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Summaries of health policy coverage from major news organizations.

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Political Cartoon: 'Knock On Wood'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Knock On Wood'" by John Deering from "Strange Brew".

Here's today's health policy haiku:


Drugmakers’ merger
Raises tax and price concerns,
Plus Dems’ and Trump’s ire.

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


After Merger To Create 'Drug Behemoth,' Pfizer Already Considering Splitting New Company

The Wall Street Journal reports that Pfizer officials have considered splits before but now may be ready to do it. Also, the announcement of the megamerger with Allergan has set off concerns about competition in the health care industry, high drug prices and U.S. tax policy.

The Wall Street Journal: Pfizer Weighs Splitting Up New Drug Behemoth
The $155 billion agreement to combine Pfizer Inc. with Allergan PLC would create a drug behemoth so big that Pfizer is already thinking of breaking it up. The deal, which was announced Monday, brings together a diverse stable of drugs, from Pfizer’s cancer medicines and vaccines, to Allergan’s skin-care treatments and eye drugs. The companies expect to achieve $2 billion in cost savings as well as significant tax benefits from the deal .... Pfizer executives have for years considered splitting the company, but they have been deterred by concerns that its businesses may not be large enough to stand alone. Now, with Allergan, the company would have strength in both high-cost, high-growth drugs as well as generic, lower-cost drugs to make such a split. (Rockoff, 11/23)

The New York Times: Pfizer Chief Defends Merger With Allergan As Good For U.S.
In phone calls to Washington lawmakers and Obama administration officials, the chief executive of the largest drug maker in the nation had a surprising message: A deal that would allow the company to move its headquarters to Ireland was actually good for the United States. The Scottish-born chief executive of Pfizer, Ian C. Read, told them that a merger with Allergan, the maker of Botox that is based in Dublin, would significantly cut Pfizer’s tax bill and give it more cash that it could invest in the United States and ultimately add jobs, according to people briefed on the calls. He made the calls in recent days as the two companies were hammering out a $152 billion deal. (de la Merced, Gelles and Picker, 11/23)

The Associated Press: $160B Deal To Combine Pfizer And Allergan Raises Outcry
A $160 billion deal announced Monday to merge Pfizer and Allergan and create the world's biggest drug company renewed the outcry in Washington over "inversions," in which U.S. corporations combine with companies overseas to lower their tax bill. The combination — the second-largest merger in history — could have ramifications around the globe, pushing up drug prices and spurring more such deals in the fast-consolidating health care sector and other fields. It is also increasing the election-year backlash from U.S. politicians who have been blasting drugmakers recently over medicine prices that can exceed $100,000 a year. (Johnson and Murphy, 11/23)

The Washington Post: Pfizer’s Tax-Avoiding Megamerger With Allergan Sparks Outcry
A $160 billion megamerger announced Monday would turn U.S. pharmaceutical behemoth Pfizer Inc. into an Irish drug company, using a controversial tactic that allows companies to dodge billions of dollars in corporate taxes by renouncing their U.S. citizenship. Pfizer’s deal with Botox-maker Allergan, which would create the world’s largest drugmaker, immediately sparked criticism from Democrats and Republicans in Congress who agree that such deals are problematic but have so far not taken legislative action against them. (Johnson and Merle, 11/23)

The New York Times: Drug Merger Reignites Tax Reform Discussion
For almost four years, Congress and the White House have done little to make their long-promised overhaul of the corporate tax code a reality. Now the blockbuster pharmaceutical merger of Pfizer and Allergan has put new pressure on all sides to act. (Calmes, 11/23)

Reuters: Pfizer To Buy Allergan In $160B Deal
[Allergan CEO Brent] Saunders said the combination would provide access to about 70 additional worldwide markets for Allergan products, such as Botox wrinkle treatment, Alzheimer's drug Namenda and dry-eye medication Restasis. For 166-year-old Pfizer, Allergan would be the fourth huge acquisition over the last 15 years - one for each of the last 4 CEOs - following purchases of Warner-Lambert, Pharmacia and Wyeth. This also caps a record year for healthcare mergers and acquisitions, taking their cumulative value in 2015 to more than $600 billion. (Pierson and Berkrot, 11/24)

CNN Money: Pfizer And Allergan Combine In Biggest Drug Merger Ever
The mega deal is also the latest example of the massive wave of consolidation in health care. Drug makers, insurers, hospitals and pharmacies have raced to bulk up in recent years as the business landscape has been altered by Obamacare and an aging population. (Wattles and Long, 11/23)

CVS' Drug-Benefits Unit Makes Exclusive Deal To Cover Amgen's New Cholesterol Drug

The agreement, which makes Repatha the only drug in a new class of cholesterol-lowering medicines that will be covered by Caremark — the CVS pharmacy benefits manager — excludes a competing drug from Regeneron and Sanofi.

The Wall Street Journal: CVS Chooses Repatha As New Cholesterol Drug For Caremark
CVS Health Corp. said Monday that Amgen Inc.’s Repatha will be the only drug of a new class of cholesterol-lowering injections in its Caremark pharmacy-benefits manager. The Food and Drug Administration recently approved Repatha and rival drug Praluent, developed by Regeneron Pharmaceuticals Inc. and Sanofi SA, as a new way to treat high cholesterol. The new class of drugs, which are known as PCSK9 inhibitors, has drawn attention for their potential to combat heart disease but also for their potential high costs to the health care system. Repatha costs about $14,100 a year and Praluent costs about $14,600. (Hufford, 11/23)

Bloomberg: CVS Makes Exclusive Deal To Cover Amgen’s Cholesterol Drug
CVS Health Corp.’s drug-benefits unit will cover Amgen Inc.’s new cholesterol-cutting injections while excluding a competing treatment from Sanofi and Regeneron Pharmaceuticals Inc., pushing for savings from medications that list for more than $14,000 a year. ... While the discount CVS obtained from Amgen was “substantial,” [CVS chief medical officer Troyen] Brennan said he would not reveal the amount or the length of the contract with Amgen. CVS will continue to require that prescriptions for Amgen’s drug be approved in advance, a practice known as prior authorization that can limit use of the medicine. (Langreth, 11/23)

Reuters: CVS Chooses Amgen's New Cholesterol Drug Over Competitor
Praluent costs $14,600 for a year of treatment and Amgen set an annual price of $14,100 for its Repatha. The companies were expected to offer rebates and discounts that would bring down the cost to the mid-$12,000 range. In comparison, the annual cost of generic statins, which are used by millions of Americans who have high levels of low-density lipoprotein cholesterol, is in the hundreds of dollars. ... The decision contrasts with that of Express Scripts Holdings Corp, the largest U.S. drug benefit manager, which signed deals to provide coverage for both drugs (Humer, 11/23)

Meanwhile, STAT offers two reports on trends within the pharmaceutical industry, including one that may lead to insurers and drug makers joining forces -

STAT: At Walgreens And CVS, A Push To Collect Customer Health Data By Dangling Discounts
Want $50 off your next purchase at Walgreens? You’ll have to run 2,000 miles. Or step on a scale 2,000 times. Or take 2,000 readings of your blood glucose level. And you’ll have to let the global pharmacy chain track all that data — and give them permission to mine it to target you with ads. ... Pharmacies across the US are dangling perks to coax their customers to relinquish all sorts of personal information, ranging from daily fluctuations in their weight to their progress in quitting smoking to their real-time location every minute of the day. (Robbins, 11/23)

STAT: Drug Makers And Insurers, Longtime Rivals, Eye An Alliance On Prices
With rising drug prices such a hot topic here, drug makers and health insurers are both coming under heavy fire. So much fire that they’re considering a radical response: working together. After years of relentlessly attacking one another, leaders of the pharmaceutical industry and the health insurance lobby are considering — warily — cooperating to shape any federal legislation that emerges from the public outrage at the high cost of medications. (Scott, 11/24)

Campaign 2016

Financing For Sanders' Plan To Expand Medicare To All Is Not Yet Clear

USA Today examines the Democratic presidential candidate's tax proposals. Also, the announcement of a blockbuster merger involving a U.S. and Irish firm drew comments from some candidates.

USA Today: Tax Impact Of Sanders' Proposals Still Up For Debate
Sen. Bernie Sanders says if he's elected president, he'll expect the wealthiest Americans to start paying their “fair share” of taxes. Exactly what that means is still largely unknown. So far, the Vermont independent has proposed raising nearly $6 trillion in revenue from corporations, Wall Street speculators and the wealthy to rebuild crumbling infrastructure, provide free college tuition, expand Social Security and finance other programs. But Sanders still hasn't provided details of his two most ambitious proposals— Medicare-style health care for everyone, and universal child care — or said how much he would raise income tax rates to pay for them. (Gaudiano, 11/23)

Politico: Drug Merger Unleashes Dem Fury — And More Calls For Tax Reform
Pfizer’s blockbuster $160 billion merger with Irish pharmaceutical maker Allergan is stoking the partisan debate on corporations that move their headquarters overseas to lessen their U.S. tax bills — with Democrats like Hillary Clinton quickly condemning the deal while Republicans called it a symptom of a broken tax code. The deal "will leave U.S. taxpayers holding the bag," Clinton said in a statement Monday, calling on Congress to limit corporations’ ability to use the tax-limiting maneuver known as an inversion. (O'Donnell, 11/23)

NBC News: Democrats — And Trump — Oppose Pfizer Merger
The Democratic Party’s field of presidential candidates is united in opposition to the massive merger between pharmaceutical giant Pfizer and Allergan, which would also include a controversial maneuver known as a tax inversion to reduce the company’s U.S. tax burden. And they’re finding an unlikely ally in GOP pack-leader Donald Trump. ... “The fact that Pfizer is leaving our country with a tremendous loss of jobs is disgusting,” Trump said in a statement to Business Insider. Other Republicans haven’t spoken out about the deal. In the past, however, they have tended to cite inversions as evidence of the need to reduce the corporate tax rate, not as an example of corporate greed. (Seitz-Wald, 11/23)

Health Law Issues And Implementation

Gallup Poll: More Than Half In U.S. Think Health Insurance Is A Gov't Responsibility

Even with this finding, though, the health law continues to enjoy only mixed support. Meanwhile, Politico Pro examines what some mid-sized businesses, which must begin offering health coverage to their employees in January, think about the health law's Medicaid expansion. Also, The Fiscal Times reports on a study that highlights the importance of shopping around during this open enrollment season.

The Fiscal Times: No Love For Obamacare, But Most In U.S. See Government Role For Health Care
They may have no love for Obamacare, but a new poll shows that more than half of Americans now think that it is the responsibility of the federal government to ensure that all Americans have health insurance overage. A new Gallup poll finds that more than half of Americans agreed with that sentiment, up six percentage points from 2014 and the first time since 2008 that a majority of Americans feel that way. (Braverman, 11/23)

The Fiscal Times: An Easy Way You Can Save Hundreds Of Dollars On Obamacare
You’re probably sick of hearing that you can save money by shopping around on the Obamacare marketplace. But a new study illustrates exactly how costly it can be if you choose the same plan from last year without comparing other options. An enrollee in the lowest-cost silver plan last year could save an average of $322 a year on premiums, or almost $27 a month, by switching into another plan for 2016, according to a study by the Kaiser Family Foundation. (Dent, 11/23)

Public Health And Education

Federal Appeals Court Rules Against Wis. Abortion Law That Mandates Doctor Credentials

The state law requires doctors who perform abortions to have admitting privileges at a local hospital. Nearly a dozen states have similar provisions, and the U.S. Supreme Court will hear a case on the issue this term. Meanwhile in Texas, women must navigate a growing number of obstacles to terminate a pregnancy, and Planned Parenthood sues the state over its threat to end Medicaid funding for the health organization.

The Associated Press: Federal Court Rules Wisconsin Abortion Law Unconstitutional
A Wisconsin law that requires abortion providers to get admitting privileges at nearby hospitals is unconstitutional, a federal appeals court panel ruled Monday. The 7th U.S. Circuit Court of Appeals panel's 2-1 decision doesn't put the question to rest. Nearly a dozen states have imposed similar requirements on abortion providers, and the U.S. Supreme Court agreed last week to hear a challenge to Texas' law in a case that could settle the issue nationally. (Richmond, 11/23)

Reuters: U.S. Appeals Court Rules Against Wisconsin Abortion Doctor Law
A Wisconsin law requiring doctors who perform abortions to have admitting privileges at a nearby hospital is unconstitutional, a U.S. appeals court ruled on Monday, addressing a topic the U.S. Supreme Court is considering during its current term. Abortion providers in Wisconsin had challenged the state law, which requires doctors to have privileges at a hospital within 30 miles (50 km). The law's supporters said the measure ensures continuity of care while opponents say it serves almost no public health value and is intended to shut clinics. (Bailey, 11/23)

USA Today: In Texas, Going The Distance For An Abortion
None of the obstacles Texas placed in her way were going to keep Veronica from driving 125 miles to her appointment at Whole Woman's Health clinic Friday. With her 3-year-old and 1-year-old in tow, she was determined to get an abortion. The state didn't make it easy. There used to be a clinic 50 miles away in Corpus Christi. But Texas — which she likens to a "big bully" — is more than halfway to its goal of reducing from 44 to 10 the number of licensed clinics in the nation's second-largest state. ... Texas' abortion law — which the Supreme Court this month agreed to review early next year — unquestionably has made abortions harder to come by. (Wolf, 11/23)

Reuters: Planned Parenthood Sues Texas Over Threat To Cut Medicaid Funding
Planned Parenthood, other women's health providers and a group of women in need of reproductive healthcare sued Texas on Monday, seeking to halt its threatened cut in Medicaid funding, a move they said was more about politics than healthcare. The suit filed in federal court in Austin comes as Texas and several other Republican-controlled states try to cut funding for Planned Parenthood after an anti-abortion group released videos it said showed Planned Parenthood officials negotiating prices for fetal tissues from abortions it performs. (Herskovitz, 11/23)

The Associated Press: Planned Parenthood Sues Texas Over Blocked Medicaid Dollars
Planned Parenthood sued again Monday over efforts by Republican governors to block Medicaid funding to the nation's largest abortion provider, this time against Texas, where the organization says health care access to 13,500 women is on the line. Federal courts have so far halted similar attempts in Arkansas, Louisiana and Alabama while lawsuits play out. Texas plans to kick Planned Parenthood out of the state's Medicaid program by Dec. 8. (Weber, 11/23)

The New York Times: Planned Parenthood Sues Texas In Dispute Over Funding For Clinics
The nonprofit organization’s lawsuit alleges that Texas violated federal law and the so-called Medicaid freedom of choice provision, which allows those enrolled in Medicaid to seek services from a qualified provider of their choice. The lawsuit also accuses Texas officials of singling out Planned Parenthood for “unfavorable treatment without adequate justification,” a violation of the 14th Amendment’s equal protection clause. (Fernandez, 11/23)

Los Angeles Times: Planned Parenthood Sues Texas Over Medicaid Funding
Planned Parenthood and 10 of its patients sued the state of Texas on Monday to block officials from cutting off Medicaid funds, calling the state’s actions political and part of a long-term pattern of denying reproductive healthcare to women. “Women in Texas today have fewer rights than they did when I was growing up, and less access to healthcare,” Planned Parenthood Federation of America President Cecile Richards told reporters when announcing the lawsuit. “This time, they're targeting some of the most vulnerable Texans — women who already have the least access to healthcare in the country.” ... A spokeswoman for the state attorney general's office declined to comment Monday, saying officials have yet to be served with the lawsuit. (La Ganga, 11/23)

The Texas Tribune: Planned Parenthood Sues Texas Over Medicaid Removal
en patients joined Planned Parenthood in the lawsuit, according to the organization. Kendra Hudson of Houston, a patient spokeswoman, said a pap smear she got at a Planned Parenthood clinic allowed her to identify an abnormal growth and prevent it from developing into cancer. "They were the provider that I trusted and felt comfortable with," Hudson told reporters on Monday. By cutting off Medicaid funding to the women’s health organization, Planned Parenthood argues that thousands of other women could lose access to similar services they couldn't get elsewhere. (Ura and Walters, 11/23)

The Dallas Morning News: Planned Parenthood Sues The State Of Texas Over Move To Cut Medicaid Funding
The Centers for Medicare and Medicaid Services contacted Texas officials last month to tell them their move to exclude Planned Parenthood from the state’s Medicaid program “may be in conflict with federal law.” “Longstanding Medicaid laws prohibit states from restricting individuals who have coverage through Medicaid from receiving care from a qualified provider,” said Marissa Padilla, a spokeswoman for the U.S. Department of Health and Human Services in a statement last month. “By restricting which provider a woman could choose to receive care from, women could lose access to critical preventive care, such as cancer screenings.” (Martin, 11/23)

Pre-Diabetes A Likely Condition For Nearly Half Of All 45-Year-Olds, Study Says

A large Dutch study used population estimates to draw this conclusion. Pre-diabetes has no clear symptoms, according to reports, but people with blood tests indicating higher than normal blood sugar should be tested regularly for diabetes. In other public health news, the Food and Drug Administration is targeting inaccurate medical tests, and as the U.S. surgeon general works on a serious public health agenda that includes addressing substance abuse, gun violence and mental health issues, he is also emphasizing happiness as a way to prevent disease and be healthy.

The Washington Post: Half Of All Healthy 45-Year-Olds Will Develop Pre-Diabetes
Almost half of 45-year-olds will develop pre-diabetes, an elevated blood-sugar level that often precedes diabetes, according to a large Dutch study using population estimates. Sometimes called impaired glucose metabolism, pre-diabetes has no clear symptoms, but people with higher than normal blood sugar based on a blood test should be tested for diabetes every one or two years, according to the American Diabetes Association. (Doyle, 11/23)

The New York Times: F.D.A. Targets Inaccurate Medical Tests, Citing Dangers And Costs
Inaccurate and unreliable medical tests are prompting abortions, promoting unnecessary surgeries, putting tens of thousands of people on unneeded drugs and raising medical costs, the Food and Drug Administration has concluded. Life-threatening diseases go undetected in some cases. In others, patients are treated for conditions they do not have. ... The findings come at a time when the use of laboratory-developed tests is booming, the Obama administration is seeking new regulatory powers and even Republicans in Congress are working on legislation to set stricter standards. (Pear, 11/23)

The Huffington Post: The U.S. Surgeon General Wants To Bring You Peace And Love
His serious public health agenda for the U.S. includes addressing the state of substance addiction and gun control as a health policy and ending stigma for mental health. But Vivek Murthy, one of the youngest surgeon generals to ever serve in the role, is also emphasizing happiness as one of the main ways to prevent disease and live a long healthy life. (Almendrala, 11/23)

Other public health headlines include reports about access to dental care in rural areas and Coke's involvement in an anti-obesity group -

Stateline: Improving Dental Care Access In Rural America
Rural communities face serious challenges to oral health, resulting in a high incidence of cavities and other dental problems. Compared to people in urban settings, rural residents are poorer and less likely to have dental insurance. Their communities are less likely to have fluoridated water, and they often have to travel long distances to find a dentist. Many rural communities are considered dental shortage areas: 60 percent of the 4,438 total designated dental health professional shortage areas nationally were located in non-metropolitan areas in 2012. In fact, every state is expected to face a dental shortage over the next 10 years, according to the Health Resources and Services Administration, part of the U.S. Department of Health and Human Services. (Stitzel and Cohen, 11/20)

The Associated Press: Emails Reveal Coke’s Role In Anti-Obesity Group
A nonprofit founded to combat obesity says the $1.5 million it received from Coke has no influence on its work. But emails obtained by The Associated Press show the world's largest beverage maker was instrumental in shaping the Global Energy Balance Network, which is led by a professor at the University of Colorado School of Medicine. Coke helped pick the group's leaders, edited its mission statement and suggested articles and videos for its website. ... When contacted by the AP about the emails, Coca-Cola Co. CEO Muhtar Kent said in a statement that "it has become clear to us that there was not a sufficient level of transparency with regard to the company's involvement with the Global Energy Balance Network." (Choi, 11/24)

Meanwhile, NPR reports on the "social" egg-freezing business -

NPR: More Women Are Freezing Their Eggs, But Will They Ever Use Them?
If egg freezing once sounded like science fiction, those days are over. Women now hear about it from their friends, their doctors and informational events like Wine and Freeze. ... In 2012, the American Society for Reproductive Medicine decided egg freezing was no longer an experimental procedure. That opened the door for clinics like Shady Grove [Fertility Center] to market it to women who don't have a medical reason to do it but are simply worried about their declining fertility — what's being dubbed as "social" egg freezing. (Barclay, 11/24)

Earlier Hep C Treatment With Pricey New Drugs May Be More Cost-Effective Than Waiting

A computer simulation finds that treating the disease when liver damage first begins can save money over the long run, especially if the cost of the new generation drugs is addressed. Some insurers won't cover the treatment until a patient's liver disease is advanced. In related news, NPR reports on the financial and public health calculations of the expensive hepatitis C prescriptions in prisons.

Reuters: Expensive New Hep C Drugs May Be Cost-Effective Even For Early Disease
Treating hepatitis C with expensive new medicines at the earliest signs of liver damage improves patients' health and is also cost-effective, a new computer simulation suggests. "Going into this, I expected to find it did make sense to wait until there was a limited amount of liver disease, but what we found to our surprise is that it makes sense to start treatment at the earliest change in the liver," said senior author Dr. James Kahn, of the University of California, San Francisco. (Seaman, 11/23)

NPR: Treating Prisoners With Hepatitis C May Be Worth The Hefty Price
Doctors, patients and insurers have been struggling with how to determine who should be treated for hepatitis C now that effective but wildly expensive drugs can all but cure the disease. Treating prison inmates is a good investment that would save money in the long run, a study finds. The drugs, Harvoni and Sovaldi, cure about 90 percent of patients, but at a hefty price, about $90,000 per patient. ... More than 15 percent of U.S. prison inmates are infected with Hepatitis C. The study, published Monday in Annals of Internal Medicine, shows that as many as 12,000 lives would be saved if inmates were screened and treated. (Kodjak, 11/23)

In other pharmaceutical news, a physicians group says that doctors should prescribe generics more frequently, and a study finds that off-label use of drugs is growing -

The Washington Post: Are Doctors Prescribing Generic Drugs Often Enough? This Group Says No.
Doctors should more diligently prescribe generic medicines whenever possible, both to help contain rising prescription drug costs and to improve the chances that patients will adhere to their therapies, a top physicians group said Monday. Generic drugs now account for roughly 88 percent of prescriptions in the United States, even though they amount to less than a third of the more than $325 billion Americans spend each year on prescription drugs. But the American College of Physicians says doctors should be using generics even more often than they already do. (Dennis, 11/23)

Four In 10 Americans Have Known Someone Addicted To Painkillers

The poll from the Kaiser Family Foundation also shows that a quarter of the respondents had a close friend or family member people who is addicted.

The Washington Post: Four In 10 Say They Know Someone Who Has Been Addicted To Prescription Painkillers
Nearly four in 10 people know someone who has been addicted to prescription painkillers, including 25 percent who say it was a close friend or family member and 2 percent who acknowledge their own addiction, according to a new poll. The Kaiser Family Foundation survey released Tuesday also reveals that 16 percent say they know someone who has died from an overdose of prescription painkillers, including 9 percent who say that person was a family member or close friend. (Bernstein, 11/24)


Specialty Medicines Injected By Doctors Straining Budgets Of Medicare And Patients

A study finds that these drugs that must be administered under doctor supervision cost Medicare $20.9 billion in 2013, while the out-of-pocket share for Medicare Part B beneficiaries ranged from $1,900 to $107,000. In other Medicare news, KHN reports on the end of a bonus program that will impact primary care doctors' pay, and Reuters writes about adult children struggling to care for two parents at once.

The Fiscal Times: How Injectable 'Biologic' Drugs Are Busting Medicare’s Budget
Many of the new specialty drugs that have come on the market in recent years have provided breakthrough treatments for seriously ill Americans, even as they have strained the budgets of Medicare and other health insurance programs. ... A new Government Accountability Office study found that by 2013 Medicare was spending a staggering $20.9 billion a year on doctor-administered drugs, and a quarter of those drugs cost $51,000 to $536,000 per person. (Pianin, 11/23)

Kaiser Health News: End Of Medicare Bonus Program Will Cut Pay To Primary Care Doctors
Many primary care practitioners will be a little poorer next year because of the expiration of a health law program that has been paying them a 10 percent bonus for caring for Medicare patients. Some say the loss may trickle down to the patients, who could have a harder time finding a doctor or have to wait longer for appointments. But others say the program has had little impact on their practices, if they were aware of it at all. (Andrews, 11/24)

Reuters: How To Care For Two Parents At Once Without Going Broke
For years, Madeleine Smithberg has been at the forefront of American comedy as co-creator of "The Daily Show" and a talent coordinator for "Late Show with David Letterman." That sense of humor was especially handy during the last few years. That is because Smithberg had to cope with not one, but two elderly parents in rapid decline. "It's heartbreaking," says Smithberg, 56, who heads a production company in Los Angeles. "And yet it's invisible, because nobody talks about it." (Taylor, 11/23)

State Watch

State Highlights: N.Y. Seeks Payments From Disabled Who Were Abused; Cancer Surgeries In Calif.

News outlets report on health care developments in New York, California, Iowa, Georgia and New Jersey.

The Associated Press: NY Bills For Costs Of Care After Alleged Cases Of Abuse
Bill Liblick was shocked to learn that his sister, a disabled woman with the mind of a 1-year-old, had repeatedly been sexually assaulted at a state-run group home. Then, after her death, he was astonished again when he received a $1.6 million bill from the state for the cost of her care. Liblick says it was a coldhearted attempt by the state to get its hands on the money her estate eventually won in a lawsuit over her abuse. ... At least three times in recent years, New York has pursued Medicaid reimbursement of $1 million or more from those who allegedly suffered devastating, even deadly, mistreatment while in state care. In two of those cases, the state eventually dropped its claims after the families contested them. (Virtanen, 11/23)

Reuters: Colorectal Screening Up, Racial Disparity Down In New York City
Through the efforts of a coalition of New York City health officials in 2003, colon cancer screening rates there rose dramatically, and by 2014 there were no longer differences in screening rates by race or ethnicity. “Nationally colon cancer screening rates have been increasing and mortality has been decreasing, but the overall decline in mortality is not equal by race,” said Lina Jandorf of the Icahn School of Medicine at Mount Sinai in New York, senior author of a publication detailing the success of the NYC program. (Doyle, 11/23)

California Healthline: Report Examines Cancer Surgeries In California Hospitals
A report released last week looked at 11 types of cancer surgeries and reviewed how often they were performed at hospitals across California. In general, hospitals performing a higher volume of some of those kinds of surgeries have better outcomes, so patients could potentially use the new information to find hospitals that do more of those surgeries. (Gorn, 11/23)

Kaiser Health News: Small Coastal California Town Fights To Keep Hospital Afloat
Board meetings for the Mendocino Coast District Hospital are usually pretty dismal affairs. The facility in remote Fort Bragg, Calif., has been running at a deficit for a decade and barely survived a recent bankruptcy. ... Now it’s barely hanging on. And some locals are worried that the only hospital in the area might close for good. "Nobody can live here without that hospital," says Sue Gibson, 78, a Mendocino resident. "I mean, the nearest hospital is an hour and a half away on treacherous mountain roads." It’s not only her family’s health and the community’s that Gibson is concerned about. She’s afraid the local economy would be wrecked: The hospital is the largest employer. (Dembosky, 11/23)

Des Moines Register: Another Medicaid Math Puzzler: Who Has The Contracts?
The Iowa Hospital Association on Monday questioned whether Iowa has reached agreements with heath care providers on more than 12,000 contracts to provide Medicaid services through for-profit management companies. Federal officials will not allow Iowa to move forward with Gov. Terry Branstad’s privatization plan on Jan. 1 unless the state has an adequate number of health care professionals who agree to accept Medicaid. At least 560,000 poor or disabled Iowans depend on the $4.2 billion annual program for their health care. (Clayworth, 11/23)

Georgia Health News: Shock As Mayo Clinic Cuts Loose Waycross Hospital
Mayo Clinic’s startling decision to pull out of its “integration agreement’’ with Satilla Health Services has left the South Georgia hospital with an uncertain future. Officials with Mayo’s Florida operation said Friday that they ended the deal with Satilla in Waycross to focus on expanding specialty care for people with complex medical needs. (Miller, 11/23)

NJ Spotlight: The List: NJ Hospitals With The Most Commercially Insured Patients
Some New Jersey hospitals face a constant fiscal challenge as they provide care to a high number of patients who are uninsured or are covered through the lower-paying Medicaid program. On the other end of the spectrum, however, are those that thrive financially, thanks to a large number of patients who have commercial health insurance. Statewide, only 33.6 percent of admitted patients are insured through commercial plans – typically through their employer, although a rising number of New Jerseyans have commercial insurance through the federal marketplace. (Kitchenman, 11/23)

Editorials And Opinions

Viewpoints: Pfizer's Merger Won't Help Health; Zuckerberg Sets Standard With Paternity Leave

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

The New York Times: Pfizer’s Big Breakthrough: Global Tax Avoidance
The $160 billion deal to combine Pfizer and Allergan, the maker of Botox, does not appear to be illegal. But it should be. This merger is a tax-dodging maneuver that enriches shareholders and executives while shortchanging the public and robbing the Treasury of money that would pay for a host of government programs — including education, scientific research and other services that also benefit corporations. (11/24)

The New York Times: Pfizer’s Huge Deal Could Work, But With Adverse Effects
Pfizer’s $160 billion opus of financial engineering theoretically could pay off. On paper, merging with Allergan will result in hefty tax and cost savings worth barely more than the $30 billion premium that Pfizer is paying. In reality, though, giant drug deals often end up disappointing backers. As the biggest tax inversion deal ever, this one will annoy the United States political class, which is taking a bigger role in health care. And slamming together two drug giants often creates discord in the laboratory. (Robert Cyran, 11/23)

STAT: Pfizer-Allergan Deal: A Boon To Shareholders, A Blow To R&D
Pfizer is the largest drug maker in the United States, but after striking a deal on Monday to buy Allergan, the company is on the verge of becoming Irish. For shareholders, this may be their lucky charm. After the merger, Pfizer will be able to shift its legal headquarters from New York to Dublin and pay lower taxes, which should bolster its bottom line. But in the process, scientists are likely to lose their jobs, innovation may suffer, and consumers could pay more for Pfizer medicines. (Ed Silverman, 11/23)

The Washington Post: Why Mark Zuckerberg’s Paternity Leave Announcement Is Such A Big Deal
Facebook has already revolutionized how we communicate, network and keep tabs on our exes. Might it — or at least its chief executive — soon “disrupt” parenting, too? On Friday company founder and CEO Mark Zuckerberg announced that he planned to go on paternity leave. And not just for a few perfunctory days, mind you, but two whole months. (The company offers its U.S. employees up to four months of paid parental leave.) It’s hard to overstate what a big deal this is. (Catherine Rampell, 11/23)

Forbes: Memo To Mike Huckabee: Seniors Do Not Pay For (All) Their Medicare Benefits, So Stop Pandering
[F]ormer Arkansas governor Mike Huckabee has engaged in rather shameless pandering to senior citizens. In an editorial penned last August ... he expressed great moral outrage at “Republicans have the nerve to grow government off the backs of seniors, and in the same breath force seniors to surrender the Social Security and Medicare benefits they have earned.” ... He claims to be “shocked by politicians who refuse to acknowledge the obvious: a promise is a promise. It’s your money!” There’s only two problems with this argument. First, virtually all proposals for entitlement reform–Republican or otherwise–”grandfather” today’s senior citizens. ... The second problem is the false claim that “it’s your money.” (Chris Conover, 11/23)

The New York Times: A Prescription For Sticker Shock Caused By Drug Costs
There are millions of people out there, like me, who are frustrated with the maddening obstacles to obtaining prescribed medications with your insurance. My doctor calls the system byzantine, a rip-off in which the government, including Medicare, is not permitted to negotiate costs with drug companies, instead allowing them to charge whatever they think the market will bear. ... Unfortunately, it is likely to take an act of Congress to change the current system, so we’re all stuck with it for some time to come, perhaps indefinitely. Within the system, however, it pays to know how to get what you need at the lowest cost and with the fewest hassles. (Jane E. Brody, 11/23)

The Wall Street Journal: Why Painkiller Addiction and Abuse Are Rising Health-Care Priorities
Discussion of health care in this country has been dominated by Obamacare since debate about the law began in earnest before its passage in 2010. Now other issues such as rising drug prices and deductibles are edging onto the agenda. This was apparent last week when United Health Care said it would consider pulling out of the insurance marketplaces and a Department of Health and Human Services forum on drug prices also made headlines. A third issue may be joining the others as a top-tier health topic at the state and federal levels: the problem of painkiller and heroin abuse and addiction. Governors and candidates are paying more and more attention to this growing health problem. (Drew Altman, 11/24)

The Wall Street Journal: Sen. John Thune Assails Affordable Care Act
Republican Sen. John Thune of South Dakota has been a very vocal critic of the Affordable Care Act. He sat down with Laura Landro, an assistant managing editor of The Wall Street Journal, to discuss why he thinks the law is flawed and what Republicans are offering as an alternative. (Landro, 11/23)

The Wall Street Journal: Leslie Dach Lays Out Health Care’s Next Phase
Leslie Dach, a former Wal-Mart Stores Inc. executive, has been a senior counselor to Health and Human Services Secretary Sylvia Mathews Burwell for more than a year. With the Affordable Care Act’s third open-enrollment season under way, Mr. Dach sat down with Wall Street Journal Assistant Managing Editor Laura Landro to discuss how health-care policy is evolving. (Laura Landro, 11/23)

Wichita Eagle: Wichita Chamber Joins Call For Medicaid Expansion
It matters a lot that the Wichita Metro Chamber of Commerce now favors expansion of KanCare, the state’s privatized Medicaid program, even though the endorsement has some conditions. Kansas so far has failed to join the 30 states that have expanded Medicaid under the Affordable Care Act. The step, which would be at least 90 percent financed by federal dollars, would cover about 150,000 low-income Kansans while helping offset painful federal reimbursement cuts to Kansas hospitals for uncompensated care. Chamber lobbyist Jason Watkins told the Kansas Health Institute News Service that the chamber board voted Thursday to add Medicaid expansion to its list of 2016 legislative priorities – a move reflecting the 70 percent support for expansion in a chamber member survey, as well as the influential advocacy of Via Christi Health and Wesley Medical Center. (Rhonda Holman, 11/23)

The New York Times: Tales Of The Super Survivors
The age of terror is an age of shocks. Individuals, families and whole societies get torn apart by unexpected stabbings, shootings and bombings. It’s horrible, of course, but over the past few years the findings of academic research into the effects of these traumas have shifted in a more positive direction. Human beings are more resilient than we’d earlier thought. Many people bounce back from hard knocks and experience surges of post-traumatic growth. In the first place, post-traumatic stress disorder rates are lower than many of us imagine. ... The best general rule for all of society seems to be that at least 75 percent of the people who experience a life-threatening or violent event emerge without a stress disorder. (David Brooks, 11/24)

The New York Times: Force-Feeding: Cruel At Guantánamo, But O.K. For Our Parents
The practice of forced feeding has been highlighted by its use on hunger strikers in Guantánamo Bay and, more recently, in Israel, where a vigorous debate about the ethics of such a practice is taking place. But you don’t have to be in prison to have a feeding tube jammed up your nose. Millions of elderly Americans are fed through tubes despite a lack of substantial evidence pointing to any clinical benefit. ... Study after study, however, has shown that tube feeding doesn’t provide any benefit compared with feeding these patients by hand, which is more labor-intensive but much better for the patients. It doesn’t improve survival, reduce infections, reduce the incidence of aspiration pneumonia or improve patients’ nutritional status over those who are hand fed or even over patients not fed at all. (Haider Javed Warraich, 11/24)