KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Kaiser Health News Original Stories

Health Law Issues And Implementation

Officials Announce Health Plan Sign-Ups Outpace Goals And Include 4M New Customers

The Department of Health and Human Services says 12.7 million people signed up for a policy through the health law's marketplaces during the regular enrollment season.

The New York Times: Health Care Signups Exceed Hopes, With 4 Million Newcomers To Federal Marketplace
About 12.7 million people signed up for health insurance under the Affordable Care Act or had their coverage automatically renewed in the third annual open enrollment season. Sylvia Mathews Burwell, the secretary of the Department of Health and Human Services, said the signups exceeded her goals and her expectations. “Open enrollment for 2016 is over, and we are happy to report it was a success,” she said. Most of the plan selections were for people in the 38 states — more than 9.6 million — who used the federal website, The other 3.1 million people were enrolled in states that run their own marketplaces. (Pear, 2/4)

Reuters: U.S. Signs Up 12.7 Million Americans For Obamacare Health Insurance
On, about 4 million new customers signed up for plans and another 5.6 million consumers returned to buy insurance again, U.S. Health and Human Services Secretary Sylvia Burwell told reporters on a call. In all, about 2.7 million people aged 18 to 34 signed up for the insurance, she said. Customers who are younger tend to have fewer medical costs and are considered an important factor in creating financial stability for the private health insurers like UnitedHealth, Aetna Inc and Anthem Inc that sell these plans. (Humer, 2/4)

The Wall Street Journal: Federal Health-Care Enrollees Exceed Goals
Top administration officials said they were especially excited to see 4 million first-time users of among the total, suggesting they had done better than expected in signing up those uninsured who may have been hard to win over. “We knocked the lights out this year,” said Kevin Counihan, the chief executive officer for the federal website and head of the Centers for Medicare and Medicaid Services unit charged with implementing the health law. (Radnofsky, 2/4)

USA Today: Nearly 13 Million People Enrolled In ACA Plans For 2016
Supporters of the law were expecting an uptick in enrollment after a strong December and the typical lull over the holidays. About 700,000 people signed up in the last week of January, compared to more than 1 million in the last week of enrollment last year. Andrew Slavitt, CMS' acting adminstrator, said that was still a strong week and reflected the agency's efforts to move more of the signups into December, which allowed people to start their policies Jan. 1 and gives insurers more time to see who their new clients are. More than 60% of new enrollees signed up for Jan. 1 coverage, Burwell said. (O'Donnell, 2/4)

The Washington Post: Affordable Care Act Enrollment Grows Modestly This Year, To 12.7 Million
[T]he latest numbers provide important signs of how the exchanges, a major feature of the 2010 health-care law, are functioning now that they are no longer new. The figures show that most repeat customers heeded warnings by HHS officials that they should return to to shop for the best available health plan if they wanted to avoid sticker shock. On the federal exchange, nearly 7 in 10 repeat customers shopped for coverage rather than let the computer system renew them automatically, and about three-fifths of those switched plans. Last year, nearly half let the computer system auto-enroll them. (Goldstein, 2/4)

CNN Money: 12.7 Million Americans Sign Up For Obamacare 3.0
Some 12.7 million Americans signed up for Obamacare for 2016, according to new figures released Thursday. Sign ups exceeded the Obama administration's initial projection that 10 million people would be enrolled by year's end, though that figure was widely seen as too modest. A large chunk of those who signed up during open enrollment will drop out over the course of the year, either because they'll find insurance elsewhere or they will stop paying their premiums. (Luhby, 2/4)

The Associated Press: Obama Health Care Law Posts Respectable Sign-Up Season
Still facing political jeopardy, President Barack Obama's health care law beat expectations by earning solid sign-ups this year, according to figures released Thursday by the administration. About 12.7 million people signed up for individual private insurance policies or renewed their coverage for 2016, said Health and Human Services Secretary Sylvia M. Burwell. That means Republicans running in this year's elections may find it harder to deliver on their promise of repeal, while Democrats may yet be able to tap the newly insured as a voting constituency. (Alonso-Zaldivar, 2/4)

Kaiser Health News: 2016 Obamacare Enrollment Tops Expectations At 12.7 Million
The annual Obamacare enrollment numbers routinely draw debate. Supporters boast that millions of people have gained coverage. Republican detractors stress millions remain uninsured because they can’t afford coverage and that not enough healthy young adults are enrolling. The latter issue threatens to make coverage uneconomical for insurers, causing them to lose money and raise prices or drop out of the exchanges. (Galewitz, 2/4)

Modern Healthcare: ACA Enrollment Pleases HHS. Insurers Will Be Tougher Crowd.
During the past several months, insurance executives and state officials have publicly griped about the state of the exchanges. UnitedHealth Group opened the charge in November when it said it may exit the ACA's marketplaces due to heavy losses. UnitedHealth, which expects to lose approximately $1 billion on its 2015 and 2016 exchange plans, blamed several elements, including what it called loose rules for special enrollments. The for-profit insurer will make a determination in the next several months. Aetna and Anthem also have voiced concerns, saying their margins are running below expectations and that the risk pool skews toward older, higher-cost patients. (Herman, 2/4)

Florida Leads States In Enrollment On Health Law Marketplaces

According to the information released by officials, 1.7 million Florida residents signed up for coverage on the exchanges. California was close behind with nearly 1.6 million. News outlets also report on enrollment numbers in Texas, Georgia, Wisconsin, Arizona, Indiana, Oregon and Delaware.

Tampa Bay Times: When It Comes To Obamacare Sign-Ups, Tampa Bay Keeps Its Top 10 Ranking
Tampa Bay remained among the top regions in the nation for Obamacare sign-ups in 2016, according to figures released Thursday by the Centers for Medicare and Medicaid Services. More than 284,000 local residents chose health insurance plans on the Affordable Care Act marketplace during the open enrollment period that ended Jan. 31. Only seven metropolitan areas in states using a federally run exchange enrolled more people .... Florida once again led all states using a federally facilitated marketplace with 1.7 million enrollees. (McGrory, 2/4)

California Healthline: Another 425,000 Sign Up For Covered California
More than 425,000 Californians have signed up on the state’s health insurance exchange — with nearly 100,000 rushing to enroll in the last four days before the 2016 open enrollment period ended Jan. 31, officials said Thursday. The exchange, Covered California, had estimated it would attract between 295,000 and 450,000 new enrollees during its third open enrollment season since the Affordable Care Act took effect. In addition to the new enrollees, about 1.15 million existing consumers re-upped this year, officials said, for a total of about 1.57 million. (Feder Ostrov, 2/4)

The Associated Press: Covered California Adds 425,000 Under Obama Health Law
Covered California, the state-run health-insurance exchange created under the federal Affordable Care Act, said young adults are making up a growing share of new enrollees. Strong enrollment by young people is crucial to the success of Obama's health overhaul because they use less health care, keeping costs lower for everyone. (Cooper, 2/4)

Houston Chronicle: 1.3 Million Texans Enroll In ACA Insurance
With the 2016 Affordable Care Act enrollment now complete, Texas has exceeded expectations and signed up a record 1.3 million people for health insurance through the federal marketplace, final U.S. Department of Health and Human Services numbers released Thursday show. The Texas tally is almost exactly 100,000 more than the 1,205,174 enrolled for 2015. About 346,000 signed up in the Houston area. (Deam, 2/4)

The Milwaukee Journal-Sentinel: Number Of Wisconsin Residents Enrolled In Obamacare Climbs 16%
The third open-enrollment period for the Affordable Care Act ended with 239,034 people in Wisconsin enrolled in health plans sold on the federal marketplace, a 16% increase from the same point last year, the federal government said Thursday. Those figures include 89,480 people in the Milwaukee area, a 72% increase from the 52,115 people at the end of the open-enrollment period last year. (Boulton, 2/4)

Indianapolis Star: Medicaid Expansion Draws Hoosiers From Obamacare
Fewer Hoosiers used the federal health exchange to get insurance this year than did last year, the federal government reported Thursday. The U.S. Department of Health and Human Services said 196,242 Hoosiers selected a 2016 plan through the open enrollment period that ended Jan. 31. That compares with 219,185 Hoosiers who selected a 2015 plan during last year’s open enrollment period. ... The drop in Indiana is because some switched their coverage to Medicaid after Indiana expanded eligibility last year, according to federal and local officials. (Groppe, 2/5)

The Oregonian: Oregonians Using Federal Health Care Website To Enroll Jumps 30 Percent
Open enrollment has ended with a 30 percent spike in the number of Oregonians signing up for health insurance on the federal website. More than 147,000 people signed up on by Jan. 31, when open enrollment ended. The website handles those seeking tax credits. According to the Oregon Department of Consumer and Business Services, 70 percent of those who enrolled this year qualified for tax credits, averaging $256 a month. (Terry, 2/4)

The Associated Press: State Officials Say Insurance Exchange Enrollment Numbers Up
State officials say figures provided by the federal government show that more Delawareans are selecting health care coverage under the Affordable Care Act. Sunday was the open enrollment deadline to sign up for exchange coverage this year. Federal officials reported Thursday that more than 28,250 people selected plans on Delaware’s exchange, either by signing up or through automatic renewals. (Chase, 2/4)

N.H. Governor Presses For Extension Of Medicaid Expansion To Help Fight Opioid Crisis

Gov. Maggie Hassan says it is important for those fighting drug addiction to have access to treatment. In other Medicaid expansion news, the Alaska legislature's lawsuit against the governor's plan has a day in court, and some Montana enrollees are finally getting necessary medical services.

New Hampshire Union Leader: Hassan In State Of State Address: NH Is In A Strong Position
[Hassan] said Medicaid expansion is essential in the fight against the drug addiction crisis. “Addiction is a disease, and we must ensure that those afflicted with addiction can access services to treat this illness, just as we would for any other chronic condition,” Hassan said, praising the Senate for approving bills Thursday to expand drug courts, provide law enforcement grants and upgrade the drug monitoring program. (Rayno, 2/4)

KTVA (Anchorage, Alaska): Judge Hears Arguments In Medicaid Expansion Case, Says No Decision Until March
Anchorage Superior Court Judge Frank Pfiffner heard oral arguments from attorneys representing the State of Alaska as well as the Legislative Council, the Republican-dominated group representing the legislature suing the Governor. Both sides agreed the case was not about the merits of expanding medicaid coverage to thousands of vulnerable Alaskans, but whether the governor had the legal right to accept federal funding for the expansion without a vote from the legislature. (Maxwell, 2/4)

Alaska Dispatch News: Legislature's Medicaid Expansion Lawsuit Inches Forward
A lawsuit to halt Gov. Bill Walker’s Medicaid expansion inched forward Thursday morning as both sides made their cases in Superior Court, with the judge telling them not to expect a decision until the end of March. Each side was given 45 minutes to make their case. While both sides made a variety of arguments, they also agreed with Judge Frank Pfiffner that the case centers on the definition of one word in the state Medicaid statute: “requires.” The law in question says, “All residents of the state for whom the Social Security Act requires Medicaid coverage are eligible to receive medical assistance.” (Andrews, 2/4)

Great Falls (Mont.) Tribune: Uninsured Now Accessing Care With Medicaid Expansion
For the first time in eight years, Holly Blouch feels like she has a chance. The 37-year-old from Kalispell is one of the 27,000 Montanans who now has health insurance because of Medicaid expansion. She’s also eligible for a kidney transplant now that she has the coverage. “I’m trying so hard to get on that list,” she said. ... The expansion of Medicaid coverage in Montana means approximately 70,000 individuals are eligible for coverage, but the state only anticipated 45,000 people would sign up in the first few years, according to Jessica Rhodes, policy director for the Montana Department of Health and Human Services. (Cates, 2/4)

Capitol Hill Watch

Lawmakers Hit Brick Wall As Shkreli Pleads The Fifth At Price Gouging Hearing

The former Turing CEO smirked his way through questions from the committee members who grew increasingly exasperated with his refusal to provide answers about his company's high drug costs.

The New York Times: Martin Shkreli Invokes The Fifth Amendment In House Appearance
Martin Shkreli’s grilling by Congress on Thursday proved to be the spectacle that many had long anticipated. Lawmakers excoriated him. He fidgeted, he smirked, he smiled for the cameras. And he refused to answer questions. Mr. Shkreli, the former chief executive of Turing Pharmaceuticals, who is facing federal securities fraud charges, repeatedly exercised his Fifth Amendment right to avoid self-incrimination, infuriating members of the House Committee on Oversight and Government Reform. (Pollack and Huetteman, 2/4)

STAT: 'It's Not Funny, Mr. Shkreli. People Are Dying.'
Martin Shkreli, the former drug executive who became the poster boy for extreme drug price increases, held his tongue as members of Congress blasted him at a hearing Thursday — but he managed to enrage the lawmakers even more as he smirked his way through the hearing. (Nather, 2/4)

The Wall Street Journal: Martin Shkreli Pleads The Fifth Before Congress
Mr. Shkreli, who gained unwelcome notoriety for a 50-fold increase in the price of one lifesaving medication, stole the show. But beyond the theatrics, the crux of the hearing came in the more serious probing of top executives from Turing Pharmaceuticals AG and Valeant Pharmaceuticals International Inc., as well as Food and Drug Administration officials, on drug costs. The lawmakers sought to better understand the motivation behind drugmakers that acquire the rights to sell long-standing drugs in the U.S. and then inflate the prices, and they also explored what can be done to curb the fast-rising costs. There were lots of questions, few solutions, and some signs of change. (Armour and Rockoff, 2/4)

NPR: House Hearing Probes The Mystery Of High Drug Prices That 'Nobody Pays'
Members of Congress at a Thursday hearing wrestled with questions about why the prices of some old drugs are rising so fast. Once Shkreli left Thursday's hearing, lawmakers grilled other witnesses about rising drug prices. The seemingly simple question about how much Daraprim costs in the real world proved pretty tricky to pin down. (Kodjak, 2/4)

The Wall Street Journal: 5 Things To Know About Today’s Drug-Price Hearing
Substantial price increases for certain drugs have turned the spotlight on industry figures like Martin Shkreli, sparked concerns about the business model of drug company Valeant Pharmaceuticals and triggered Congressional probes. A hearing by the House Oversight and Government Reform Committee on Thursday was watched closely not only by those following the outspoken Mr. Shkreli but many wondering if Congress or regulators might take action to curb drug-price gouging. (Rockoff, 2/4)

Reuters: Shkreli Insults Congress On Twitter After Refusing To Testify
Former Turing Pharmaceuticals Chief Executive Officer Martin Shkreli on Thursday called members of the U.S. Congress "imbeciles" on Twitter, moments after he refused to testify before a House of Representatives committee on why his company raised the price of a lifesaving medicine 5,000 percent. "Hard to accept that these imbeciles represent the people in our government," said Shkreli, using his @MartinShkreli Twitter handle. (Burns, 2/4)

Politico: Martin Shkreli Calls Lawmakers 'Imbeciles'
The drug industry’s most notorious CEO pleaded the Fifth Amendment before Congress on Thursday and then promptly called lawmakers "imbeciles" on Twitter. The appearance of the hoodie-wearing, hip-hop-loving indicted millennial multimillionaire created congressional theatrics — even though the usually chatty businessman, who showed up Thursday wearing a suit and no tie, stayed silent during the House hearing. Democrats, including the presidential contenders, portray Shkreli as the face of an industry that increasingly puts profit above patients. Republicans, who oppose more government intervention in health care, depict him as a “bad apple,” an outlier besmirching an industry dedicated to life-saving innovation. (Karlin, 2/4)

The Wall Street Journal: Valeant Needs More Volume Amid The Noise
Valeant Pharmaceuticals International emerged from a congressional grilling over its pricing policies with its share price intact. Questions about Valeant’s business model will still linger. It is an understatement that Thursday’s House Oversight Committee hearing was uncomfortable to watch. For instance, Rep. Buddy Carter (R., Ga.) told representatives of Valeant and closely held Turing Pharmaceuticals that he found their companies’ conduct “repulsive.” Valeant interim CEO Howard Schiller acknowledged the company had made mistakes in its past. (Grant, 2/4)

Campaign 2016

Clinton, Sanders Wage War Over Progressive Label At Debate

In their first one-on-one debate, the two Democratic primary candidates clashed over health care, ties to pharmaceutical companies and more.

The New York Times: In Democratic Debate, Candidates Clash On Money’s Role
From its opening moments, the [Democratic] debate devolved into a series of searing exchanges over one overarching theme: which of the two Democrats was the most progressive. On one level, the debate was over semantics: The candidates share a similar worldview about aggressive government support for universal health care, public education and aid to the poor, and both of them used the word “rigged” to describe the American economy. But they kept putting their own personal spin on the word “progressive,” with Mrs. Clinton deriding Mr. Sanders as the “self-proclaimed gatekeeper for progressivism” and accusing him of judging her unfairly. Rebutting Mr. Sanders’s claim that she is a political moderate. (Martin and Healy, 2/4)

Politico: Clinton And Sanders Get Ugly
After pledging early on to not engage in any negative attacks on his rival, Bernie Sanders has more pointedly called out Clinton for her record and used the poison “E” word – establishment. “What being part of the establishment is, is, in the last quarter, having a super PAC that raised $15 million from Wall Street, that throughout one's life raised a whole lot of money from the drug companies and other special interests,” he said. And he dismissed Clinton’s notion that his proposals for free college and universal healthcare are progressive, but not possible. “Now all of the ideas that I'm talking about, they are not radical ideas,” he said. (Debenedetti, 2/4)

Los Angeles Times: Clinton And Sanders Vigorously Spar In New Hampshire Debate, A Sign Of Things To Come
Clashing one-on-one for the first time, in a Thursday night debate a day after a New Hampshire town hall, the more than two hours of jostling — over healthcare, Wall Street regulation, what it means to be a true progressive — came down to a fundamental question: Do Democrats want ground-shaking change after eight years in control of the White House, as Sanders promises, or mere refinement of the programs and policies that President Obama put into place, as Clinton suggests? (Barabak and Halper, 2/4)

The Washington Post: Democratic Candidates Exhibit A New Ferocity In Last Debate Before N.H. Vote
Clinton used her opening statement to needle the senator from Vermont, who describes himself as a democratic socialist, over what she has contended are unrealistically liberal plans for universal health care, free college and other programs. “I’m fighting for people who cannot wait for those changes, and I’m not making promises that I cannot keep,” the former secretary of state said. (Gearan and Tumulty, 2/4)

Modern Healthcare: Sanders Wouldn't Scrap ACA
Democratic presidential candidate Sen. Bernie Sanders of Vermont said at a debate Thursday he would not dismantle the current health insurance system created by the Affordable Care Act while creating his single-payer system. Hillary Clinton said at the debate in New Hampshire, which has its primary Tuesday, that she shares Sanders' wish for universal health insurance coverage but “the disagreement is where do we start from.” (Muchmore, 2/4)

NBC News: Fact Checking The MSNBC Debate
In the first question of the night, [Hillary] Clinton was asked why she thinks [Vermont Sen. Bernie] Sanders' proposed policies would not turn into actual legislation. Clinton said health care was a prime example where Sanders would essentially redo what President Barack Obama had already put into action. (Sotomayor, 2/5)

On the Republican side of the 2016 race, Donald Trump promises to combat high drug prices and John Kasich is taking one last shot at the nomination —

The Wall Street Journal: Trump Vows To Take On ‘Powerful’ Drug Companies, Drive Down Prices
Republican presidential candidate Donald Trump on Thursday vowed to renegotiate the prices Medicare pays for drugs, arguing that pharmaceutical companies had been let off the hook by policymakers in thrall of their campaign contributions. “When it comes time to negotiate the cost of drugs, we are going to negotiate like crazy,” Mr. Trump told a crowd of several hundred people gathered at a town hall-style campaign event here. (Haddon, 2/4)

The Washington Post: Kasich Lays Off Attack Politics, Lays It All On The Line In New Hampshire
The Ohio governor is trying to turn Tuesday’s New Hampshire primary into a test of whether his party has room for a throwback brand of Republicanism. As he travels the state, Kasich is emphasizing fiscal policy and other issues that have long been important to Republicans but have not animated the party base in recent elections. He boasts his centrist credentials, embracing his decision in Ohio to accept more Medicaid funds as part of President Obama’s health-care law. (Kranish, 2/4)

Meanwhile, Kaiser Health News provides a voters' guide to the candidates' claims on health care —

Kaiser Health News: A Voter’s Guide To The Health Law
Nearly six years after its enactment, the Affordable Care Act remains a hot-button issue in the presidential race — in both parties. “Our health care is a horror show,” said GOP candidate Donald Trump at the Republican debate in South Carolina Dec 15. Texas Sen. Ted Cruz, winner of the Iowa caucuses, said at the debate in Des Moines Jan. 28 that the health law has been “a disaster. It is the biggest job-killer in our country.” Democrats largely support the law, but even they can’t agree on how to fix its problems. ... Here is a brief guide to some things the health law has — and has not — accomplished. (Rovner, 2/5)

Administration News

Obama's Proposed Cadillac Tax Tweak Deemed 'Insufficient' By Opponents

"We're glad the administration recognizes the Cadillac tax is seriously flawed. But its impact in high cost areas is just one of its many problems," says James Klein, president of the American Benefits Council, a nonprofit representing employers. And apart from the Cadillac tax change, Reuters lays out what else will be in the president's budget, set to be released on Tuesday.

Bloomberg: 'Cadillac Tax' Tweak Hated By Business Wins Obama No Friends
President Barack Obama is having a tough time winning friends for his Cadillac tax. His plan to dial back the unpopular Affordable Care Act tax on high- cost health plans, to be detailed in the fiscal 2017 budget he'll release Feb. 9, has won him no applause from employers, labor unions or health insurers. The tax still must be repealed, they say, not merely modified. (Keane and Tracer, 2/5)

Reuters: What Will Be In Obama's Final Budget Proposal?
President Barack Obama is set on Tuesday to unveil his budget proposal for fiscal year 2017, his final year in office. But since the Republican-controlled Congress controls the purse strings, much of Obama's budget will likely stay on the drawing board. ... The budget will include three years of federal funding to 19 state governments that passed up an earlier offer to expand Medicaid coverage for more than 4 million low-income people. Obama will [also] ask for tweaks to a tax on certain health insurance plans that is unpopular with labor unions. (Rampton and Rascoe, 2/5)


Anthem Merger Plan Deals Blow To Cigna's Profits

The insurer's profits fell 8.8% in the fourth quarter.

The Wall Street Journal: Cigna Profit Falls 8.8%
Cigna Corp. on Thursday said its fourth-quarter profit fell 8.8% as the health-care provider took a hit from charges related to its proposed merger with Anthem Inc., though revenue increased. The company also gave full-year guidance below analysts’ expectations, saying it expects earnings of $8.85 to $9.25 a share, compared with estimates of $9.30 a share, according to Thomson Reuters. (Steele, 2/4)

Modern Healthcare: Cigna's Profit Slumps; Medicare Suspension Dings Outlook
Fourth-quarter earnings at health insurer Cigna Corp. dropped 9%, but there are bigger questions about how Cigna will rectify the problems in its Medicare Advantage and Part D plans. ... Looking ahead to this year, Cigna projected adjusted earnings per share between $8.85 and $9.25, below previous company and Wall Street expectations. That's because last month, the CMS put a halt to Cigna's Medicare operations. The CMS said in a strongly worded letter (PDF) that “Cigna's conduct poses a serious threat to the health and safety of Medicare beneficiaries” and builds on the insurer's “long-standing history of noncompliance with CMS requirements.” For example, some Medicare Advantage members asked Cigna to cover medical services, but Cigna denied the requests without getting insights from providers. Cigna also stymied the appeals process for people who challenged Cigna's medical determinations, according to the CMS. (Herman, 2/4)

Women’s Health

Zika, Rubella And Abortion: How Health Crises Can Change Public Perception

Before there was the Zika virus, there was German measles, which could lead to birth defects in babies, and it helped flip the abortion conversation in America in the 1960s. Meanwhile, the CDC's new advice for women and drinking sparks outrage, and a Missouri Republican pushes back against calls to end investigations into the sale of fetal tissue.

The Washington Post's Wonkblog: How A Zika-Like Illness Helped Transform American Acceptance Of Abortion
The 23-year-old mother was pregnant with her fourth child when she contracted a dreaded disease. Thousands of women who had been similarly infected had gone on to have children with birth defects ranging from heart problems to blindness to microcephaly, an abnormally small head. Knowing that her baby was likely to suffer from severe disabilities, the young mother, the wife of a construction worker, decided to get an abortion. It was illegal where she lived, but her doctor agreed. ... This wasn’t a reaction to Zika virus, the mosquito borne illness that has rapidly escalated into a public health emergency. It was a reaction to German measles. In 1970. In Minnesota. (Johnson, 2/5)

The Oregonian: CDC Infographic On Women And Drinking Whips Up Viral Dust-Up
A campaign against fetal alcohol syndrome by the Centers for Disease Control and Prevention has whipped up a viral storm. The problem is a poster. It warns that alcohol can cause miscarriages, stillbirths, sudden infant death syndrome and fetal alcohol spectrum disorders. It also says that women who drink can face domestic violence, sexually transmitted diseases and unwanted pregnancies. It's that last bit especially that has sparked outrage, with critics questioning whether the CDC is telling women not to drink. (Terry, 2/4)

NPR: Women Blast CDC's Advice To Use Birth Control If Drinking Alcohol
New advice from the Centers for Disease Control and Prevention aimed at preventing fetal alcohol syndrome has created quite a stir. The CDC estimates that about 3 million women "are at risk of exposing their developing baby to alcohol because they are drinking, sexually active and not using birth control to prevent pregnancy." So the CDC is now advising women to stop drinking if they are trying to get pregnant or not using birth control with sex. That's right, abstain from drinking. (Aubrey, 2/4)

McClatchy: Rep. Vicky Hartzler Of Missouri Rejects Call To End Inquiry Into Abortion Providers
Rep. Vicky Hartzler of Missouri has pushed back against calls from Democrats to end congressional investigations into abortion providers, including Planned Parenthood. Hartzler, a Republican, is on a special House panel investigating whether abortion providers are profiting from the sale of fetal tissue and whether they have violated any federal laws. The panel was formed in October after an anti-abortion group released undercover video of officials from Planned Parenthood discussing how they harvest fetal tissue for medical research. (Wise, 2/4)

Public Health And Education

FDA Announces New Opioid Strategy: 'We're Not Winning The Battle At This Point'

The Food and Drug Administration will now mandate that any new opioid go before an outside committee of experts, unless the product has abuse-deterrent properties, and require more warnings and safety information on drug labels, said Robert Califf, the White House's nominee to direct the FDA. But even with that announcement, three of the senators who have placed holds on Califf's nomination do not plan on removing them, saying the steps "fall short of what is needed."

The Washington Post: ‘We Can Do More,’ FDA Says In Announcing Overhaul Of Approach To Opioid Painkillers
The Food and Drug Administration, which has been criticized as too willing to approve addictive narcotic painkillers and too slow to fight their abuse and overuse, said Thursday that it will overhaul policies addressing the powerful class of drugs. The announcement comes amid an epidemic of prescription drug and heroin overdoses, which now kill more Americans each year than automobile accidents. (Dennis, 2/4)

The Wall Street Journal: FDA Gets Tougher On New Painkillers In Light Of Overdoses
The Food and Drug Administration, hoping to reduce deaths related to the abuse of powerful painkillers, said it would insist that new versions of the drugs get tougher scrutiny and that manufacturers gather evidence about their effects once they are on the market. The changes were announced by Robert Califf, the FDA’s deputy commissioner and the White House’s nominee to become commissioner. (Burton, 2/4)

CQ Healthbeat: FDA Outlines Changes To Opioid Approvals
A week after three senators said they would block the nomination of Robert Califf to lead the Food and Drug Administration over agency policies on opioid painkiller approvals, the FDA announced plans on Thursday to help address the opioid abuse epidemic. The announcement, however, may not change the outlook for Califf. Sen. Edward J. Markey, D-Mass., who along with Sen. Joe Manchin III, D-W.V. and Sen. Kelly Ayotte, R-N.H., has blocked the nomination over this issue, will not lift his hold in light of the announcement, his office said on Thursday. (Siddons, 2/4)

The Hill: Dems 'Not Impressed' With The FDA's Plan To Fight Drug Abuse
A Democratic senator said he will not remove his hold on President Obama's nominee to lead the Food and Drug Administration nominee even after the agency announced a sweeping plan to tackle drug abuse in an effort to sway the senator. Sen. Ed Markey (D-Mass.) said he would continue his hold on Dr. Robert Califf until the FDA agrees to an even wider review of its process of approving prescription painkillers, which are fueling an opioid epidemic in his state and many others. (Ferris, 2/4)

Meanwhile states address the opioid crisis —

The Baltimore Sun: Md. Legislation Would Create Drug-Use Facilities, Decriminalize Possession Of Small Amounts
Nearly 47,000 Americans died from a drug overdose in 2014 — more than from gunshot wounds or car crashes. In Maryland, the governor's office has defined the problem as an "epidemic … destroying lives." Indeed, heroin deaths alone have increased by 186 percent from 2010 to 2015 in the state. Not only are drug related deaths on the rise, so are the associated harms, including: drug-related crime and violence, the spread of HIV/AIDS and Hepatitis C and the financial burden for taxpayers who shoulder the costs of health care and criminal justice. (LaSalle, 2/4)

'Who Shot You?' ER Personnel Could Help Fill Gap On Missing Police Violence Data

With little data available on how many people are shot by police, a criminologist sees potential in emergency departments. Meanwhile, news outlets report on other public health developments related to pain management for newborns, new poultry safety standards, problems with the BMI ratings and a $100-million lawsuit related to the Flint water crisis.

NPR: Could Hospital ERs Provide Missing Data On Police Shootings?
For the past two years, Joseph Richardson has been trying to figure out how to keep young black men with knife and gunshot wounds from turning up again with similar injuries at Prince George's Hospital Trauma Center outside Washington, D.C. Richardson is director of the Violence Intervention Research Project at the trauma center. When these men are admitted, he shows up at their rooms to ask them to take part in his ongoing study on risk factors for repeat violent injuries. Sometimes he finds them handcuffed to a hospital bed, guarded by a police officer or two. Richardson has to walk away. The patients are under arrest and off-limits to him. (Rancano, 2/4)

WBUR: Calls For Better Pain Relief Measures For Newborns, Premature Infants
What could be more heartbreaking than witnessing some of the smallest, sickest babies undergoing painful medical procedures? Yet that’s precisely the population subject to some of the most intrusive prodding and pricking, the “greatest number of painful stimuli” in the neonatal intensive care unit, or NICU. (Zimmerman, 2/4)

The Des Moines Register: Poultry Standards Toughened To Prevent Salmonella
Chicken wings, legs and breasts could be safer to eat as part of new standards finalized Thursday by the federal government. The Agriculture Department said the new measures would reduce salmonella and campylobacter in ground chicken and turkey and raw chicken breasts, legs and wings, preventing an average of 50,000 food-borne illnesses annually. (Doering, 2/4)

Los Angeles Times: BMI Mislabels 54 Million Americans As 'Overweight' Or 'Obese,' Study Says
Good news for some in the high-BMI crowd: A new study from UCLA finds that some 54 million Americans who are labeled as obese or overweight according to their body mass index are, when you take a closer look, actually healthy. The findings, published in the International Journal of Obesity, reveal that employers could potentially saddle people with unfairly high health insurance costs based on a deeply flawed measure of actual health. (Khan, 2/4)

Modern Healthcare: Flint Hospital, State Hit With $100M Lawsuit Over Legionnaires' Outbreak
A $100 million lawsuit has been filed against McLaren Flint hospital and Michigan Gov. Rick Snyder on behalf of four patients who allegedly contracted Legionnaires' disease while being treated at the hospital. The plaintiffs in the case (PDF) say they contracted the bacterial pneumonia shortly after being treated at McLaren Flint between 2014 and 2015. In mid-2014 Flint changed its water supply from Lake Huron to the Flint River, whose water is now understood to be so corrosive that it leached unsafe levels of lead from the city's water pipes. (Rubenfire, 2/4)

And in consumer cost news —

State Watch

Democratic Senators In Iowa Press Bill To Stop Medicaid Privatization

But Republican leaders of the House say they are not interested in considering the measure. News outlets also look at Medicaid news in Virginia and Kansas.

Des Moines Register: Iowa Senate To Pass Medicaid Privatization Repeal
Iowa Senate Democrats say they will approve a bill next week to repeal Gov. Terry Branstad's plan to privatize Iowa's Medicaid program. However, House Republicans are signaling that the measure will be dead on arrival when they receive it. ... The state-federal Medicaid health insurance program serves about 560,000 low-income and disabled Iowans at a cost of about $4.2 billion annually. Branstad, a Republican, has pushed for outside management of Medicaid to control costs and improve patient outcomes. But the scheduled Jan. 1 implementation of the change was delayed by federal officials until at least March 1 because of numerous problems that have arisen. (Petroski, 2/4)

Iowa Public Radio: Democrats: Repeal Medicaid Privatization
Democrats say privatizing Medicaid will disrupt long-standing relations between patients and providers and compromise patient care. Their bill would cancel the contracts with three for-profit, out of state companies chosen to manage the program. Democrats report numerous complaints from Medicaid patients and their families. Republican House Speaker Linda Upmeyer is also hearing from constituents. “I’m hearing people with questions and the reason we’re having so many questions is because we’re spending our time protecting the status quo instead of moving forward,” Upmeyer says. “Any change is a challenge for all of us.” (Russell, 2/4)

The Associated Press: Iowa Democrats Propose Bill To End Medicaid Privatization
Republican House Speaker Linda Upmeyer said the bill would have no chance of passing in her chamber and that she is disappointed that opponents continue to fight Branstad's privatization plan. "I'm certainly not interested in passing any bill that faces a certain veto, so that's probably not something we'll do," she said. Upmeyer said the current Medicaid system continually uses up more state funding and has problems because it doesn't focus on wellness, chronic disease management and making people better. (Pitt, 3/4)

Modern Healthcare: Virginia Seeks Medicaid Waiver To Use Managed Care; Won't Renew Duals Demo
Virginia has submitted a waiver to transform its Medicaid program and move the state's most vulnerable populations into managed care. The 1115 waiver seeks approval from the CMS to implement two initiatives. The first is to transition blind, elderly and disabled people into capitated health plans. This group includes individuals dually eligible for Medicaid and Medicare. As a result the state plans to allow a demonstration it now has to coordinate care for duals to end next year. The second part of the waiver requests a Delivery System Reform Incentive Payment program to allow the state to use federal Medicaid funding to create financial incentives for providers to pursue delivery-system reforms. (Dickson, 2/4)

State Highlights: Massachusetts Insurers List 2016 Issues To Watch; Drug Transparency Measure Stalls In Virginia Assembly

New outlets report on health care developments in Massachusetts, Virginia, Kansas, Iowa, California, Illinois, Texas and Missouri.

The Boston Globe: Three Health Insurance Issues To Track In 2016
Health care costs in Massachusetts are among the highest in the nation, and they’re continuing to rise. Against that backdrop, representatives from several major health insurance companies convened Thursday to share their outlooks for the year. Their comments came at a forum in Newton, organized by the New England Employee Benefits Council, an association of employee benefits professionals. (Dayal McCluskey, 2/4)

The Associated Press: Drug Price Transparency Bill Fails; Set For Further Study
Legislation to make drug makers reveal how much they spend marketing high-priced drugs has stalled in the Virginia General Assembly, at least for this year. State senators said the bill wasn’t ready for prime time, but was an issue worth reviewing after further study. A Senate panel voted Thursday to delay consideration of the bill until next year. (Suderman, 2/4)

The Kansas Health Institute News Service: Hospitals, AARP Remain At Impasse On Caregiver Act
AARP Kansas still believes the state needs a law requiring hospitals to notify designated caregivers of patient discharge instructions and, if necessary, demonstrate those instructions. Kansas hospitals still disagree. AARP introduced the Caregiver Act last year following a pre-session advertising blitz, but the bill ran into skepticism from lawmakers who questioned whether legislation was the best way to reach the goal of smoother transitions to home care. (Marso, 2/4)

The Des Moines Register: Medicap Pharmacy Warns Of Possible Data Breach
Medicap Pharmacy is warning customers about a possible data breach. The company said in a notice that an external hard drive was "inadvertently" disposed of on Nov. 5, 2015. The hard drive contained personal information. Medicap believed all of the information was encrypted, but said it learned on Dec. 3 that some information did not have encryption. (Patane, 2/4)

The Sacramento Bee: Jerry Brown Selects California’s First Medical Marijuana Chief
California has found its czar for medical marijuana. On Thursday, Gov. Jerry Brown announced the appointment of Lori Ajax, currently the chief deputy director of the California Department of Alcoholic Beverage Control, to the newly-created post overseeing the Bureau of Medical Marijuana Regulation in the Department of Consumer Affairs. (Koseff, 2/4)

The Daily Southtown: Sunny Hill Nursing Home Converts To Private Rooms
Will County's Sunny Hill Nursing Home will be converting to mostly private rooms over the next 18 months -- in response to a growing trend in the health care field. "Ask any resident what they want and they will say 'a private room,'" Sunny Hill administrator Karen Sorbero told the county board's public health committee during Thursday's meeting. (Lafferty, 2/4)

The Center for Investigative Reporting: Medical Neglect Can Be Fatal In Privatized Immigrant-Only Prisons
Big Spring is different from other federal prisons. It is one of 11 Bureau of Prisons facilities used exclusively for noncitizens. Some are held for crimes that anyone could commit: Garay was incarcerated for selling drugs. But of the nearly 23,000 inmates in this shadow prison system, 40 percent are serving time for immigration crimes, according to 2014 data – mostly “illegal re-entry,” or crossing back over the border after being deported. And nearly unique within the federal prison system, private corporations operate all of these facilities. Five of them, including Big Spring, are run by The Geo Group Inc.; medical care in many of these facilities is provided by subcontractors. (Wessler, 2/4)

The Kansas City Star: 11 Are Indicted In Oxycodone Conspiracy
Eleven people are charged in federal court in Kansas City with a $1.2 million conspiracy to distribute oxycodone obtained by forged and fraudulent prescriptions, according to an indictment unsealed Thursday. The defendants allegedly obtained the Drug Enforcement Administration registration numbers of health care providers to prepare false prescriptions that were then filled at pharmacies in Kansas City and elsewhere in the region. The drugs were then distributed to others. (Campbell, 2/4)

Health Policy Research

Research Roundup: Pediatric ACOs; High-Deductible Health Plans; Zika And Women

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

JAMA Pediatrics: Effect Of Attribution Length On The Use And Cost Of Health Care For A Pediatric Medicaid Accountable Care Organization
Little is known about the effect of pediatric accountable care organizations (ACOs) on the use and costs of health care resources, especially in a Medicaid population. ... [Researchers used a] retrospective study of Medicaid claims ... for patients attributed from September 1, 2013, to May 31, 2015. ... Among the 28 794 pediatric patients receiving treatment ..., continuous attribution to the ACO for more than 2 years was associated with a decrease ... of 40.6% ... in inpatient days but an increase ... of 23.3% ... in office visits, 5.8% ... in emergency department visits, and 15.3% ... in the use of pharmaceuticals. These changes in the use of health care resources combined resulted in a cost reduction of 15.7%. (Christensen and Payne, 2/2)

Health Affairs/Robert Wood Johnson Foundation: High-Deductible Health Plans
High-deductible health plans (HDHPs) are increasing in prevalence in both the group and individual markets. ... The central debate over HDHPs is whether or not the plans reduce health care costs and use in a way that could negatively affect health. The Institute of Medicine estimates that 30 percent of health spending is waste. HDHPs are designed to reduce unnecessary use. There is mounting evidence that HDHPs are successful at reducing costs and care use, but results are mixed on the impact of this reduced care use on health status. ... Health care costs have slowed in recent years but are growing once again. Forecasting predicts that health spending will continue to grow faster than the GDP, at a rate of 5.8 percent from 2014 to 2024, and will rise to 19.6 percent of the GDP by 2024. As health care spending climbs, the prevalence of high-deductible plans will likely continue to increase. (Dolan, 2/4)

The New England Journal of Medicine: The Role Of Risk-Reducing Surgery In Hereditary Breast And Ovarian Cancer
In this review, we address issues related to the care of women in families with hereditary breast and ovarian cancer syndrome who have not had cancer. We discuss risk assessment for breast and ovarian cancers according to the woman’s age, the efficacy of risk-reducing surgery, the complications and psychosocial effects of these procedures, alternative strategies for risk management, and the best ways to facilitate individual decision making. (Hartmann and Lindor, 2/4)

The Kaiser Family Foundation: Zika Virus: The Challenge for Women
Active Zika transmission is now reported in 18 countries in Latin America and the Caribbean, as well as several other territories, and the World Health Organization (WHO) predicts it could affect 4 million people across the Americas this year alone. ... Of particular concern is the association between Zika infection and microcephaly, a severe birth defect of the newborn brain. ... The United States government may have an important role to play in addressing health access and rights for women in Zika-affected countries, both through its direct health and development assets as well as its diplomatic engagement and public health expertise. To understand more about where these issues are likely to be more acute, we examine available country-level data on access to contraception, abortion policies, and the US government’s foreign assistance and global health presence in Zika-affected countries. (Kates, Michaud and Valentine, 2/1)

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

CNN: Study Links Eating Fish With Healthier Brains, Regardless Of Mercury
Eating at least one serving of seafood a week could help stave off Alzheimer's disease, according to a study. A strong case has been building for the role that omega-3 fatty acids found in fish could play in protecting against Alzheimer's and other forms of dementia. But questions remained about whether these benefits could be canceled out by the mercury in fish, which at high enough levels can be toxic to the brain. The new study suggests that is not the case. (Storrs, 2/2)

The New York Times: Whooping Cough Booster Shot May Offer Only Short-Term Protection
The rapidly fading effectiveness of the pertussis booster vaccine may help explain recent widespread outbreaks of whooping cough. The United States stopped using a whole-cell pertussis vaccine in the 1990s and began using an acellular version called DTaP. Five vaccinations are given during childhood, and a booster vaccine, called the Tdap, is given to adolescents and adults. Researchers looked at 1,207 pertussis cases among children who had had the acellular vaccine in childhood. The study, in Pediatrics, found that when these children got the Tdap booster, it was 69 percent effective after the first year, then dropped to less than 9 percent two to three years later. (Bakalar, 2/5)

CNN: New Vaccines For HPV, Meningitis Recommended For Kids And Adults
New vaccines for meningococcal type B and HPV and are among the updates to the immunization schedule published for children and adults. The Advisory Committee on Immunization Practices, known as ACIP, makes the updates every year. ACIP is a part of the Centers for Disease Control and Prevention. A number of medical groups, including the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians, have endorsed the new schedules. (Storrs, 2/4)

JAMA Medical News: US Infant Mortality Rate Declines But Still Exceeds Other Developed Countries
The newest federal data on US infant mortality in 2014 can be viewed as a glass half full or a glass half empty. The good news from the Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics (NCHS) is that the 2014 infant mortality rate of 582 deaths per 100 000 live births—23 215 infant deaths—is a 2.3% decrease from the 2013 rate. It’s also the lowest recorded US infant mortality rate. ... The bad news is that the US infant mortality rate, which the CDC defines as death before 1 year of age, still far outstrips infant death rates in other developed countries, such as Finland and Iceland, both of which had a 2013 infant mortality rate of 180 deaths per 100 000 births. (Jacob, 2/2)

Forbes: Health On-Demand Attracts $1B In Investments
The move to make the healthcare system a digital-first industry as Uber and Lyft have done for U.S. transportation will trigger a quadrupling to $1 billion the projected venture capital investment in on-demand health products this year. A new report from Accenture says on-demand healthcare investment will grow from $250 million today to more than $1 billion by 2017. (Japsen, 2/2)

Reuters: An Ethical Way To Choose Which Kids Get Chemo During A Shortage?
When chemotherapy is in short supply, doctors should choose kids to receive treatment based on which patients have the best odds of being cured by the drugs, argues a group of oncologists. Shortages of life-saving cancer medicines for children are frequent and can complicate typical treatment protocols, creating substantial ethical challenges, the doctors write in the Journal of the National Cancer Institute. (Rapaport, 1/29)

Reuters: Dietary Fiber In Teen Years May Lower Later Breast Cancer Risk
For girls and young women, getting a lot of fiber could pay off decades later with lowered risk of developing breast cancer, according to a large U.S. study. Researchers analyzed data on more than 44,000 women participating in a long-term study and found those who ate the most fiber during high school and early adulthood were about 20 percent less likely to develop breast cancer by middle age than those who ate the least fiber in their youth. (Doyle, 2/1)

Editorials And Opinions

Viewpoints: Negative Prognosis For The Cadillac Tax; UnitedHealth's Misplaced Obamacare Blame

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

Bloomberg View: Obamacare's Cadillac Tax Will Not Survive
The Cadillac tax may not be quite dead yet. But at best, it certainly stuns easily. I'm not optimistic. The Cadillac tax, you may remember, was an excise tax on especially expensive employer-sponsored health insurance plans. It was a substitute for two things the administration wanted to do, but didn’t quite dare: get rid of the tax deduction for employer-sponsored insurance, and institute serious cost control measures. Doing either of those things would have made an already-embattled Obamacare bill impossible to pass into law. (Megan McArdle, 2/4)

Los Angeles Times: How A Huge Insurance Company Screwed Up On Obamacare
UnitedHealth Group is the nation's biggest private health insurer, so when its executives started whining last year about how it was losing millions on Affordable Care Act exchange plans and threatened to leave the ACA market as early as 2017, people took notice. Even Obamacare devotees wondered whether United's experience signaled deeper problems with the ACA exchanges generally. Obamacare's critics gorged on United's words and still do: As recently as last week, the Wall Street Journal's editorial writers lamented that "the ObamaCare money-pit sunk [United's] year-over-year profit margin to 3.7% from 4.3%." They blamed, among other things, the ACA's "bureaucratic nuisance." (Michael Hiltzik, 2/4)

Forbes: After The Martin Shkreli Circus, How Can We Fix Drug Pricing?
There was no doubt that hauling Martin Shkreli, the infamous young pharmaceutical entrepreneur, in front of Congress would be dramatic. Of course it was. But did it get us any closer to preventing the next Martin Shkreli from taking an old drug and raising the price 5,000%? At the hearing held this morning by the U.S. House of Representatives Oversight Committee, Elijah Cummings (D-MD) assumed the manner of a preacher, begging Shkreli to turn his life around. “You can go down in history as the poster boy for greedy drug company executives or you can change the system,” Cummings said. (Matthew Herper, 2/4)

The New York Times: Who Hates Obamacare?
Ted Cruz had a teachable moment in Iowa, although he himself will learn nothing from it. A voter told Mr. Cruz the story of his brother-in-law, a barber who had never been able to afford health insurance. He finally got insurance thanks to Obamacare — and discovered that it was too late. He had terminal cancer, and nothing could be done. (Paul Krugman, 2/5)

The Washington Post: Hillary Clinton Will Help Democrats Move Obamacare Forward
In all of our years promoting progressive legislative policies in Congress, no vote was more challenging or consequential than the one to pass the Affordable Care Act. As the former chairs of the two House committees that had primary jurisdiction over health-care reform when the ACA was passed in 2010, we’re proud to have helped realize a long-standing goal of the Democratic Party, moving our nation significantly closer to attaining universal health care. ... We believe that Sanders’s proposal to throw away the ACA to pursue a single-payer system is counterproductive at best and dangerous at worst. (Sander M. Levin and Henry Waxman, 2/4)

The Baltimore Sun: Adding To The Anesthesia Care Team
This is an exciting and challenging time in health care, with an estimated 10,000 baby boomers reaching retirement age every day and entering a health care system that is strained to capacity. That is why it was disappointing to read Jacqueline C. Mitchell's letter opposing legislation to add certified anesthesiologist assistants to hospital and clinic anesthesia care teams. (Setty, 2/4)

JAMA: Oregon’s Medicaid Coordinated Care Organizations
In 2012, the state of Oregon transformed its Medicaid program by establishing 16 “coordinated care organizations,” or CCOs, to provide comprehensive care for its Medicaid population. Coordinated care organizations can be considered a type of accountable care organization (ACO): they are locally governed; are accountable for access, quality, and health spending; and emphasize primary care medical homes. However, CCOs differ from most Medicare and commercial ACOs in their acceptance of full financial risk in the form of a global budget. ... Oregon is now 3 years into this experiment, providing an opportunity to assess the performance midway through this ambitious Medicaid ACO reform. (K. John McConnell, 2/4)