KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: 'Are We There Yet?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Are We There Yet?'" by Hilary Price.

Here's today's health policy haiku:

COSTLY ADDITION TO THE MEDICINE CHEST

It’s an uphill climb
To keep cholesterol down…
Will these new drugs help?

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Health Law Issues And Implementation

Officials In Alaska, Iowa, Massachusetts. And Washington Approve Increases In Health Premiums

The increases range from 40 percent for two companies in Alaska to about 4 percent for the average rise in Washington state.

The Associated Press: Rate Increase Approved For Individual Health Care Market
Alaska's Division of Insurance has approved average rate increases for next year of nearly 40 percent for the two companies providing individual health insurance plans through the federally run online marketplace. Division director Lori Wing-Heier said Thursday that Premera Blue Cross Blue Shield and Moda Health cited the high cost of medical services as one of the factors in requesting rate increases. (Bohrer, 8/28)

The Des Moines Register: Wellmark, Coventry Double-Digit Rate Increases Approved
Iowa's chief insurance regulator has approved double-digit premium rate increases affecting thousands of Iowans. The Iowa Insurance Division said Wednesday that Insurance Commissioner Nick Gerhart has approved increases requested by Wellmark Blue Cross & Blue Shield, Coventry Health Care and Gundersen Health Insurance. ... For Wellmark, Iowa's dominant health insurance carrier, Gerhart approved rate increases of 17.6 percent to 28.7 percent on average for different insurance plans. Those rate increases affect about 137,000 Wellmark policyholders. (Leys, 8/26)

The Boston Globe: 300,000 In Mass. To See Health Policy Rates Rise 6 Percent
Health insurers in Massachusetts will boost rates more than 6 percent for small businesses and individuals in 2016, a troubling sign that costs are once again accelerating. The increase, approved by the state Division of Insurance last week, is more than double the rise in premiums at the beginning of this year and triple the rise in 2014. (Dayal McCluskey, 8/27)

The Associated Press: Washington Health Insurance Rates To Go Up 4.2 Percent
People who buy their health insurance on the Washington Healthplanfinder exchange can expect an average 4.2 percent increase in their rates in 2016. The rate increases approved Thursday by the Office of the Insurance Commissioner are lower than the insurance companies had requested. Insurance officials have approved 12 health insurance companies to sell 136 individual health plans on Washington Healthplanfider in 2016. The companies requested an average rate change of 5.4 percent. (8/27)

Meanwhile, insurance companies seek lobbying help as they prepare for mergers -

The Hill: Cigna, Aetna Hire Lobbyists Amid Mergers
As the health insurance market prepares for a duo of mergers, the companies involved are hiring teams of lobbyists to make sure the process goes smoothly. Most recently, Cigna, which agreed to a $54 billion takeover by insurance company Anthem last month, hired two firms. WilmerHale and Polaris Government Relations will be working on anti-trust issues for the company as it navigates the merger. (Wilson, 8/27)

Alaska Judge To Rule Today On Suit Against Governor's Medicaid Expansion Plan

The judge said the ruling will be on the Republican legislators' request to temporarily bar the Medicaid expansion while legal questions are fully argued. Also in the news, a look at how flexible spending accounts may be affected by the "Cadillac tax" and an analysis of the fiscal problems of the insurance co-ops set up in the health law.

Alaska Dispatch News: Judge To Issue Initial Ruling Friday On Alaska Legislature's Medicaid Lawsuit
A trial court judge said Thursday he would deliver an oral ruling Friday on the Alaska Legislature’s lawsuit to stop Gov. Bill Walker from unilaterally expanding the public Medicaid health-care program. ... The ruling, [Judge Frank] Pfiffner said, will approve or deny the Legislature’s request to temporarily bar Medicaid expansion while legal questions are fully argued. Friday’s decision will not address the underlying question of whether Walker's executive power allows him to use federal money to expand the Medicaid program without legislative approval. (Herz, 8/27)

Politico Pro: Flexible Spending Accounts May Vanish As Result Of Cadillac Tax
A popular middle-class tax benefit could become one of the first casualties of the Affordable Care Act’s so-called Cadillac tax, potentially affecting millions of voters. Flexible spending accounts, which allow people to save tax free for everything from doctor’s co-pays to eyeglasses, may vanish in coming years as companies scramble to avoid the law’s 40 percent levy on pricey health care benefits. (Faler, 8/27)

Politico Pro: Despite Enrollment Gains, Co-Op Losses Pile Up
Nonprofit health insurers created with billions of dollars in Obamacare loans have doubled their enrollments this year, but they haven’t been able to slow their financial losses, according to a POLITICO analysis of their most recent financial reports. Although the nearly two dozen co-op plans have signed up almost 1 million customers during Obamacare’s second enrollment period, they’ve lost roughly $200 million during the first six months of this year. That puts the nonprofit plans on pace to lose nearly the same amount as they did during their first year of operations. (Demko, 8/27)

Capitol Hill Watch

Planned Parenthood Analysis Alleges Manipulation, Editing Of Covert Videos

Planned Parenthood sent to members of Congress a detailed letter and an accompanying report defending its practices and alleging that a string of eight undercover videos was heavily altered.

The Associated Press: Planned Parenthood Alleges 'Smear' In Letter To Congress
Planned Parenthood Federation of America defended its practices Thursday in a lengthy letter to congressional leaders and included a report by experts it hired who found undercover videos of officials discussing fetal tissue for research were heavily altered by anti-abortion activists. The report supports the organization's claims that the secretly recorded videos were distorted to misrepresent conversations employees had with anti-abortion activists posing as biomedical company employees interested in buying fetal tissue, Planned Parenthood said. (Melley, 8/27)

The New York Times: Planned Parenthood Videos Were Altered, Analysis Finds
Planned Parenthood on Thursday gave congressional leaders and a committee that is investigating allegations of criminality at its clinics an analysis it commissioned concluding that “manipulation” of undercover videos by abortion opponents make those recordings unreliable for any official inquiry. “A thorough review of these videos in consultation with qualified experts found that they do not present a complete or accurate record of the events they purport to depict,” the analysis of a private research company said. (Calmes, 8/27)

The Wall Street Journal: Dueling Assessments Of Planned Parenthood Videos
The [Planned Parenthood ] letter and analysis are the organization’s first concerted response to investigations by federal lawmakers following the release of eight videos by the Center for Medical Progress, another antiabortion group. Americans United for Life on Thursday also sent letters to congressional leaders, saying its lawyers had reviewed seven unedited videos, concluding that they raise probable cause that Planned Parenthood violated at least six federal laws. (Armour, 8/27)

The Washington Post: Videos Deceptively Edited, Planned Parenthood Tells Congress
The letter, [written by the ­organization’s president, Cecile Richards] was accompanied by a 10-page report commissioned by Planned Parenthood and penned by an independent investigator, former Wall Street Journal reporter Glenn Simpson. Through his firm Fusion GPS, Simpson enlisted experts who analyzed both the short, highly produced videos publicized by the antiabortion group, as well as hours of “full” footage the group posted on YouTube. The implication is that the longer footage was unedited. But Simpson said he found significant gaps. (Somashekhar, 8/27)

Politico: Report For Planned Parenthood Finds Sting Videos Manipulated
Planned Parenthood also told lawmakers that only two of the 59 Planned Parenthood affiliates are currently involved in fetal tissue research — and that there is no evidence any affiliate has broken federal or state laws. “The attacks on us have the intended purpose of making it appear that fetal tissue research is an enormous focus of Planned Parenthood,” Cecile Richards, the president of Planned Parenthood Federation of America, wrote in a letter to House Speaker John Boehner and Minority Leader Nancy Pelosi, Senate Majority Leader Mitch McConnell and Minority Leader Harry Reid. “But the simple fact is that 99 percent of our health centers have no involvement in this work.” (Haberkorn, 8/27)

The Hill: Planned Parenthood To House, Senate Leaders: Videos Manipulated
The documents offer the closest look so far at how Planned Parenthood has fared since it came under attack from the makers of the videos. It also offers new details about the tissue program’s history, such as the “modest reimbursement” of $60 per tissue specimen that Planned Parenthood’s California provider receives from a tissue procurement company. It also says that Planned Parenthood has launched an internal review of its "policies and practices" surrounding the program. The measures are part of an effort to pressure supporters on Capitol Hill to “intervene in what is clearly an unnecessary and distracting process,” Planned Parenthood Executive Vice President Dawn Laguens told reporters Thursday. (Ferris, 8/27)

CNN: In Report To Congress, Planned Parenthood Says Videos Are Deceptive
At the time of the examination, CMP had released five videos, Planned Parenthood said. The report said experts found that there were at least 42 splices where content is cut and edited together to create the appearance of seamless conversations. "In some cases, these splices completely change the meaning of statements," the report said. "Phrases on the video were isolated and removed, stringing together unrelated sentences to change the meaning." (Scott, 8/27)

NPR: Planned Parenthood Fights Back
The videos, which were released by the anti-abortion activist group Center for Medical Progress, have prompted calls for congressional investigations, which are expected to begin next month. There have also been public protests over the weekend around the country, both condemning and defending Planned Parenthood. (Kelly, 8/27)

The Associated Press: Q&A: Questions, Answers In Planned Parenthood Controversy
[Planned Parenthood] sent a letter Thursday to congressional leaders and included a report by experts it hired who found that undercover videos of its officials were heavily altered by anti-abortion activists. The move was the latest development in a heated dispute that has riled people on both sides of the abortion debate. The videos were produced by a California-based anti-abortion group called the Center for Medical Progress, which began releasing them in July. Here are answers to some of the questions at the heart of the controversy. (Melley, 8/28)

Meanwhile, news outlets also offer some related Planned Parenthood articles.

Bloomberg: Planned Parenthood Restrictions Could Be Kept Off Funding Bill
Republican leaders in Congress are considering a pledge to hold a separate vote on defunding Planned Parenthood as a way to keep the issue from derailing legislation to keep the government running, said congressional aides with knowledge of the discussions. In private discussions, the leaders are looking at using reconciliation procedures to let a Planned Parenthood bill come up for a filibuster-proof Senate vote, the aides said. (Rowley, 8/28)

New Orleans Times-Picayune: Bobby Jindal's Administration Says Planned Parenthood Can't Sue Over Canceled Medicaid Contract
If Planned Parenthood Gulf Coast wants its Medicaid contract restored, it should appeal to the federal government for intervention -- not file a lawsuit in federal court, according to Gov. Bobby Jindal's administration. The argument is part of the administration's response to Planned Parenthood Gulf Coast's lawsuit filed Tuesday (Aug. 25) that seeks to have the court issue a temporary restraining order to keep Jindal from canceling its Medicaid contract. The organization, which does not perform abortions in Louisiana, says more than 5,000 patients will lose access to care such as cancer and sexually transmitted infection screenings if the contract is canceled. (Litten, 8/27)

The St. Louis Post-Dispatch: Report Claims Missouri Did Not Receive Required Lab Reports On Fetal Tissue
A Brentwood, Mo.-based pathology lab failed to send the state an unknown number of reports on fetal tissue from the St. Louis Planned Parenthood clinic, a state inspection report says. State officials said this week they had no idea how long the tissue exam reports weren't filed, even though state law requires that a pathology lab contracted by Planned Parenthood send reports to the Department of Health and Senior Services. (Stuckey and Liss, 8/27)

Marketplace

Second In New Class Of Cholesterol-Lowering Drugs Approved By FDA

Amgen's Repatha, the second in a class of new, expensive biotech drugs approved by the Food and Drug Administration over the last month, targets artery-clogging cholesterol that cannot be treated as effectively by traditional statin medications.

The Washington Post: FDA Approves Another In A New Class Of Cholesterol-Fighting Drugs
But because PCSK9 drugs are so new, researchers have yet to determine whether their cholesterol-lowering effects actually will translate into fewer heart attacks, strokes and other cardiovascular problems. Over the next couple years, studies should begin to offer clearer answers about how the drugs work over time. While many experts agreed about the promising potential for the new drugs, the price tag for PCSK9 inhibitors already has caused concerns in the health-care world, given the number of patients that eventually could end up using them. (Dennis, 8/27)

USA Today: New Drug Could Dramatically Reduce Cholesterol
The Food and Drug Administration on Thursday approved the second in a new class of cholesterol drugs that promises to dramatically lower cholesterol, although at a very high price. Amgen's Repatha, also known generically as evolocumab, belongs to a new class of injectable cholesterol fighters called PCSK9 inhibitors, which are man-made antibodies. The FDA last month approved the first of these drugs, Praluent, made by Sanofi and Regeneron Pharmaceuticals. Both drugs will cost more than $14,000 a year. (Szabo, 8/28)

The Associated Press: Amgen Wins Approval For Second Biotech Cholesterol Drug
Amgen Inc. has won federal approval for the second medicine in a new class of pricey biotech drugs that reduce artery-clogging cholesterol more than older statin drugs that have been used for decades. The drug Repatha could eventually help millions of Americans who face increased risks of heart disease because they cannot control their cholesterol with existing drugs and methods. But concerns about the medication's price tag — $14,100 per year — and long-term benefits will likely limit its use in the near-term. (Perrone, 8/27)

Meanwhile, the FDA also proposes a new convention for labeling biosimilars -

The Associated Press: FDA Lays Out Proposal For Naming Lower-Cost Biotech Drugs
The Food and Drug Administration released its proposal Thursday for naming lower-cost biotech drugs, a critical step in creating a market for the new class of medicines. These quasi-generic biotech drugs have the potential to save the U.S. health care system billions of dollars in costs. But representatives for the generic drug industry warned that the FDA’s proposal could curb those savings by making the drugs more difficult to prescribe. (Perrone, 8/27)

Medicare

Miami Doctor Sentenced For Defrauding Medicare $25M For Services Performed In Nicaragua

In another fraud scheme, four people in New York plead guilty for filing $4 million in false Medicare claims.

Miami Herald: New Twist On Medicare Scam: Services Actually Were Provided — In Nicaragua
Only in Miami: A local doctor was sentenced to four years in prison on Thursday for providing millions of dollars in medical services to U.S. expatriates at a clinic in Nicaragua — all fraudulently billed to the taxpayer-funded Medicare program. Dr. Santiago B. Montoya received the same punishment as his son, Rodney, a one-time lawyer, who was sentenced earlier this summer to four years in prison for his role in the unprecedented $25 million healthcare fraud scheme. The father and son, who cut plea deals, operated a clinic in Managua under the network of a now-closed managed-care business, Florida Healthcare Plus. (Weaver, 8/27)

Public Health And Education

FDA Objects To Tobacco Makers Marketing Cigarettes As 'Natural'

The use of terms like “additive-free,” “natural” or "organic" on labels violates federal law, the Food and Drug Administration warned the owners of Winston, Natural American Spirit and Nat Sherman brands in a letter.

The Wall Street Journal: FDA Warns Cigarette Makers On ‘Natural’ Labeling
The agency said the warning is the first it has issued for use of those terms. It was sent to: Reynolds American Inc., owner of Natural American Spirit; Imperial Tobacco PLC, owner of Winston; and Sherman’s 1400 Broadway N.Y.C. Ltd., owner of Nat Sherman cigarettes, for its Nat Sherman cigarette brand. “The FDA’s job is to ensure tobacco products are not marketed in a way that leads consumers to believe cigarettes with descriptors like ‘additive-free’ and ‘natural’ pose fewer health risks than other cigarettes, unless the claims have been scientifically supported,” said Mitch Zeller, director of the FDA’s Center for Tobacco Products, in a statement. Reynolds said it is reviewing the FDA’s letter. Nat Sherman declined to comment. (Mickle, 8/27)

The Associated Press: F.D.A. Warns 3 Tobacco Makers About Language Used On Labels
In three separate letters made public on Thursday, the F.D.A. told the manufacturers of the brands that they did not have the agency’s approval to claim that their products were free of certain harmful substances, or that they posed less risk to consumers than other tobacco products. The warnings were sent to ITG Brands, which makes Winston cigarettes; Santa Fe Natural Tobacco, which makes Natural American Spirit; and Sherman’s 1400 Broadway N.Y.C., the maker of Nat Sherman cigarettes. (Abrams, 8/27)

More Parents Allowing Children To Be Vaccinated Since Measles Outbreak, Survey Finds

The trend is viewed as good news by health care professionals. In related news, the latest data shows that California lags behind other states in vaccination rates.

MinnPost: Fewer Parents Refusing Vaccines For Children, Physician Survey Shows
Last winter’s much-publicized “Disneyland” measles outbreak may have led to one positive outcome: an increase in vaccine acceptance among parents. In a recent nationwide survey by the physician-oriented website Medscape, 42 percent of pediatricians and other health professionals said they believed parents had become more accepting of vaccines since the Disneyland outbreak — particularly the measles vaccine. That trend is welcomed news for public health officials and others who have become concerned by the growing problem of parents refusing or delaying immunizations for their children. (Perry, 8/27)

Los Angeles Times: California Lags In Vaccinating Children, CDC Says
California lawmakers quickly moved to tamp down a growing resistance to vaccination that had been fostered in some communities by unfounded safety concerns. By summer, Gov. Jerry Brown had signed one of the nation's toughest laws to keep parents from opting not to inoculate their kids. Nationwide data released Thursday by the U.S. Centers for Disease Control and Prevention show that although California children are immunized at a high level, the state's vaccination rate still lags behind the rest of the country. (Karlamangla, 8/28)

Administration News

HHS Proposes Narrowing Drug Discount Program

The program, known as the 340B program, would tighten control on the deep discounts that some patients, drugs and providers get.

Modern Healthcare: 340B 'Mega Guidance' May Narrow Drug Discounts
Federal regulators released their long-awaited “mega-guidance” for the 340B Drug Pricing Program to clarify who is eligible to participate. It comes amid mounting criticism that the program has become overly broad with insufficient oversight. In the draft omnibus guidance, the Health Resources and Services Administration proposed several changes that could limit the types of care delivery that would trigger eligibility for a patient's drugs to be purchased under the program. (Johnson, 8/27)

Politico Pro: HHS Clamping Down On Huge Drug Discount Program
HHS on Thursday proposed a rewrite of the rules for a rapidly expanding drug discount program that has become a flashpoint between hospitals and the drug industry. The long-awaited draft “mega-guidance” on the 340B program seeks to tighten controls on which patients, drugs and providers qualify for the deep manufacturer discounts. (Norman, 8/27)

Campaign 2016

John Kasich Aims To Break Out From GOP Field With 'Compassionate' But Not Moderate Message

On the Democratic side of the presidential race, Hillary Clinton calls out the Republican candidates for what she alleges are their "extreme views" about women.

Los Angeles Times: John Kasich Might Have A Little Donald Trump In Him, And He's A Threat To Jeb Bush
His philosophy plays better in New Hampshire than in states with more conservative Republican voting bases. Kasich accepted federal money to expand Medicaid in his state as part of the Affordable Care Act, infuriating the law’s opponents. He supports the Common Core education standards that have become wildly unpopular with many core Republicans. And he has resisted harsh immigration rhetoric, while embracing a plan to provide legal status for people in this country illegally. ... On other issues, including abortion, he is fairly conservative. (Bierman, 8/28)

The Associated Press: Clinton Likens GOP's Views On Women To Those Of Terrorists
Hillary Rodham Clinton on Thursday drew parallels between terrorist organizations and the field of Republican candidates for president when it comes to their views on women, telling an Ohio audience her potential GOP rivals were pushing "out-of-date" policies. ... Former Florida Gov. Jeb Bush responded on Twitter: .@HillaryClinton compares pro-life Americans to terrorists, but defends despicable PP treatment of unborn? Her priorities are totally wrong. Bush was referring to Planned Parenthood. (8/27)

State Watch

Minnesota Works To Clear Medicaid Backlogs

News outlets also report on Medicaid developments in Florida and Iowa.

Pioneer Press: State Works To Clear MinnesotaCare, Medicaid Backlogs
About 40,000 low-income Minnesotans will lose their government health care next week as the state finally works its way out from underneath a massive backlog in its MinnesotaCare and Medicaid programs. Those 40,000 people -- about 28,000 households -- have either become ineligible for those low-income health programs or are still eligible but didn't submit necessary information in time. But this deadline should have come as early as January. Instead, a series of computer glitches delayed the renewals of almost 180,000 households well into the summer -- a months-old backlog that Minnesota won't finally put to rest until the end of September. (Montgomery, 8/27)

Tampa Bay Times: Florida Gives 7.7 Percent Rate Increase To Medicaid Insurers
State health officials have approved a 7.7 percent rate increase for the private health plans covering Florida's poorest residents. The plans had asked for a $400 million raise plus a 12 percent rate increase, saying they needed the money to cover rising prescription drug costs and an unexpected uptick in doctors visits. But the state Agency for Health Care Administration, which oversees Florida's $23 billion Medicaid program, wasn't willing to go that far. (McGrory, 8/27)

The Associated Press: Ex-Lawmaker's Role In Iowa Medicaid Bidding Faces Criticism
A former lawmaker's role is casting doubt on the process used to select companies to manage Iowa Medicaid, with one losing vendor alleging she provided an unfair advantage to a winning bidder after working as a state contractor.A second losing bidder claims the ex-representative, Renee Schulte, gave its lobbyists inside information that a key official in the selection process had made "derogatory comments" and was biased against the company. (Foley, 8/27)

Private Foundation Support Keeps Colo. Birth Control Program Alive

The program, which provides long-acting reversible contraceptives to low-income and uninsured teenagers and women, received $2 million in support from private foundations, which is enough to keep it operating for at least one year. In other news, an Alaska state court judge ruled that a state law defining what qualifies -- for the purposes of Medicaid funding -- as a medically necessary abortion is unconstitutional.

The Denver Post: Colorado's Birth Control Program Kept Afloat By $2M In Temporary Funds
Roughly $2 million has been pledged in temporary funding to keep afloat a hot-button Colorado program that provides long-acting reversible contraceptives to low-income and uninsured teenagers and women. The Colorado Department of Public Health and Environment on Tuesday announced the funding for the Colorado Family Planning Initiative in a news release. Officials say money for the initiative, which is aimed at reducing teen pregnancy and abortion rates, is coming from more than a dozen organizations. (Paul, 8/27)

The Associated Press: Judge Strikes Down Law To Limit Medicaid Funds For Abortions
A state court judge in Alaska ruled Thursday that a law further defining what constitutes a medically necessary abortion for purposes of Medicaid funding is unconstitutional. Superior Court Judge John Suddock ordered that the state be blocked from implementing the law, passed last year, and a similar regulation, finding both violated the equal protection clause of the Alaska Constitution. (Bohrer, 8/28)

Abortion Foes Pursue Public Records On Clinic Data, Comb Through Trash

Activists in Washington state are asking for data from abortion clinics on womens' ages, races, length of pregnancy and how past pregnancies ended, as well as where the women lived. And they literally go through the clinic trash sometimes to find such patient information.

ProPublica: Activists Pursue Private Abortion Details Using Public Records Laws
A few years back, Jonathan Bloedow filed a series of requests under Washington state’s Public Records Act asking for details on pregnancies terminated at abortion clinics around the state. For every abortion, he wanted information on the woman’s age and race, where she lived, how long she had been pregnant and how past pregnancies had ended. He also wanted to know about any complications, but he didn’t ask for names. This is all information that Washington’s health department, as those in other states, collects to track vital statistics. (Ornstein, 8/27)

ProPublica: Foes Dive For Discarded Records In Abortion Clinic Dumpsters
The scene in front of abortion clinics is often tense, with clinic workers escorting patients past activists waving signs and taking photographs. But increasingly, another drama is unfolding out back. There, abortion opponents dig through the trash in search of patient information. Using garbage as their ammunition, anti-abortion activists – who have sometimes been accused of violating abortion seekers’ privacy – are turning the tables. They claim it’s the clinics that are violating patients’ privacy by discarding medical records in unsecured ways. (Ornstein, 8/27)

State Highlights: New Texas Law To Help Consumers With Surprise Medical Bills About To Take Effect; Judge Halts Calif. Lawsuit Brought Against Narcotic Drug Makers

Health care stories are reported from Texas, California, Minnesota, New York, Massachusetts, Maryland and North Carolina.

The Dallas Morning News: Hospital Patients Hit With Surprise Bills Gain New Leverage
Help is on the way for Texans who get a nasty surprise after a hospital visit — huge bills, even though the hospital is in their health insurer’s provider network. A law that takes effect Tuesday will allow more patients to enlist help from the Texas Department of Insurance to negotiate lower bills from hospital-based doctors who are not “in network.” (Garrett, 8/27)

Los Angeles Times: Judge Halts Counties' Lawsuit Against 5 Narcotic Drug Manufacturers
A judge halted a government lawsuit Thursday against five of the world's largest narcotics manufacturers in spite of an impassioned plea by Orange County Dist. Atty. Tony Rackauckas that the companies pay for the damages of a prescription drug epidemic. The ruling came in a suit filed last year by Orange and Santa Clara counties accusing the companies of fraudulently marketing addictive painkillers to undermine the effect of warning labels required by the U.S. Food and Drug Administration. The counties say that the efforts boosted sales of the dangerous drugs at the expense of public health. The companies say that the claims are unfounded. (Girion, 8/27)

MinnPost: Will St. Paul Let People Inc. Move A Crisis Center To An East Side Convent
We're just hours away from knowing if People Incorporated, a community mental health provider, is allowed to move one of its three short-term crisis centers from the Midway area of St. Paul to a vacant convent on the the east side. It would help the organization serve more people. But there are questions — zoning questions, parking questions, safety questions. Nimby questions. The St. Paul City Council will take it up tonight (Wednesday, Aug. 26). Right now it looks about 50-50. People Incorporated, which operates more than 60 programs in seven counties, sure would like to make the move. (Wahlberg, 8/26)

The Associated Press: Chairman Promises Review Of Unspent Charity
Nearly $10 million in charitable donations by California taxpayers sat unspent in government accounts at the end of last year, The Associated Press has found, and the Senate Governance and Finance Committee chairman said Thursday that he wants a review of state accounts and will hold a hearing to find out why the money hasn’t been spent. ... The money was donated by Californians when they filed their tax returns and was supposed to go for causes such as cancer research and to help sea otters. ... Health agencies never used funding for a colorectal cancer prevention program, promoted by Erin Stennis, a Culver City woman who lost her husband to colon cancer in 2003. In 2005, Gov. Arnold Schwarzenegger signed legislation sponsored by Stennis’ family foundation creating a tax checkoff fund that raised $237,000 for colorectal cancer screenings, with a focus on African-Americans who are disproportionately killed by the disease. Not a single dime has been spent on cancer prevention. (Nirappil, 8/27)

The New York Times: Brisk Business At Bronx Hotel, Center Of Legionnaires’ Outbreak
The Opera House Hotel had to turn off its air-conditioning one hot day this month so that a cleaning crew could scrub away the Legionella bacteria lurking in the cooling tower on its roof. ... Not much else has changed at the hotel at the center of the worst outbreak of Legionnaires’ disease in the city’s history. Business has been, if anything, a little brisker. Occupancy rates have hovered between 90 and 95 percent for the past two months, slightly higher than a year ago, the management said. An online reservation system showed the hotel was completely booked for this Saturday, and for four nights in September. (Hu, 8/27)

NPR: Help Wanted: Last Pediatrician On Mendocino Coast Retires
For more than 35 years, Mahon examined patients day in and day out at his small clinic, next to Mendocino Coast District Hospital, the only hospital for miles. He handled everything from regular checkups to broken bones to very sick kids who might need a spinal taps or IV treatment. He got to know families closely. Going anywhere in town almost certainly involved bumping into a former patient. Now [Dr. Bill] Mahon is mostly retired. (Romero, 8/27)

The Associated Press: Things Are Looking Up For Massachusetts Hospitals
A new analysis has found that Massachusetts' 62 hospitals had combined earnings of $1.2 billion last year and all but eight finished the year in the black. The report released Wednesday was conducted by the state's Center for Health Information and Analysis. Eight hospitals posted losses in 2014, down from 11 the previous year. The center's executive director says the numbers show that the state's hospitals are adopating to the new realities of the health care system that include fewer patient admissions, more competition and pressure to be more efficient. (8/27)

The Baltimore Sun: Trauma Training Aims To Help City Employees In Dealing With Public
Stanley Smith has spent nearly four decades helping troubled young people earn GEDs and get jobs, but he learned something new this week that he thinks will help him do his job even better. Smith, an employment advocate with the Mayor's Office of Employment Development, was among 150 Baltimore city employees who sat through training on how to recognize, understand and respond to people who have experienced some form of trauma. As the city faces a surge of violent crime, Mayor Stephanie Rawlings-Blake has made it a priority to get city workers at all levels to better understand the residents they serve and why they may be behaving the way they are. (McDaniels, 8/27)

North Carolina Health News: UNC Study Finds Rural Medicare Recipients Less Likely To Receive Follow-Up Care
A team of UNC-Chapel Hill researchers has found Medicare patients in rural areas are less likely to receive adequate follow-up care after leaving the hospital than patients in urban areas. As a result, they may well be at greater risk of winding up back in the hospital or the emergency room soon after discharge. Matthew Toth, now a research public health analyst at RTI International, was lead author of the study, conducted while he was earning a doctorate in health policy and management at UNC’s Gillings School of Global Public Health and serving as a research assistant with the Cecil G. Sheps Center for Health Services’ N.C. Rural Health Research Program. (Sisk, 8/27)

Health Policy Research

Research Roundup: Palliative Care; Increasing Cost Of Insulin; Health Coverage For Prisoners

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

The New England Journal of Medicine: Palliative Care For The Seriously Ill
Palliative care is the interdisciplinary specialty focused on improving quality of life for persons with serious illness .... Over the past decade, the field has undergone substantial growth and change, including an expanded evidence base [and] new care-delivery models .... The core components of palliative care include the assessment and treatment of ... symptoms, identification of and support for spiritual distress, expert communication to establish goals of care and assist with complex medical decision making, and coordination of care. Ideally, many of these components can and should be provided by primary treating clinicians .... most physicians and other health care professionals ... have had limited or no formal training in these areas. The following sections highlight key concepts and recent developments in palliative care practice. (Kelley and Morrison, 8/20)

JAMA Internal Medicine: Trends In Medicaid Reimbursements For Insulin From 1991 Through 2014
Newer, more expensive insulin products and the lack of generic insulins in the United States have increased costs for patients and insurers. ... In the 1990s, Medicaid reimbursed pharmacies between $2.36 and $4.43 per unit [1 mL of insulin]. By 2014, reimbursement for short-acting insulins increased to $9.64 per unit; intermediate, $9.22; premixed, $14.79; and long-acting, $19.78. Medicaid reimbursement for rapid-acting insulin analogs rose to $19.81 per unit. The rate of increase in reimbursement was higher for insulins with patent protection ($0.20 per quarter) than without ($0.05 per quarter) .... Total Medicaid reimbursements peaked at $407.4 million ... in quarter 2 of 2014. ... Our findings suggest a lack of price competition in the United States for this class of medications. (Luo, Avorn and Kesselheim, 8/24)

Health Affairs: Aligning FDA And CMS Review
Both the Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid Services (CMS) play a critical role in the development and uptake of new medical technologies. ... The FDA approves drugs and devices based on evidence that the product is "safe and effective," whereas CMS makes coverage determinations based on whether the product is "reasonable and necessary." In practice, this has created two separate evidentiary hurdles for some product sponsors, which can lead to substantial delays or limitations in patient access or can even block market entry. ... Two initiatives have the potential to help address this bottleneck: parallel review and coverage with evidence development (CED). However, implementation of these two programs has been slow and somewhat piecemeal, and they have yet to reach their full potential. (Richardson, 8/27)

Centers for Disease Control and Prevention/Mortality and Morbidity Weekly: QuickStats: Percentage Of Adults Aged 19–25 Years With A Usual Place Of Care, By Race/Ethnicity — National Health Interview Survey, United States, 2010 And 2014
From 2010 to 2014, the percentage of persons aged 19–25 years who had a usual place to go for medical care increased for Hispanics (50.7% to 65.1%) and non-Hispanic blacks (65.4% to 74.3%). In 2010, among persons aged 19–25 years, non-Hispanic blacks (65.4%) were less likely than non-Hispanic whites (73.0%) to have a usual place to go for medical care; however, in 2014, no significant difference between the two groups was found. In 2010 and 2014, Hispanic adults aged 19–25 years were the least likely to have a usual place to go for medical care. (Martinez, Ward and Adams, 8/21)

National Health Law Program/The Kaiser Family Foundation: State Medicaid Eligibility Policies For Individuals Moving Into And Out Of Incarceration
Many individuals in prisons and jails have significant physical and behavioral health care needs, but lack health insurance and regular access to care. ... Medicaid coverage for individuals moving into and out of incarceration may help increase their access to care and improve their health status, and thus contribute to broader benefits. Enrolling these individuals in Medicaid may also contribute to state savings. ... this brief highlights how state eligibility policies for incarcerated individuals differ, based on a review of state statutes, regulations, Medicaid eligibility manuals and other Medicaid agency guidance publicly available online and Medicaid managed care contracts. (McKee et al., 8/4)

Here is a selection of news coverage of other recent research:

Reuters: Women, Minorities Still Underrepresented In Medical Specialties
Too few women and minorities are entering certain medical specialties in the U.S., researchers say. Diversifying the physician workforce may be key to addressing health disparities and inequities, Dr. Curtiland Deville of Johns Hopkins University in Baltimore, Maryland, who worked on the study, said in an email. "Minority physicians continue to provide the majority of care for underserved and non-English speaking populations,” Dr. Deville added. Yet "in no specialties . . . were the percentages of black or Hispanic trainees comparable with the representation of these groups in the US population," he and his colleagues wrote in JAMA Internal Medicine. (Brooks, 8/24)

Reuters: Veterans Discharged For Misconduct Have Higher Risk Of Homelessness
U.S. veterans returning from Afghanistan and Iraq who were discharged due to misconduct are more likely to be homeless than other returning vets, according to a new study. “The most significant finding was that 26 percent of veterans who were separated for misconduct-related reasons were homeless at their first VA encounter; and this number climbed to 28 percent within one year after their first VA encounter,” said lead author Dr. Adi V. Gundlapalli of the VA Salt Lake City Health Care System. (Doyle, 8/25)

The New York Times: School Lunches Becoming Healthier, Statistics Indicate
The humble school lunch — the staple of most every American child’s diet — has become healthier. That was the conclusion of new federal data released Thursday that showed that the nutritional profile of meals in the nation’s public schools had improved substantially since higher government standards went into effect in 2012. (Tavernise, 8/27)

Reuters: Use Of Statins Rising Among Very Elderly
Between 1999 and 2012, the use of cholesterol-lowering statin drugs increased among people over age 79 with no history of coronary heart disease, stroke or vascular disease, according to a new study. People who have had a heart attack, stroke or diabetes are often prescribed a statin like atorvastatin (Lipitor) to reduce their risk of another event in the future, but there is little evidence for using the drugs preventively in the oldest old who have not had a heart attack or stroke, the authors write in a research letter in JAMA Internal Medicine. (Doyle, 8/25)

Reuters: Spouses Of Stroke Survivors Face Lingering Health Issues
Spouses of stroke survivors may themselves face lasting mental and physical health issues, according to a new study. These caregiver spouses are at an increased risk of mental and physical health issues even seven years after their care recipient’s stroke, said lead author Josefine Persson, a Ph.D. candidate at Sahlgrenska Academy, University of Gothenburg, Sweden. (Doyle, 8/26)

Reuters: Endometrial Cancer On The Rise In U.S., Black Women Most At Risk
Endometrial cancer is becoming more common in the U.S. and black women appear more likely to get the most aggressive types of tumors and die from the disease, a new study suggests. Researchers analyzed cancer registry data from 2000 to 2011 and found incidence rates for endometrial tumors increased among all racial and ethnic groups. But for white women, the increase was less than one percent overall, compared with 1.8 percent for Hispanic women and 2.5 percent for black and Asian women. (Rapaport, 8/19)

The Chicago Tribune: Pain Relievers May Factor Into Cancer Protection
Regularly taking low-dose aspirin or other common pain relievers may lower long-term risk of colon cancer, new research suggests. Men and women who took low-dose (75 to 150 milligrams) aspirin for five years or more saw their risk of colon cancer drop by 27 percent. And taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for that long was linked to a 30 percent to 45 percent drop in colon cancer risk, the study found. (Mozes, 8/25)

Reuters: Military Kids May Be More Apt To Smoke, Drink And Carry Guns
Teens with parents or caregivers in the military may be more likely to drink, smoke, and carry weapons than other kids, a U.S. study suggests. Researchers also found that adolescents with close ties to the military were more apt to be victims of physical violence and harassment. (Rapaport, 8/17)

Medscape: Delivery Outcomes Similar With Family Doctors, Obstetricians
For pregnant women who are at low risk for delivery complications, newborn and maternal outcomes are similar for obstetric deliveries by family physicians and obstetricians, according to a retrospective, population-based cohort study published online August 24 in the Canadian Medical Association Journal. (Barclay, 8/25)

Editorials And Opinions

Viewpoints: Improving Drug Prices; Bundling Payments For Hip And Knee Replacements

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

Los Angeles Times: Here's Why Drugmakers Are Held In Low Esteem
Are you befuddled by the cost of prescription drugs? There may be a legitimate reason. "It's certainly not an efficient market," Jason Doctor, an associate professor of pharmaceutical and health economics at USC, said about prescription drug prices. ... According to a recent study by Consumer Reports, one-third of patients said the cost of their usual prescription rose $39 on average over the last year. ... Among the drugs that saw the biggest jumps in prices were treatments for common ailments such as asthma, high blood pressure and diabetes. I asked about a dozen experts whether the drug market was rigged against consumers. The answer, surprisingly, was no. But they said there were steps that could be taken to improve things. (David Lazarus, 8/28)

Los Angeles Times: Ohio's Nonsensical Attack On Abortion Rights
A bill in the Ohio Legislature that would ban a woman from having an abortion solely because of a prenatal diagnosis of Down syndrome is blatantly unconstitutional and probably unenforceable. The bill, still winding its way through the Ohio House of Representatives, would make it a felony for a doctor to perform an abortion if he or she knows the pregnant woman is seeking the procedure to avoid having a baby with Down syndrome. It would also require the state to revoke the doctor's license if the procedure were conducted. (8/27)

The Washington Post: Robbing The Victims Of Lead Paint Poisoning
You know there is something terribly wrong with an industry when even those who profit from it concede the need for stricter rules and more oversight. Such is the situation in Maryland’s little-regulated world of structured settlement buyouts. People terribly damaged in childhood by lead paint poisoning are being robbed of the compensation that is supposed to sustain them. State lawmakers need to enact true protections, and those who have been complicit in exploiting these vulnerable people, including judges who have enabled opportunistic businesses, should be held accountable. (8/27)

Tampa Bay Times: Expanding Medicaid Would Have Been Wrong Move
My organization, Americans for Prosperity, recently launched television and digital advertisements thanking state legislators for not expanding the Affordable Care Act. This paper responded with a critical editorial and some questionable claims about the federal money Florida is supposedly giving up. More importantly, the Times conflated Medicaid expansion with increased access to quality health — a claim they offer no facts to support. The cost of expanding Medicaid by 800,000 enrollees would be immense. Nearly every state that has expanded has experienced massive cost overruns. (Chris Hudson, 8/27)

news@JAMA: Insurers Are Once Again At Odds With Hospitals And Physicians
The longest running battle in medical care is heating up again. I refer, of course, to the struggle between insurers and physicians, hospitals, and pharmaceutical companies. In recent weeks, Aetna and Humana announced their intention to merge, as did Anthem and Cigna. If these mergers go through, the “big 5” health insurers will be down to the “big 3.” Physicians and hospitals were not happy with the news. “Given the troubling trends in the health insurance market, the AMA believes federal and state regulators must take a hard look at proposed health insurer mergers,” said Steven J. Stack, MD, the group’s president, in a statement. ... For their part, the insurers argue that consolidation on their end is needed, among other reasons, to combat the growing size of medical groups and health care facilities. (David Cutler, 8/27)

The New England Journal of Medicine: Mandatory Medicare Bundled Payment — Is It Ready For Prime Time?
In July, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule for a new Comprehensive Care for Joint Replacement (CCJR) program. The program would establish bundled payments for total hip and knee replacements, covering hospitalizations, professional fees, and all clinically related Medicare Part A and Part B services for 90 days after discharge, including skilled nursing facility care, home care, and hospital readmissions. ... CMS proposes implementing the 5-year program in 75 metropolitan statistical areas with approximately 750 hospitals beginning January 1, 2016. ... without risk adjustment, some hospitals will question the mandate to participate unless CMS offers additional financial protection. (Robert E. Mechanic, 8/26)

The Baltimore Sun: Cancer Cuts Are Too Deep
The Centers for Medicare and Medicaid Services recently unveiled proposed changes to their payment approach for cancer care services delivered to American seniors. Hidden within the complicated language and updated payment codes lies a harsh reality for community-based oncology centers and, more importantly, the patients we serve. ... the proposed physician fee schedule for 2016 would cut payments to freestanding radiation facilities by 6 percent next year. This is on top of cuts to freestanding centers that have totaled nearly 20 percent over the last decade. (Denise Gooch, 8/27)

The Baltimore Sun: Why Do Poor Kids Get More Cavities?
Despite decades of community water fluoridation, fluoride toothpaste use, improvements in nutrition and hygiene education, dental caries — also known as cavities — remain the most common childhood disease in America. They lead to pain, infections, nutritional deficits, lack of sleep, poor concentration, slower physical growth and a loss of about a dozen school hours per child. Families with incomes below the federal poverty line — often families of color — experience twice the incidence of dental caries compared with higher earning families. Part of the problem is that they're not receiving the treatment they need. A quarter of all children from low income families have not seen a dentist before kindergarten, according to the National Institute of Dental and Craniofacial Research. (Sarah Uehara, 8/27)

The New England Journal of Medicine: Invisible Colleagues
[Ms. F and I] share a place of work: she as a janitor, and I, a resident. ... Shortly after I met Ms. F., she spent 2 months in a nearby homeless shelter because of financial insecurity brought on by her father's death. She continued to work during that time, earning about $12 per hour, similar to the income of many janitors at Maryland teaching hospitals. Today, she and her family have their own place, and she connects the dots between public assistance programs to satisfy their basic needs. ... Ms. F.'s story runs contrary to the purported mission of my academic medical center — and probably most others. We claim ... we seek to improve the health of our communities. ... The people who live near and work in these institutions appear to have no place in these missions: they are not celebrated as our colleagues, nor can they afford to be our patients. (Benjamin J. Oldfield, 8/27)