KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Your Colonoscopy Is Covered, But Surprise! The Prep Kit May Not Be

KHN’s consumer columnist Michelle Andrews answers questions from readers about the coverage of bowel prep kits for a colonoscopy, how travel insurance handles pre-existing conditions and prenatal screening coverage for tobacco, drugs and alcohol. (Michelle Andrews, 6/30)

Political Cartoon: 'Ignite The Night?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Ignite The Night?'" by Paul Fell.

Here's today's health policy haiku:


U.S. Chamber takes
On global task: Beating back
Anti-smoking laws.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Health Law Issues And Implementation

Insure Tennessee's Push For Medicaid Expansion Reinvigorated By Supreme Court Decision

Meanwhile, the National Journal examines the extent to which the Obama administration will go to advance efforts to expand the health insurance program for low-income people -- a central aspect of the Affordable Care Act.

Chattanooga Times Free Press: Insure Tennessee Supporters Renew Push For Medicaid Expansion
Fresh off last week's U.S. Supreme Court ruling that upheld one key provision of the federal Affordable Care Act, supporters of Gov. Bill Haslam's failed Insure Tennessee plan are renewing their push to pass the Medicaid expansion to an estimated 280,000 low-income Tennesseans. Backers of the plan, including state Sen. Richard Briggs, R-Knoxville, U.S. Rep. Jim Cooper, D-Tenn., business leaders and others filled an auditorium at St. Thomas Midtown Hospital in Nashville on Monday for a news conference. ... Republican-controlled Senate committees twice rejected Haslam's Insure Tennessee plan last session. Some lawmakers' objections included the uncertainty of the health insurance exchange issue. (Sher, 6/29)

The Nashville Tennessean: Insure TN 'Not Perfect,' Would Reduce Worry Of ER Costs
A patient came to Siloam Family Health Center with a two-day-old gunshot wound to the abdomen. The man hadn't been to the emergency room for two reasons, said Dr. Morgan Wills, president and CEO of the clinic. A native of Vietnam, the wounded man was concerned about someone not speaking his language, and he wanted to go somewhere offering affordable care. (Fletcher, 6/29)

National Journal: How Far Is Obama Willing To Go To Expand Medicaid?
After the law survived its latest potentially devastating legal challenge, Medicaid expansion will be a legacy-defining issue for the president during his last 18 months, one that will determine whether Obamacare achieves its full, desired impact. But how far can—and will—his administration go to achieve that goal? ... The administration has made ample use of that carrot as it has negotiated with GOP-led states to expand Medicaid. But it also is trying the stick, fighting with Florida this year over Medicaid expansion and federal funding for the uninsured while warning Texas that it could do the same there next year. ... But the agency has its limits. It has denied state requests to require people below the poverty line to pay premiums, as well as to limit benefits packages. One redline for the administration is requiring Medicaid enrollees to work or look for work. (Scott, 6/29)

Court Order Will Allow Some Charities To Skip Federal Birth Control Coverage Requirement

The order will be in effect until the Supreme Court decides whether to hear an appeal filed by the nonprofit organizations. In other health law implementation news, an Urban Institute report looks at pricing by co-op plans and Medicaid insurers and finds they are among the cheapest available on state exchanges where they do business. Meanwhile, on Capitol Hill, Sen. Charles Grassley, R-Iowa, is leading an attack on the Internal Revenue Service's penalties.

The New York Times: Court Lets Some Charities Avoid Rules On Birth Control Coverage
The Supreme Court issued an order on Monday that allows certain nonprofit religious groups to avoid compliance with federal rules concerning insurance coverage of contraceptives for women. The order bars the Obama administration from enforcing the rules against the religious groups and church officials until the court decides whether to hear an appeal they filed this year. (Pear, 6/29)

CQ Roll Call: Grassley Leads Attack On IRS Health Law Penalties
Sen. Charles E. Grassley, R-Iowa, has taken the lead on a new bipartisan proposal aimed at preserving traditional health reimbursement plans for small businesses and protecting them against stiff daily penalties that go into effect Wednesday under an Internal Revenue Service plan for enforcing the health care overhaul. (Ota, 6/29)


Looming 'Cadillac Tax' Adds To Pressure To Cut Employee Health Benefits

Also in the news, the Society of Human Resource Management finds in its annual survey of employee perks that wellness programs are becoming more common.

The Wall Street Journal's CFO Journal: Pressure To Cut Employee Benefits Threatens Labor Peace
In all, major employers have about 400,000 union workers whose contracts are up for negotiation this year. They include the Detroit auto makers, whose workforces have a combined 140,000 members of the United Auto Workers; a group of railroad operators including CSX Corp., with 142,000 union employees; and telecom companies like Verizon Communications Inc., which is in talks with about 40,000 wireline workers. Most labor talks involve some head-butting over benefits. But what’s different this time, corporate finance chiefs say, are a looming “Cadillac tax” on health-care plans and pension burdens that are dragging down profits. At New York-based Verizon, executives want to “redesign and reshape” health plans in a bid to cut overall cost, said Fran Shammo, chief financial officer. (Monga and Johnson, 6/30)

The Washington Post: The Workplace Perks That Are In — And Out
In its latest annual survey of what's in and what's out in the world of employee perks, the Society of Human Resource Management found that wellness benefits are only increasing in prevalence. For years, companies have been doing things like offering smoking cessation programs and rewarding employees with discounts for taking health assessments. But Evren Esen, director of survey programs for SHRM, said this year's data show that a greater range of benefits are quickly "becoming more integrated into the organizational fabric of companies." (McGregor, 6/29)

And from WBUR, a look at increased availability of health benefits for same-sex couples -

Americans Say They'd Like To Talk To Their Doctors Via Email, Facebook

A survey conducted by Johns Hopkins University's Bloomberg School of Public Health shows that many Americans would like to chat with their doctors the same way they talk with friends and family. Other studies show continuing health care disparities for blacks and efforts to overhaul medical school entrance exams to find students attuned to issues like the social determinants of health.

The Huffington Post: Communicating With Your Doctor On Facebook May Be The Future Of Healthcare
We communicate with our friends, our families and our coworkers via email and Facebook, and apparently, most Americans also wish that they could keep in touch with their health care providers this way. A national survey of 2,252 pharmacy customers conducted by Johns Hopkins University's Bloomberg School of Public Health highlights the gap between what patients want from their health care providers in terms of communication and engagement, and what they're actually getting. ... Lee emphasized that of course, it's critical to safeguard patient information. But "Health care organizations need to figure out how to take advantage of resources like Facebook," she added.(Gregoire, 6/29)

The Huffington Post: The Quality Of Health Care You Receive Likely Depends On Your Skin Color
Unequal health care continues to be a serious problem for black Americans. More than a decade after the Institute of Medicine issued a landmark report showing that minority patients were less likely to receive the same quality health care as white patients, racial and ethnic disparities continue to plague the U.S. health care system. That report, which was published in 2002, indicated that even when both groups had similar insurance or the same ability to pay for care, black patients received inferior treatment to white patients. This still hold true, according to our investigation into dozens of studies about black health across multiple disciplines. (Schumaker, 6/29)

NPR: Medical School Hopefuls Grapple With Overhauled Entrance Exam
It's T minus four days until exam day, and Travis Driscoll is practically living at his desk. "Each day, I'm easily here for five hours," he says. "I haven't done much of anything else but studying for the last two months." Driscoll is one of 13,000 medical school applicants across the U.S. taking the new Medical College Admissions Test, or MCAT. He's got stacks of science books on his desk to help him prepare, and a rainbow of biochemistry charts pasted to the walls: glycolysis, citric acid cycle, electron transport chain, mitosis, meiosis and DNA replication. (Dembosky, 6/29)

Public Health And Education

Advocacy Groups Sue FDA For Trial Data From Its Accelerated Review Of Hep C Drugs

The approval process for Gilead's Sovaldi and Harvoni was fast tracked by the Food and Drug Administration due to the medications' breakthrough designation, but two health groups want the clinical trial records to see if there were gaps in drug efficacy or unidentified side effects. Meanwhile, the New York Times' reports on how the tobacco lobby is turning to the U.S. Chamber of Commerce to fight a new wave of anti-smoking legislation around the world.

The Wall Street Journal's Pharmalot: FDA Is Sued By Advocacy Groups That Want Gilead Hepatitis C Trial Data
File this under ‘Show me the data.’ A pair of public health advocacy organizations has filed a lawsuit against the FDA, claiming the agency failed to release clinical trial data for Gilead Sciences’ hepatitis C treatments on a timely basis. And the move is only the latest installment in an ongoing drama in which researchers and patient advocates have tussled with drug makers and regulators over access to such information. (Silverman, 6/29)

The New York Times: U.S. Chamber Works Globally To Fight Antismoking Measures
When it came time to defend the tobacco industry, a man named Taras Kachka spoke up. He argued that several “fantastic tobacco companies” had bought up Soviet-era factories and modernized them, and now they were exporting tobacco to many other countries. It was in Ukraine’s national interest, he said, to support investors in the country, even though they do not sell tobacco to Australia. Mr. Kachka was not a tobacco lobbyist or farmer or factory owner. He was the head of a Ukrainian affiliate of the U.S. Chamber of Commerce, America’s largest trade group. (Hakim, 6/30)

State Watch

High Court Temporarily Blocks Restrictive Texas Abortion Law

The Supreme Court has issued a stay on the law while the justices decide whether they will review it. This determination will not likely be made until after the court's next session begins in the fall.

NPR: Supreme Court Places A Stay On Abortion Law In Texas
The Supreme Court has placed a stay on a lower court's ruling that upheld new abortion standards in Texas, to give opponents of a controversial 2013 law time to take their case to the nation's highest court. The stay is temporary: If the Supreme Court refuses to hear the case, the stay will be lifted and the law will take effect. If the justices agree to hear the case, the stay would remain in effect until a ruling is issued. (Chappell, 6/29)

The New York Times: Supreme Court Allows Texas Abortion Clinics To Remain Open
The case concerns two parts of a state law that imposes strict requirements on abortion providers. One requires all abortion clinics in the state to meet the standards for “ambulatory surgical centers,” including regulations concerning buildings, equipment and staffing. The other requires doctors performing abortions to have admitting privileges at a nearby hospital. (Liptak and Fernandez, 6/29)

Los Angeles Times: Supreme Court Blocks Texas Abortion Law From Taking Effect
On Monday, abortion rights activists and providers heaved a sigh of relief that what they deem to be politically motivated and dangerous intrusions into women’s lives have been put on hold. Texas officials vowed to keep fighting a decision by the highest court that Atty. Gen. Ken Paxton said “just put Texas women in harm’s way. (Savage and La Ganga, 6/29)

Houston Public Media/Kaiser Health News: Supreme Court Reprieve Lets 10 Texas Abortion Clinics Stay Open For Now
Supporters of the law say every woman deserves good medical care whatever the procedure. “While we hope that she would not be compelled to choose abortion, we hope that her life would of course not be at risk should she choose to do that,” said Emily Horne of Texas Right to Life. “Pro-life does not just mean care for the life of the unborn child, it’s care for the life of the woman undergoing the abortion as well.” (Feibel, 6/30)

The Washington Post: Supreme Court Temporarily Blocks Texas Abortion Law
The court did not offer a reason for its 5-to-4 decision, and the law’s ultimate fate remains unclear. The court’s reliably conservative justices — Antonin Scalia, Clarence Thomas, Samuel A. Alito and Chief Justice John G. Roberts Jr. — dissented and would have let the law take effect. (Somashekhar, 6/29)

Politico: Supreme Court Blocks Texas Abortion Law Ruling
The soonest the justices could decide whether to take the case would be when they come back into session in October, CRR attorney Stephanie Toti said. Texas Gov. Greg Abbott expressed confidence Monday afternoon that the Supreme Court will ultimately uphold the law. (Villacorta and Haberkorn, 6/29)

The Texas Tribune: Supreme Court Puts Texas Abortion Law On Hold
Attorneys for the abortion providers said that the Supreme Court's order also blocked the state from enforcing a separate provision of the law that requires doctors who perform abortions to have admitting privileges at a hospital within 30 miles of an abortion clinic. The Supreme Court restored a lower court's ruling striking down both provisions of the law statewide, the attorneys said. (Ura, 6/29)

The Hill: Supreme Court Halts Texas Abortion Law, Letting Clinics Stay Open
This is the second time that the Supreme Court has stepped in to temporarily halt pieces of the 2013 law, which activists say gives them hope that the court will eventually overturn lower courts' decision to uphold the law. "We think it’s a strong possiblity that the court will take this case," said Nancy Northup, president and CEO of the Center for Reproductive Rights. (Ferris, 6/29)

The Associated Press: Texas Abortion Providers Study Whether Clinics Could Reopen
Abortion providers cheered a move by the U.S. Supreme Court to temporarily block part of a Texas law that would have closed more than half the state's 19 remaining abortion clinics. Now they are studying whether it could also allow them to reopen some previously shuttered facilities and whether that would even be feasible. (Vertuno, 6/29)

California Senate OKs Mandatory Vaccine Bill

The measure is now headed for the desk of Gov. Jerry Brown, who has not publicly stated whether he would sign it.

Los Angeles Times: California Legislature Passes Mandatory Vaccination Bill
Gov. Jerry Brown must now decide whether to sign into law a bill that would require mandatory vaccinations for nearly all California schoolchildren. The measure, spawned by an outbreak of measles at Disneyland that ultimately infected more than 150 people, cleared its final legislative hurdle Monday in the state Senate. Brown has not said publicly whether he would sign it. (Mason, 6/29)

The Wall Street Journal: California Vaccination Bill Passes, Heads To Governor
The California Senate on Monday passed a much-debated bill to restrict vaccine exemptions, putting one of the country’s strongest state-level efforts to clamp down on unvaccinated students in the hands of Gov. Jerry Brown. Senate Bill 277, spurred by a measles outbreak that began last year at Disneyland Resort in Anaheim, Calif., allows for medical exemptions but doesn’t permit parents to cite personal beliefs to avoid vaccines for children attending school. (Porter, 6/29)

The Sacramento Bee: California Senate Sends Mandatory Vaccines Bill To Governor
After months of packed committee hearings and lengthy floor debates, California’s controversial mandatory vaccinations proposal now heads to Gov. Jerry Brown for consideration. In a 24-14 concurrence vote, the state Senate on Monday accepted Assembly amendments to Senate Bill 277, which would eliminate California’s personal and religious belief exemptions for vaccinating schoolchildren, and sent the measure to Brown’s desk. (Koseff, 6/29)

The Associated Press: Experts: California Vaccine Bill Would Prevent New Outbreaks
If California's strict school vaccine bill becomes law, experts believe it could help prevent another outbreak like the one that occurred at Disneyland. The bill was introduced after a measles outbreak traced to the theme park in December infected over 100 people in the U.S. and Mexico. It would likely be successful in increasing immunization rates and stopping the spread of disease, pediatric doctors said Monday after the Senate sent the legislation to the governor. (6/20)

State Highlights: Md. Hospitals' Experiment Generates $100M In Medicare Savings; N.Y. To Invest $7.3B In Delivery System Overhaul

News outlets report on health care developments in Maryland, Connecticut, New York, Alaska and Kentucky.

The Baltimore Sun: Hospitals Save $100 Million In Medicare Costs
Maryland hospitals collectively generated more than $100 million in Medicare savings in the first year of an experimental payment system being watched closely by the federal government as a possible national model for reducing health care costs. The state's medical institutions agreed last year to a five-year agreement with the U.S. Centers for Medicare and Medicaid Services. It drastically changed the way they did business and aimed to curb costs, in part by reducing expensive hospital stays and handling more patient care at the doctor's office. (McDaniels, 6/29)

The Associated Press: NY Health Care Providers To Share $7.3 Billion For Overhaul
New York officials say $7.3 billion is going to 25 networks of health care providers statewide to help overhaul the delivery of care and cut unneeded hospital visits. Meanwhile, state health officials say average spending for the state's Medicaid patients has declined to $8,233 annually while enrollments rose by 500,000 to nearly one-third of the state's 19 million people. (6/29)

The Connecticut Mirror: Health, Labor, Environment Bills Revived In Special Session
A wide range of legislative priorities that failed to clear both chambers of the General Assembly before the June 3 end of the regular session won final approval early Tuesday as part of a massive budget implementation bill. The 686-page everything-but-the-kitchen-sink bill also includes several controversial new provisions, including a plan to fund pay increases for nursing home workers but give the bulk of the money to those at unionized nursing homes, and one that expands the governor’s authority to hire and fire workers in several types of jobs. (Levin Becker, Pazniokas, Phaneuf, Rabe Thomas and Spiegel, 6/29)

Alaska Dispatch News: Alaska Freezes Inflation-Linked Payment Increases To Medicaid Providers
Citing a “significantly underfunded” budget for the new fiscal year, the Alaska Department of Health and Social Services has told Medicaid providers they won’t be seeing the usual rate increases for inflation. In a public notice posted Monday morning, DHSS filed emergency regulations to freeze rates that customarily rise a percentage point or two every year. (Andrews, 6/29)

USA Today: ER Visits For Dental Problems On The Rise
What started as a toothache from a lost filling became a raging infection that landed Christopher Smith in the University of Louisville Hospital emergency room, then in intensive care on a ventilator and feeding tube. "It came on so quickly and violently. I was terrified," said Smith, 41, of Jeffersonville, Ind., who lacked dental insurance and hadn't been to a dentist for years before the problem arose this month. "I had no idea it could get this serious this quickly." (Ungar,6/29)

Editorials And Opinions

Viewpoints: Judicial Activism On Health Law; Science And Jerry Brown's Choice On Vaccines

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

Los Angeles Times: The Supreme Court's Bad Call On Affordable Care Act
In King vs. Burwell, the Supreme Court ruled that the Affordable Care Act permits individuals who purchase insurance on the federal exchange to receive taxpayer subsidies. Though the King decision pleases the ACA’s ardent supporters, it undermines the rule of law, particularly the Constitution’s separation of powers. ... When judges take it upon themselves to “fix” a law — or to bless an executive “fix” — they diminish political accountability by encouraging Congress to be sloppy. And they bypass the political process established by the Constitution’s separation of powers, arrogating to itself — and the executive — the power to amend legislation. This leads to bad laws, bad policy outcomes and fosters the cynical belief that “law is politics.” (David B. Rivkin Jr. and Elizabeth Price Foley, 6/29)

Bloomberg: What Some Conservatives Aren't Willing To Do To Kill Obamacare
When the Supreme Court last week swatted down a legal challenge that could have crippled a centerpiece of President Barack Obama's health-care law, it merely kicked the debate back from the legal to the political arena. Conservatives are still determined to fight Obamacare. But now, they're fighting over how to fight it. The latest plan, floated by a couple of top-tier Republican presidential hopefuls, is already facing pushback from the right. In recent days, former Florida Governor Jeb Bush, officially a candidate for president, and Wisconsin Governor Scott Walker, who appears likely to make his campaign official in July, have both hit on the same idea for getting rid of Obamacare. But it would involve killing a Washington sacred cow that is, if anything, more beloved of conservatives than it is of liberals. Namely, the Senate filibuster. (Sahil Kapur, 6/30)

The Baltimore Sun: Republicans Still Beating A Dead Horse On Obamacare
The Supreme Court's decisive 6-3 vote confirming the right of all Americans to federally supported health-care insurance should end the Republican Party's losing war on Obamacare — but it probably won't. The party tried and failed in 2012 to win back the White House behind Mitt Romney and a pledge to "repeal and replace" the president's signature Affordable Care Act. Now it seems determined to continue the fight, to the point that most of its 2016 presidential aspirants have signaled their willingness to walk the same plank right through the next election. (Jules Whitcover, 6/29)

Los Angeles Times: Republicans Secretly Cheer Supreme Court Obamacare Decision
As happy as the president is with the result, though, Republicans may be even happier. If the court's decision had gone the other way, the GOP governors in those 33 states would have had a crisis on their hands and the Republican Congress would have been expected to come up with a very quick remedy or risk facing the wrath of millions of voters suddenly dumped from the healthcare system. Now Republicans in the House and Senate can continue to rail against Obamacare, hone their talking points and make vague assertions that they have a better idea without having to do anything -- and congressional Republicans have proven pretty convincingly that doing nothing is what they do best. (David Horsey, 6/26)

Des Moines Register: Obamacare Opponents Need To Move On
Last week the U.S. Supreme Court upheld the Affordable Care Act — again. The 6-3 decision maintains a cornerstone of the law, which provides federal subsidies to Americans purchasing private health insurance. The ruling has been characterized as a relief for people who rely on those subsidies and health providers compensated by insurers for care. Perhaps most relieved are anti-Obamacare politicians who had no feasible plan in place if the court issued a decision that resulted in millions of Americans losing their coverage. These politicians knew they could be held responsible. The lesson opponents should learn from all this: Move on. (6/29)

San Antonio Press Express: Supreme Court's White Lie On Obamacare
As a conservative, I think it serves the country best if elected officials, not judges, repair what's wrong in Obamacare. Former Texas Gov. Rick Perry, a 2016 GOP presidential hopeful, hit the right note when he said he did not agree with the ruling. "It never was up to the Supreme Court to save us from Obamacare," he said in a statement issued Thursday. Because the Democratic Congress wrote a heavy-handed provision, which the Obama White House determined it was best to ignore, the Supreme Court got handed a live grenade. With all the Democratic justices on board, Roberts jumped on the grenade - leading with a bogus argument. The real casualty is any notion that the U.S. Supreme Court remains an honest broker. (Debra J. Saunders, 6/29)

Los Angeles Times: In Battling Racist Policies, Taking Down The Confederate Flag Is Barely A First Step
State laws and procedures, especially in the South, are rife with political and economic discrimination, subtle and otherwise. Even if some of these policies can be defended as not overtly racially motivated, their racially discriminatory effect is plain. The region is the epicenter of opposition to the Affordable Care Act; among Southern states, only Arkansas has expanded Medicaid, the provision of Obamacare most specifically directed at low-income Americans, a group in which black residents are overrepresented. (Michael Hiltzik, 6/29)

Los Angeles Times: Vaccine Opponents Are Passionate, Persistent And Science-Averse
Despite all the noise around mandating vaccinations for schoolchildren, most California adults -- some 67%, according to a recent poll -- think it’s a good idea. We will soon know whether Gov. Jerry Brown agrees. On Monday, the Legislature sent him a bill that would end the personal belief exemption, a routinely abused loophole that has seriously eroded the immunization rates in many of California’s school districts. Children who cannot be vaccinated for medical reasons would be allowed to attend school. (Robin Abcarian, 6/29)

The Wall Street Journal: My Spinal Taps For Alzheimer’s
The best moment of my first spinal tap came after it ended. I was not supposed to move, so I lay still and watched the lab technician deftly drip my cerebrospinal fluid into 50 tubes, one drop at a time. “You have just created 50 samples for Alzheimer’s research,” he said. Fifty samples. From a couple of tablespoons of fluid. Fifty samples, in exchange for allowing myself to be numbed with one needle and then delicately poked with another while I lay curled on my side. It felt like the most useful thing I’d ever done. Certainly, it was the most useful thing I’d ever done to fight Alzheimer’s disease. (Ann Hedreen, 6/28)

The New York Times' The Upshot: A Promising Medicare Plan, If Only Health Organizations Would Stick Around
Two recent studies of Medicare’s new way to pay for health care show that it’s reducing spending and improving quality. The problem is, health care organizations don’t always stick with the program. Both studies examined Medicare’s 32 Pioneer Accountable Care Organizations. This program, and a related, similar one with a larger number of participants, offers health care organizations the opportunity to earn bonuses in exchange for accepting some financial risk, provided they meet a set of quality targets. (Austin Frakt, 6/29)

JAMA: Measuring The Performance Of Health Insurance Marketplaces
The logic of US federalism ensures that states will experiment with various approaches to organizing their health insurance marketplaces. Before rushing to reinvent their current marketplace models, legislators should proceed with caution. The performance of ACA insurance marketplaces varies widely; no single organizational structure predicts better outcomes. Indeed, [state partnership marketplaces] and [federally facilitated marketplaces] models often outperform [state based marketplaces] in terms of cost-effectiveness, enrollment growth, and effects on health insurance premiums. (Robert B. Hackey and Erika L. May, 6/29)

JAMA Neurology: The Importance Of Lesbian, Gay, Bisexual, And Transgender Health In Neurology
Health care disparities in neurological conditions have become increasingly apparent during the past decade, principally focusing on racial and ethnic disparities. However, disparities involving the lesbian, gay, bisexual, and transgender (LGBT) community continue to be understudied in medicine, including neurology. Although the significance of an LGBT identity frequently goes unrecognized in neurological care, this community faces unique challenges and potential disparities that are vital for neurologists to understand to provide thorough and culturally competent care. (Nicole Rosendale and S. Andrew Josephson, 6/29)