maine as it deals with an aging population are turning up elsewhere. Rural America is aging faster than its urban counterparts, as fewer children are born and younger, working-age adults are moving away. (Bergal, 10/25)

Boston Globe: At Dana-Farber, A Robot Roams The Halls To Deliver Meds 
Dana-Farber executives have high hopes for “Lucy,” one of the newest technologies in use at Boston’s best-known cancer center. Lucy is being developed to deliver prescription drugs directly to patients while they sit in infusion rooms receiving chemotherapy — a treatment that can take many hours. If the system works, it will save patients the time and trouble of having to stand in line to pick up their prescriptions at a pharmacy after an already long and draining day of treatment. (Dayal McCluskey, 10/24)

Atlanta Journal Constitution: Ga. Doctor Sentenced To Prison After $1M Billing Fraud
An Atlanta-based physician was sentenced Monday to federal prison for filing more than $1 million in false claims for services he did not perform, the U.S. Attorney’s Office said. Robert E. Windsor, 55, of Cumming, claimed for more than three years between January 2010 and July 2013 that he had monitored the neurological health of patients during surgery when he actually had an unqualified medical assistant do the work, U.S. Attorney’s Office spokesman Bob Page said in a news release Monday. (Eldridge, 10/24)

Orlando Sentinel/Tampa Bay Tribune: UCF Trustees Take Another Step Toward New Teaching Hospital 
UCF could get the green light from the state as early as January to build a teaching hospital through its joint venture with the hospital chain HCA, university officials said during a trustee meeting on Monday. That's if the UCF-HCA Certificate of Need application for a 100-bed hospital in Lake Nona adjacent to the medical school is not contested by other hospitals or doesn't face letters of concern by competitors. In those cases, the process can drag on for several months or years before the application is approved or denied. (Miller, 10/24)

New Hampshire Union Leader: School District Employees Considered For Transgender Benefits Coverage
City school administrators are looking at the possibility of offering transgender-inclusive health-care benefits to school district employees. The discussions come on the heels of a vote last week by city aldermen to offer benefits — such as sex-change surgery — to municipal employees and their families covered under city health insurance plans starting July 1. The aldermen were acting on a request from city Human Resources Director Jane Gile asking aldermen to approve requesting health insurance provider Anthem “remove all transgender exclusions or limitations of coverage for all health services related to gender transition from the templates of the city’s medical benefit plan,” opening the door for Manchester to offer the health benefits to municipal employees. (Feely, 10/24)

Columbus Dispatch: Program Helps Teens, Parents Deal With Asperger's
Making those kinds of connections is what makes Teen Aspirations, a program started in 2002 by the OSU Department of Neurology and the Nisonger Center, so special, parents say... The goal of the eight-week program, which is held several times a year, is simple: Help teens with a high-functioning autism spectrum disorder learn how to go after their “aspirations” in school, at work and in life. This includes developing self-awareness so they can see how their strengths will help overcome any challenges that come up, learning to experience positive social interactions and relationships, and realizing the importance of being successful at school or at work, now and into the future. (Pyle, 10/25)

Miami Herald: Zika Virus: Pregnant Woman In Miami Has Contracted Zika But Baby Is Fine, Doctors Say
As of Monday, the Florida Department of Health reported seven new travel-related Zika cases in the state — three in Miami-Dade, two in Broward and two involving pregnant women, bringing the statewide total of infected people to 1,058. Of those, 113 pregnant women have tested positive for Zika statewide, the health department said Monday. In June, [Yessica] Flores learned she was seven weeks pregnant. (Flor, 10/24)

Sacramento Bee: Virtual Dementia Tour Offers A Glimpse Into The World Of Those With Alzheimer's
Most of us will never truly know what it’s like inside the mind of someone afflicted with dementia or Alzheimer’s. But there are ways to get a glimpse. On a recent afternoon at Atria El Camino Gardens, a senior living and memory care facility in Carmichael, staffers and family members took a “virtual dementia tour” to experience what those brain impairments can feel like. (Buck, 10/24)

New Hampshire Union Leader: Families: Mental Illness Led To Murder-Suicide 
Mental illness has arisen as a factor in the 2014 murder-suicide that left a vivacious Manchester woman dead at the hands of a former roommate in the Lincoln condo they once shared. A brother of killer Douglas Marsden said the family had been receiving disturbing telephone calls and text messages from the 48-year-old in the weeks before the murder-suicide. They tell a story of a man in the midst of a crisis. (Hayward, 10/24)

Editorials And Opinions

Public Health Perspectives: Disposing Of Unused Meds; Anxiety, Worry And The Election Season

Opinion and editorial writers offer their thoughts on these issues.

St. Louis Post-Dispatch: Secure And Destroy Unused Medication
St. Louis is experiencing a public health emergency. This year, we are on track to break the record for the number of fatal prescription opioid and heroin overdoses. And while this problem doesn’t exist just in our city or just in Missouri; it’s here, and it’s killing our kids. Four of every five heroin users started with and became addicted to prescription opioids (e.g. hydrocodone, oxycodone, OxyContin, etc.), and almost all of those cases started with medication that was appropriately prescribed to someone else. While opioid pain medications are important for patients recovering from surgery or suffering from chronic pain, far too often, they are diverted and misused by family, friends or other acquaintances. Unlocked, unsecured prescription pain medication poses a terrible and measurable risk, especially to young people. A recent review of federal data found that the odds of a young adult becoming addicted to opioid medications increased 37 percent over the last decade. (Amy Tiemeier and Howard Weissman, 10/25)

The New York Times: The Epidemic Of Worry
We’ve had a tutorial on worry this year. The election campaign isn’t really about policy proposals, issue solutions or even hope. It’s led by two candidates who arouse gargantuan anxieties, fear and hatred in their opponents. As a result, some mental health therapists are reporting that three-quarters of their patients are mentioning significant election-related anxiety. An American Psychological Association study found that more than half of all Americans are very or somewhat stressed by this race. (David Brooks, 10/25)

The New York Times: Don’t Lock ’Em Up. Give ’Em A Chance To Quit Drugs.
By the time the police found him smoking crack in a Seattle parking garage one afternoon in late 2013, Roland Vasquez had been arrested more than two dozen times. Once a paralegal in his hometown, San Antonio, Vasquez says he started using drugs about 16 years ago after helping to negotiate bail for a dealer — and receiving a half-pound of heroin as a “thank you.” A father of three young children, he moved to Seattle in the mid-2000s to be closer to his own dad and farther from the people who got him hooked. But his cravings soon overwhelmed him, and he resigned himself to cycling between jail and the streets. (Caroline Preston, 10/25)

Bloomberg: Tobacco Taxes Work, But Only If They’re High
When smoking costs more, more people quit. That’s why higher cigarette taxes are almost always good policy, for smokers and the public health, too. There’s a catch, though -- and it’s one that voters in four states should keep in mind as they consider ballot initiatives next month to raise cigarette taxes: Sin taxes work only if they’re high enough. Voters in California, Colorado and North Dakota are being asked to raise state taxes to well over $2 a pack. Then there’s Missouri, where voters will choose from two increases so meager that they make a mockery of the very idea of sin taxes. (10/24)

WBUR: After 3 Decades Of Seizures, Life With My New Brain
Research has shown that epilepsy surgery is relatively safe. Most patients no longer have seizures afterwards. Pre-op testing can predict how patients will fare. Temporal resections -- where the piece of the brain’s temporal lobe that is causing the seizures is removed — are the most common type of epilepsy surgeries. (Letitia Browne-James, 10/24)

Viewpoints: Impact Of Obamacare Sticker Shock; What's Next On The Health Policy Agenda?

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

The Wall Street Journal: Another ObamaCare Shock
President Obama took a health-care victory lap last week in Miami, celebrating “all the progress that we’ve made in controlling costs” and portraying the law’s critics as “false and politically motivated.” Does that apply to the actuaries at the Health and Human Services Department too? On Monday they reported that ObamaCare premiums will soar 25% on average next year, and this is “progress” all right, in the wrong direction. (10/24)

Bloomberg: Why Obama Won’t Listen To Reason On Obamacare
Obamacare has substantially increased the number of Americans who have health insurance, as the president boasted. Some of his other claims -- notably, “This law has actually slowed down the pace of health care inflation” -- are more dubious. But the core problem with his speech was not that he overestimated the merits of Obamacare (as much as I believe that he did). Nor was it the partisan silliness in which the president sometimes indulged. It’s that he refused to acknowledge that conservatives have reasonable disagreements with him about the direction of health-care policy. (Ramesh Ponnuru, 10/24)

RealClear Policy: Our Next Administration's Health-Care Agenda
For the past six years, Republicans have been voting to repeal and replace the Affordable Care Act (ACA). But they never actually came up with an alternative until June 22, 2016, when House Republicans unveiled their plan. It declares: “Obamacare simply does not work. It cannot be amended or fixed through incremental changes. Obamacare must be repealed so that Congress can move forward with the kinds of reforms that will give Americans the care they deserve.” Are the Republicans right? Does the ACA not work? No matter the metric — access, quality, or cost — the ACA has undeniably been a success. It may not be perfect — but it is still a success. (Ezekiel Emanuel and Emily Gudbranson, 10/24)

RealClear Health: The ACA Revisited
The Affordable Care Act (ACA) is in serious trouble, and the next president and Congress may well have to gut or replace it. While many Affordable Care Act supporters remain optimistic, concerns are bipartisan. An article by two conservative writers proclaims, “ObamaCare’s Meltdown Has Arrived … half of Tennesseans covered under the plan are losing their coverage.” Minnesota’s Democratic Governor Mark Dayton says the law has "some serious blemishes and serious deficiencies" and is “no longer affordable to increasing numbers of people.” Former President Bill Clinton said, “the people who are out there busting it … wind up with their premiums doubled and their coverage cut in half. It's the craziest thing in the world." (Robert Graboyes, 10/24)

Lexington Herald Leader: Reject Obamacare; Let Free Market Lower Costs, Expand Access
Obamacare has been a failure for the many Kentuckians who lost their insurance despite the president’s promise that if you “like your plan, you can keep your plan.” The law’s red tape, mandates and taxes continue to drive up health-care prices forcing many Kentuckians to choose between insurance plans they cannot afford or government-run plans they do not want. Next year, health insurance premiums in Kentucky will increase an average of 27 percent. A report from the Foundation for a Healthy Kentucky found that only 26 percent of Kentucky small businesses will be able to offer their employees health insurance, a drop of 10 percent in the last year. And the collapse of the Kentucky Health Cooperative forced 51,000 Kentuckians to find new insurance, many for the second or third time since the law was enacted. (Rep. Andy Barr, R-Ky., 10/24)

The New York Times: Why The U.S. Still Trails Many Wealthy Nations In Access To Care
Many are still unhappy with Obamacare. The main intent of the Affordable Care Act was to expand the safety net (Medicaid), regulate the non-employer-based private insurance market (the insurance exchanges) and help people buy that insurance (subsidies) in order to reduce the number of Americans who are uninsured. On those metrics, it appears to be succeeding. (Aaron E. Carroll, 10/24)

Houston Chronicle: Healthcare Costs In Retirement Could Break You 
If you are about to retire or already retired, you are already thinking about your potential health care costs and wondering if you are going to have enough to pay the bills as you age. While costs can be staggering, some planning can help increase the likelihood that you will in fact have enough wealth to pay for things like doctor's visits, hospital stays and even long term care facilities. The numbers are big. Fidelity did a study in 2002 that showed a retired couple, both age 65, spends about $160,000 on medical expenses in retirement. (Byron Ellis, 10/24)

Fortune: John Oliver's Anti-Pharma Rant Had One Glaring Omission
Last Week Tonight host John Oliver delivered one of his signature barnburners on Sunday. This time, the HBO comedian’s target was the pharmaceutical industry, and its role in America’s devastating prescription painkiller and heroin overdose epidemic, which has seen 165,000 prescription opioid-related deaths since 1999. But while Oliver nailed how drug makers’ marketing of powerful opioids, like OxyContin or Percocet, helped set the stage for 2.6 million Americans getting addicted, he missed a crucial part of the story: that Big Pharma and the U.S. health system, including insurance giants, which helped create the crisis, are now actively involved with coming up with answers to address it. (Sy Mukherjee, 10/24)

Stat: Why Are Female Doctors Being Hidden In Plain Sight?
Many reasons have been offered to explain the gap between the salaries of male and female physicians and scientists, between their levels of federal funding for research and their academic promotions. One pervasive problem has been overlooked. I call it “the invisible woman” problem. In reality, female health care professionals are everywhere — women account for approximately 75 percent of hospital employees and health service managers, 50 percent of US medical school graduates, and 40 percent of the faculty of US medical schools. They hold positions at every level — including president, CEO, and other positions in the C-suite. Yet their names, faces, and voices are often not seen or heard. (Julie K. Silver, 10/24)