KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Political Cartoon: 'Spare No Expense?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Spare No Expense?'" by Rex May.

Here's today's health policy haiku:

PROMISES OF A MIRACULOUS CANCER CURE CAN TURN HOPE TO POISON

Consequences of
Believing the hype can be
Deadly for patients.

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Summaries Of The News:

Health Law

All Eyes Turn Toward Moderates As Conservatives Give Approval To Revived GOP Health Plan

It's unclear whether the compromises made to woo the Freedom Caucus cost them moderate votes, but some lawmakers say they're hopeful it will pass. The vote could come possibly as early as Friday, although some members suggest it will take longer for lawmakers to make their decisions.

The New York Times: Hard-Line Republican Caucus Backs Revised Bill To Repeal Obamacare
The House Freedom Caucus, a group of hard-line conservatives who were instrumental in blocking President Trump’s plan to repeal the Affordable Care Act last month, gave its approval Wednesday to a new, more conservative version, breathing new life into Republican efforts to replace President Barack Obama’s health law. (Steinhauer and Pear, 4/26)

The Associated Press: Conservatives Back Revised Health Bill, GOP Moderates Balk
The changes would let states escape a requirement under President Barack Obama's health care law that insurers charge healthy and seriously ill customers the same rates. They could also be exempted from Obama's mandate that insurers cover a list of services like maternity care, and from its bar against charging older customers more than triple their rates for younger ones. (Fram, 4/26)

The Hill: Freedom Caucus Endorses Revised ObamaCare Bill 
"While the revised version still does not fully repeal Obamacare, we are prepared to support it to keep our promise to the American people to lower healthcare costs," the Freedom Caucus said in a statement. "We look forward to working with our Senate colleagues to improve the bill. Our work will continue until we fully repeal Obamacare." (Marcos, 4/26)

The Wall Street Journal: House GOP Health Insurance Plan Gains New Life
With Democrats firmly opposed to the legislation, pressure to support the bill is now on Republican centrists. Ensuring protections for people with pre-existing conditions remained a key concern for some. Rep. Mike Coffman (R., Colo.), who had previously backed the bill, said he was now undecided.“What I’ve got to do is to make sure people are protected in terms of pre-existing conditions and I’m not there yet,” he said. The bill retains deep cuts to Medicaid and other elements of the original proposal that concerned centrist GOP members who worried too many people would lose coverage. Many of the centrist Republicans who had been opposed to the bill last month said their position had not shifted, among them GOP Reps. Jeff Denham of California, Dan Donovan of New York and Leonard Lance of New Jersey. (Armour, Peterson and Hackman, 4/27)

CQ Roll Call: Moderates Hedge On New Obamacare Repeal Amendment
Many moderates have expressed concerns in the past about changes that would eliminate the protections for individuals with pre-existing conditions that are at the center of the 2010 health care law (PL 111-148, PL 111-152). The MacArthur-Meadows amendment would let states apply for waivers from some of those protections, like the requirement that everyone be charged the same price. The amendment would keep a requirement that insurers offer coverage to people with pre-existing conditions, and consumers who maintained continuous coverage would also be protected. Dent said he feels the latest proposal "is simply a matter of blame shifting and face saving."(Mershon and McPherson, 4/26)

Politico: Freedom Caucus Endorses Obamacare Repeal Compromise
Senior House Republican sources said they still didn’t have the votes for passage Wednesday evening. But GOP leaders felt bullish enough about their progress that they began considering a vote as early as this week. Nothing is scheduled. However, Republicans on Wednesday — through an obscure House rule for another piece of legislation — gave themselves same-day authority to fast-track any bill at the last minute, through Saturday. (Cheney and Bade, 4/26)

Politico: MacArthur ‘Cautiously Optimistic’ About His Obamacare Replacement Amendment
Shortly after his amendment received an endorsement from the conservative House Freedom Caucus, U.S. Rep. Tom MacArthur said Wednesday he was “cautiously optimistic” the changes he’s negotiated to revive the House GOP Obamacare replacement plan could soon become a reality. “I don’t think the issue was ever needing to move moderates from no to yes,” MacArthur, who represents the 3rd Congressional District, told POLITICO New Jersey in a phone interview. “We gained some votes from the Freedom Caucus and that’s helpful, extremely helpful. I think we now need to make sure we hold the people that were yes before. And if we do, I’m cautiously optimistic we can get this done.” (Jennings, 4/26)

Politico: GOP Senators Not So Keen On House's Obamacare Repeal
The House may finally be on its way to scrapping Obamacare, but don’t expect the Senate to go along: Any plan sent over will undergo major surgery — and survival is far from assured. The hurdles in the upper chamber were on vivid display Wednesday as House Republicans celebrated their breakthrough on the stalled repeal effort. The compromise cut with House Freedom Caucus members won over the right flank, but the changes will almost surely make it harder to pick up votes in the more moderate-minded Senate. (Kim and Everett, 4/27)

The Hill: The Hill's Whip List: Who To Watch On GOP's New ObamaCare Bill
House Republicans have an updated bill to repeal and replace ObamaCare, and The Hill has a new whip list. The updated bill includes an amendment that would allow states to opt out of key ObamaCare rules, including on minimum coverage requirements and allowing insurers to charge more based on individuals' health. (4/26)

The Hill: Club For Growth, FreedomWorks Throw Support Behind Latest GOP Health Plan 
Two influential conservative groups that opposed the GOP's original ObamaCare repeal-and-replace plan will now support the latest version of it. Club for Growth and FreedomWorks on Wednesday announced their support for the American Health Care Act after seeing proposed text of an amendment that would make conservative changes to the bill. The amendment, drafted by Rep. Tom MacArthur (R-N.J.) of the moderate Tuesday Group and Rep. Mark Meadows (R-N.C.) of the conservative Freedom Caucus, would allow states to waiver out of some ObamaCare regulations. (Hellmann, 4/26)

GOP Leaders Offer Option To End Provision That Guaranteed Their Coverage In Health Bill

The compromise that conservatives and moderate Republicans worked out this week as a replacement for the federal health law contained a provision that exempted members of Congress and their staffs from losing their guaranteed benefits. That brought jeers from Democrats, and party leaders crafted a bill to get rid of that exemption.

Politico: Ryan Moves To Ax Lawmaker Exemption In Obamacare Repeal Bill
House GOP leaders are moving quickly behind the scenes to iron out a wrinkle in their latest Obamacare repeal legislation: a controversial provision that preserves Obamacare coverage protections for members of Congress and their staffs while allowing states to opt out of them. Late Wednesday night, the House Rules Committee posted the text of a one-page bill that strikes the exemption for lawmakers that caused such a ruckus for Republicans on Wednesday morning. Discovery of the loophole, first reported by Vox, had triggered charges of hypocrisy from Democrats the entire day. (Bade and Bresnahan, 4/27)

The Hill: House GOP Health Bill Changes Exempt Members Of Congress
The new changes to the bill would allow states to apply for waivers for certain ObamaCare provisions, such as a ban on insurers charging premiums based on a customer's health and the requirement that insurers' basic health plans cover certain services, like prescription drugs and mental health. The GOP amendment exempts members of Congress and their staffs to ensure that they will still be protected by those ObamaCare provisions. ... Democrats quickly jumped on the development, arguing that Republicans are willing to take away protections for the general public, but not themselves.  (Sullivan, 4/26)

What's In The New Version Of Republicans' Health Care Bill?

The New York Times and The Associated Press offer a look at the compromises being proposed in Republicans' efforts to revive the stalled plan.

The New York Times: What Changed In The Health Repeal Plan To Win Over The Freedom Caucus
A month after pulling their health care overhaul bill from the floor, House Republicans are growing increasingly confident that they may have found a way to pass it. An amendment drafted by Tom MacArthur, a New Jersey congressman, would keep much of the American Health Care Act in place. But it would set up a waiver program that would allow states to apply to eliminate three major insurance regulations established by Obamacare. (Sanger-Katz, 4/26)

Trump Backs Off On Threat To Insurer Subsidies Easing Way For Spending Negotiations

The administration said it will continue to pay for the subsidies after House Speaker Paul Ryan (R-Wis.) said they wouldn't be included in the spending bill. Minority Leader Nancy Pelosi (D-Calif.) says the move is progress, but insurers contend it doesn't go far enough to protect the payments.

The Wall Street Journal: Trump Administration To Continue Key Funding For Health Law
President Donald Trump’s administration said Wednesday he would maintain critical funding for health plans, a pledge that reduced the chances of a government shutdown but left uncertainty in the already fragile insurance markets. White House Chief of Staff Reince Priebus told House Minority Leader Nancy Pelosi (D., Calif.) Wednesday afternoon that the administration would keep making “cost-sharing reduction” payments to insurers despite the lack of a formal appropriation for them in the April spending bill, a Pelosi aide said. (Radnofsky, Peterson and Wilde Mathews, 4/26)

Stat: Amid Budget Talks, White House Says It Will Continue ACA Subsidies
The “cost-sharing subsidies,” which congressional Republicans have long contended the Department of Health and Human Services is not authorized to make, subsidize insurers who offer lower premiums on state exchanges. A federal judge sided with Republicans in 2016, saying the executive branch could not continue the payments without an appropriation from Congress. The payments were allowed to continue while the Obama administration appealed the ruling. (Facher, 4/26)

The Associated Press: Dispute Over Health Payments Defused, Spending Bill On Track
The dispute with Democrats, especially House Minority Leader Nancy Pelosi, threatened to hold up the $1 trillion-plus spending bill. A temporary funding bill expires Friday at midnight, and GOP leaders late Wednesday unveiled another short-term spending bill to prevent a government shutdown this weekend — Trump's 100th day in office. The weeks-long sniping over the health care issue had snagged the talks, which have progressed steadily for weeks and gained momentum earlier this week after Trump dropped demands for immediate money for building his long-promised border wall. (Taylor, 4/26)

CQ Roll Call: Trump To Pay Obamacare Subsidies, But Future Funding Unclear
House Minority Leader Nancy Pelosi, D-Calif., had been advocating to ensure an upcoming spending bill includes funding for the so-called cost-sharing subsidies, in part because congressional action would provide more clarity on the payments than a decision by the administration to continue them. She nevertheless called the White House commitment "progress." “Our major concerns in these negotiations have been about funding for the wall and uncertainty about the CSR payments crucial to the stability of the marketplaces under the Affordable Care Act. We’ve now made progress on both of these fronts,” she said in a statement. (Williams and Mershon, 4/26)

Los Angeles Times: White House Will Continue Obamacare Payments, Defusing A Potential Obstacle In Talks To Avert Shutdown
The funding, totaling about $7 billion this year, soon became a bargaining chip in the current talks over a must-pass spending bill to prevent a government shutdown before a midnight Friday deadline. Democrats seized on Trump's threat to end the payments as a way to negotiate with Republicans who wanted extra funding for military programs or the border wall with Mexico. (Mascaro and Levey, 4/26)

Politico: White House To Continue Obamacare Payments, Removing Shutdown Threat
[It] would allow Republicans to avoid blame for causing chaos and confusion in the insurance markets. “If we pull the subsidies … I think there would be nobody with a health insurance plan next year.” said Rep. Phil Roe (R-Tenn.). But some Republicans slammed the White House decision, saying it undermines the party’s position in an ongoing lawsuit that the payments are unconstitutional. (Everett, Caygle and Dawsey, 4/26)

Reuters: U.S. Congress May Seek One-Week Funding Extension To Avert Shutdown
The U.S. Congress inched toward a deal to fund the government through September but was preparing to possibly extend a midnight Friday deadline in order to wrap up negotiations and avoid an imminent government shutdown. The one-week extension would give leading Republicans and Democrats "a little breathing room" to finish negotiations and present their plan for spending around $1 trillion through the rest of the fiscal year to rank-and-file lawmakers, according to a House of Representatives source familiar with the talks. (Cowan, 4/26)

The Hill: Insurers Say Trump Commitment On ObamaCare Payments Falls Short
The trade group America's Health Insurance Plans (AHIP) said it still believes Congress should actively appropriate the funds for the cost-sharing reduction (CSR) payments and not leave it up to the administration. "Our position has not changed – The American people need Congress to fund CSRs now," said Kristine Grow, spokeswoman for AHIP. (Sullivan, 4/26)

And e-cigarette supporters see an opening in this spending bill --

USA Today: E-Cigarette Industry Gains Allies In Regulation Fight
The electronic cigarette industry and its free-market allies are seeing fresh opportunities to ease federal rules on e-cigarettes as Congress races to pass a government spending bill this week and President Trump fills key public-health posts in his administration. More than a dozen conservative groups wrote to congressional leaders this week, calling on them to add a pro-vaping provision to a spending measure that must pass by midnight Friday to avert a government shutdown. If successful, the measure would be the latest sign of the $4.4 billion vaping industry’s growing clout in Washington. (Schouten and O'Donnell, 4/26)

Anthem Throws Gauntlet Over Subsidies, Vowing To Leave Markets Or Raise Premiums Without Them

CEO Joseph Swedish sets a deadline of early June for a decision on the cost-sharing reductions, saying Anthem would weigh increasing rates by at least 20 percent next year without them.

The Associated Press: Insurer Anthem Hands Feds Deadline On Crucial ACA Subsidies
Anthem CEO Joseph Swedish said his company may ask for more rate increases, stop selling certain products or leave some markets if it doesn’t have some assurance on the subsidies. Indianapolis-based Anthem Inc. sells coverage on exchanges in 14 states, including key markets like California, New York and Ohio. If the subsidies go away, customers could see rate hikes of 20 percent or more, Swedish told analysts during a conference call to discuss his company’s first-quarter results. Tack on another 3 to 5 percent if a health insurance tax returns from its moratorium this year. (Murphy, 4/26)

The Wall Street Journal: Anthem Says Loss Of Federal Health Payments Could Cause 20% Premium Hike
Anthem’s position on the ACA marketplaces is being closely watched because of its reach—it is a major presence in 14 state exchanges, with nearly 1.6 million people enrolled in its ACA plans, 1.1 million of those bought through the marketplaces. Currently, 302 counties in states including Georgia, Missouri and Ohio have only Anthem plans available on their marketplaces, according to the Kaiser Family Foundation. (Wilde Mathews and Hufford, 4/26)

Bloomberg: Anthem Threatens Higher ACA Rates If Funds For Poor Stop
Anthem Inc. threatened to raise rates for its Obamacare plans next year if the U.S. government stops funding subsidies for lower-income customers, putting pressure on the administration and Republicans to support a key piece of the health law. Chief Executive Officer Joseph Swedish said on a conference call Wednesday that the insurer could raise its rates by 20 percent if the subsidies aren’t paid to insurers. The subsidies are currently the subject of a political debate in Washington and it’s unclear whether President Donald Trump’s administration will continue to fund them. (Edney, 4/26)

In other news on Anthem —

Bloomberg: Express Scripts Whipsaws Amid Public Soap Opera With Anthem 
A 15-month fight between Anthem Inc. and Express Scripts Holding Co. spilled into public view again this week as the companies traded volleys over whether or not the insurer will renew its pharmacy benefit management contract with Express Scripts at the end of 2019. On Monday afternoon, Express Scripts shares plunged after the company said that it had been told by Anthem, its biggest customer, not to bother making an offer for the contract. Then, Wednesday morning, Anthem’s CEO said not so fast -- the insurer had made no decisions yet. Observers were left scratching their heads about what is going on. (Langreth, 4/26)

Pharmaceuticals

A New Way To Address High Drug Costs: Look At What's Being Thrown Into The Trash

Nursing homes routinely dispose of good prescription medication when they could be funneling the pills to needy patients.

ProPublica: America’s Other Drug Problem 
Every week in Des Moines, Iowa, the employees of a small nonprofit collect bins of unexpired prescription drugs tossed out by nursing homes after residents died, moved out or no longer needed them. The drugs are given to patients who couldn’t otherwise afford them. But travel 1,000 miles east to Long Island, New York, and you’ll find nursing homes flushing similar leftover drugs down the toilet, alarming state environmental regulators worried they’ll further contaminate the water supply. (Allen, 4/27)

Medicaid

Ark. Governor Expected To Ask Lawmakers To Trim Eligibility For Medicaid Expansion Program

Under the plan -- previewed by state officials -- about 60,000 people who gained Medicaid through the health law's expansion will lose coverage but they could instead apply for insurance through Obamacare marketplace policies. Also, the Florida House passed a bill that would set up work requirements for Medicaid enrollees.

Arkansas Online: 4-Year Savings Put At $66M If State Cuts Medicaid Rolls
A plan to move about 60,000 Arkansans off the state's expanded Medicaid program will save the state at least $66 million over the next four years while increasing premiums in the state's market for individual insurance plans by as much as 1.7 percent, state Department of Human Services officials said Wednesday. The savings would come from limiting eligibility in the state's Medicaid program to adults with incomes of up to the poverty level, instead of 138 percent of the poverty level. (Davis, 4/27)

Arkansas News: Official: Medicaid Changes Could Save $93 Million Over 5 Years
Changes Arkansas is seeking for its Medicaid expansion program could save the state up to $93 million over the next five years while causing a “minimal” number of people to lose health insurance, state Department of Human Services Director Cindy Gillespie said Wednesday. Gov. Asa Hutchinson is expected to call a special session next week to ask lawmakers to approve legislation authorizing DHS to make changes to the program formerly known as the private option and now known as Arkansas Works. Hutchinson has said that if his proposed changes get legislative approval, he will seek waivers from the federal government to allow their implementation. (Lyon, 4/26)

Public Health And Education

Little-Known, Cheap Blood-Clotting Drug Could Reduce Hemorrhages For Women After Labor

The drug costs less than $2 and doesn't need to be refrigerated, a boon for developing countries.

The New York Times: Inexpensive Drug Prevents Deaths In New Mothers, Study Finds
An inexpensive generic drug that saves the lives of wounded soldiers and civilian car crash victims has now been shown to rescue women suffering hemorrhages in childbirth. Postpartum hemorrhage, in which women bleed uncontrollably after childbirth, kills an estimated 100,000 women a year in poor and middle-income countries. The complication also forces doctors to perform emergency hysterectomies, especially when hospitals have too little blood on hand to provide transfusions. (McNeil, 4/26)

The Washington Post: Dangerous Bleeding After Childbirth Could Be Treated With A $1 Injection
The results of a remarkable clinical trial released Wednesday in the journal Lancet suggest that a single injection of an old drug — and one that costs less than $1 a dose — may be able to save tens of thousands of lives each year. ... In the study, known as the WOMAN (or World Maternal Antifibrinolytic) Trial, patients were randomized to receive either a placebo or tranexamic acid (TXA), which helps the blood to clot. The treatment, given intravenously, was used alongside other actions that emergency doctors would normally take to try to stop such bleeding. The trial was double-blind, meaning neither the doctors and researchers nor the patients knew what they got. (Cha, 4/26)

Escalation To Elephant Tranquilizers Marks New Normal In Rampant Opioid Epidemic

Recent deaths in a handful of states have been tied to carfentanil, which is 100 times more potent than the already-powerful fentanyl. “It shows how callous these drug dealers are,” Synan said. “It has no human use whatsoever and they’re putting it out on the street and wreaking havoc.”

The Washington Post: Elephant Tranquilizer Is The Latest Lethal Addition To The Heroin Epidemic
A substance used to tranquilize elephants that is 100 times more potent than the drug that killed Prince is hitting the Washington suburbs, adding the region to a growing list of communities nationwide reporting fatal overdoses linked to the exotic and toxic sedative. Three cases out of Anne Arundel and Frederick counties this month mark the first carfentanil-related fatalities in Maryland, alarming local health and law enforcement officials already in a state of emergency combating the opioid crisis. (Bui and Hermann, 4/26)

New Hampshire Public Radio: What Does It Mean To Have Carfentanil In New Hampshire? 
On Tuesday, public health officials confirmed the first cases of overdose deaths from carfentanil in New Hampshire. Carfentanil is a synthetic opiod and much more potent than the painkiller fentanyl... Tim Pifer is Forensic Lab director with the New Hampshire State Police. He explains how it got here and what it means to now have carfentanil in the state. (Biello, 4/26)

In other news on the crisis —

The Baltimore Sun: DEA Raid On Baltimore Pain Clinic Prompts City Health Department To Issue Alert About Possible Increase In Overdoses 
Health officials warned a network of medical providers throughout Baltimore this week of a possible increase in drug overdoses and withdrawals among local patients after a pain management clinic in North Baltimore was raided and closed by federal and local law enforcement, officials confirmed Wednesday. The Baltimore City Health Department heard Tuesday from local law enforcement officials that they had closed a health care provider's office, and health officials immediately began notifying hospital emergency rooms, emergency service providers, treatment centers and others. (Rector and Cohn, 4/26)

Stem Cells Touted As Miraculous Cure For Some Diseases Found To Have Cancer-Causing Mutations

Five out of 140 registered stem lines have cells with the mutation, two of which had been used in clinical trials in an unknown number of patients. In other public health news: tracing the origins of autism and epilepsy; reality meets hype when it comes to cancer drugs; funding the Zika battle; caregiving and dementia; and more.

Stat: Cancer-Causing DNA Found In Stem Cells Used In Some Clinical Trials
Some human stem cells growing in labs that researchers have used in experiments to treat serious diseases contain serious cancer-causing mutations, scientists reported on Wednesday. The discovery raised alarms that patients could be treated for one disease, such as macular degeneration, only to develop another, cancer. Harvard scientists obtained samples of most of the human embryonic stem cell lines registered with the National Institutes of Health for use in both basic research and in developing therapies for patients with diseases including diabetes, Parkinson’s, and macular degeneration. They found that five of the 140 lines had cells with a cancer-causing mutation. (Begley, 4/26)

NPR: 'Minibrain' Study Yields Insights Into Roots Of Autism And Epilepsy
Tiny, 3-D clusters of human brain cells grown in a petri dish are providing hints about the origins of disorders like autism and epilepsy. An experiment using these cell clusters — which are only about the size of the head of a pin — found that a genetic mutation associated with both autism and epilepsy kept developing cells from migrating normally from one cluster of brain cells to another, researchers report in the journal Nature. (Hamilton, 4/26)

Kaiser Health News: Widespread Hype Gives False Hope To Many Cancer Patients
After Michael Uvanni’s older brother, James, was diagnosed with a deadly form of skin cancer, it seemed as if everyone told the family what they wanted to hear: Have hope. You can beat this, and we are here to help. The brothers met with doctors at a half-dozen of the country’s best hospitals, all with impressive credentials that inspired confidence. (Szabo, 4/27)

McClatchy: Senate Panel Approves $100 Million In Funding To Fight Zika 
A Senate panel approved a bill that authorizes an additional $100 million in grant funding to fight the mosquito-carrying Zika virus. The bill could now be voted on by the full Senate before summer begins, but only if Congress doesn’t repeat last year’s delay that saw the money tied up by political wrangling for months. The money approved Wednesday would fund local mosquito-control efforts, centers that test for the virus and research into improving mosquito-control programs. (Irby, 4/26)

The Philadelphia Inquirer: Dementia Caregivers: Learning To Live In Your Loved One's Reality
Dementia is now a far more complicated realm. There are 48 kinds, including variations of Alzheimer's, Lewy body, and frontotemporal dementias, Tam Cummings, a gerontologist from Texas, told 400 family and professional caregivers last week. They all have fatal, untreatable brain destruction in common, but their symptoms and courses are different. Cummings urged family members to ask their doctors more questions — as many questions as they might ask if the diagnosis were cancer.  Knowing more, she said, may help them understand and cope with the memory lapses, confusion, delusions, falls, depression, and stubbornness that often accompany dementia. (Burling, 4/26)

Chicago Tribune: Baby Who Had Extra Legs Removed From Neck At Advocate Children's Reunited With Family 
An 11-month-old baby who underwent a rare surgery at Advocate Children's Hospital to remove an extra set of legs from the back of her neck has been reunited with her family in Africa. Baby Dominique's mother stood with her hands over her mouth as an escort pushed her daughter, in a stroller, toward her April 20 in the Abidjan International Airport in the Ivory Coast. The mother knelt and gently took the baby's hands in her own, touching her for the first time in more than two months. (Schencker, 4/26)

NPR: Poison Garden Curates Medicine's Medieval Roots
From the front door of the glass-walled gift shop at the Alnwick Garden in the far northeast of England, the scene looks innocent enough. A sapphire green English lawn slopes gently downward, toward traditional, ornamental gardens of rose and bamboo. Across the small valley, water cascades down a terraced fountain. But a hundred or so plantings kept behind bars in this castle's garden are more menacing — and have much to tell visitors about poison and the evolutionary roots of medicine. (Silberner, 4/27)

Women’s Health

Motivated By Current Political Climate, International Group To Provide Abortion Pill Advice In U.S.

Women Help Women is a business headquartered in the Netherlands that provides women with counseling on abortion medication through its websites. And, media outlets report on other women's health news out of Louisiana, Kansas, Virginia, Pennsylvania and Texas.

The Washington Post: Website Aims To Help Women Self-Induce Abortions Using Drugs
An international advocacy group concerned about restrictive laws in the United States plans to help women self-induce abortions at home, offering online advice and counseling about how to use medications that can terminate their pregnancies. Women Help Women, a three-year-old organization headquartered in the Netherlands, this week launched an online service to provide one-on-one counseling services for women seeking to end their early pregnancies using the abortion pill, which is legally available only by prescription in the United States but can be purchased on the Internet or from other countries. (Somashekhar, 4/27)

The Associated Press: Judge Strikes Down Louisiana Abortion Law: Unconstitutional
A federal judge has struck down a Louisiana law requiring doctors who perform abortions to have permission to admit patients to a nearby hospital, citing a U.S. Supreme Court decision against a similar Texas law. U.S. District Judge John deGravelles ruled Wednesday in Baton Rouge. He had barred the state from enforcing the law in a preliminary opinion saying it was unconstitutional, but a federal appeals court overruled him. However, the state agreed to wait on enforcement. (McConnaughey, 4/26)

Kansas City Star: Tougher Abortion Restrictions Still On Agenda For Missouri Lawmakers
A decision by a federal judge to rescind some laws restricting abortions in Missouri had Planned Parenthood advocates celebrating last week — but Republicans aren’t going down without a fight. A handful of bills making their way through the legislature aim to make it more difficult for women to get an abortion in Missouri, ranging from new inspection standards for abortion clinics to new parental notification requirements. (Pecorin, 4/26)

The Washington Post: New Law Orders Va. Insurers To Cover 12-Month Supply Of Birth-Control Pills
Virginia women will be able to have their insurance provider cover a full year of birth-control pills at once under a bill signed Wednesday by Gov. Terry McAuliffe at an Arlington County clinic. McAuliffe (D), surrounded by about a dozen elected officials and more than 50 women’s rights advocates, said he was happy to sign what he called the first positive women’s reproductive health measure to emerge from the legislature in his term. (Sullivan, 4/26)

The Philadelphia Inquirer: Measure To Cut Planned Parenthood Funding Heads To Pa. Senate
A measure that would cut funding to Planned Parenthood is heading to the full Pennsylvania Senate after getting approved by a committee Wednesday. The bill would prioritize spending on family planning services according to a list of categories. Its sponsor, Sen. John Eichelberger (R., Blair), said the purpose is to provide adequate health services for patients. But he acknowledged its effect would be to strip funding from Planned Parenthood because, he said, it provides fewer types of services than other health centers and clinics. (Langley, 4/26)

Texas Tribune: Whole Woman's Health CEO On Texas, Trump And The Future Of Women's Health Care 
Amy Hagstrom Miller knows the fight isn’t over. Whole Woman’s Health, the women's health organization of which she's founder and CEO, was lead plaintiff in a lawsuit, Whole Woman's Health v. Hellerstedt, that resulted in the U.S. Supreme Court striking down one of Texas' most restrictive abortion laws, commonly referred to as House Bill 2, which passed in 2013. Though it eventually won in court, Whole Woman’s Health was one of dozens to close clinics and stop services in the wake of HB 2's passage, and many have not returned since. (Evans, 4/27)

McClatchy: What Is Stealthing, And Is It A Form Of Sexual Violence? 
A man and a woman are about to have sex, and agree to do so while using a condom. But during the act, the man decides he’d rather not wear it and takes it off – without telling the woman. It’s more common than you may think, according to a study by Alexandra Brodsky published in the Columbia Journal of Gender and Law on April 20. (Irby, 4/26)

State Watch

California's Long-Shot Single-Payer Health Bill Advances

"It is time to say once and for all that health care is a right, not a privilege for those who can afford it," said Democratic state Sen. Ricardo Lara of Bell Gardens, who wrote the bill along with Democratic state Sen. Toni Atkins of San Diego. However, an essential question is unanswered: Where will the money come from?

Los Angeles Times: California Single-Payer Healthcare Bill Passes First Committee Test
The Senate Health Committee approved the measure on a 5-2 vote after a nearly three-hour hearing, but Democrats and Republicans alike signaled unease with the major question still unanswered in the legislation: how the program would be paid for. The bill, SB 562, would establish a publicly run healthcare plan that would cover everyone living in California, including those without legal immigration status. The proposal would drastically reduce the role of insurance companies: The state would pay for all medical expenses, including inpatient, outpatient, emergency services, dental, vision, mental health and nursing home care. (Mason, 4/26)

State Highlights: Grand Jury Indicts Doctors In Genital Mutilation Case; Doctors' Salaries In Baltimore Some Of Lowest In Country

Media outlets report on news from Michigan, Kansas, Maryland, Minnesota, Missouri, Iowa and Illinois.

The Washington Post: Detroit-Area Doctors Indicted In ‘Brutal’ Genital Mutilation Case
In what is believed to be the first case of its kind in the United States, a grand jury issued a federal indictment Wednesday against two Detroit-area doctors and a medical officer manager for scheming to perform female genital mutilation. The doctors — Jumana Nagarwala and Fakhruddin Attar — along with Attar’s wife, Farida Attar, were charged with performing female genital mutilation on minor girls at Fakhruddin Attar’s medical office in Livonia, Mich. Until Wednesday, only Nagarwala, 44, was charged with performing the procedure; the others were merely charged as conspirators in the case. (Schmidt, 4/27)

The Baltimore Sun: New Survey Says Baltimore Doctors' Salaries Among Lowest In The Country 
Baltimore area doctors earn on average some of the lowest salaries in the country, according to a new survey by Doximity, a social network of health care professionals. The compensation report found that on average physicians earned $281,005 a year. Only doctors in two others metropolitan areas reported lower salaries. The the average salary was $267,598 in the Durham, NC area and $272,398 in Ann Arbor, MI and surrounding areas. (McDaniels, 4/26)

KCUR: A New Uber-Style App Helps Riders With Disabilities In Kansas City
The Kansas City Area Transportation Authority is launching an app next week to help people with disabilities get a ride. The launch follows a year of development and two months of trials in a partnership with the company Transdev. Anyone can use the RideKC Freedom app, but it’s specially designed for the more than 300,000 people with disabilities who use the KCATA’s subsidized paratransit services. CEO Robbie Makinen says the Uber-style app is an innovation for the public transit agency. (Wood, 4/27)

Iowa Public Radio: Iowa's Gonorrhea Infection Rate Up 75 Percent Since 2013 
Reported cases of gonorrhea infections in Iowa are up 75 percent in the last three years, according to preliminary data from the Iowa Department of Public Health. The department says while Iowa's overall infection rate isn't unusual, the sudden increase in infections from 2013 is unique. IDPH STD program manager George Walton says part of the reason for this increase is that providers are conducting more comprehensive testing, which has identified cases that would have otherwise gone undetected. (Boden, 4/26)

New Orleans Times-Picayune: Peoples Health To Cut 42 Positions In 'Organizational Changes'
Peoples Health, a Metairie-based Medicare Advantage Plan provider, is eliminating 42 positions as part of what it's calling "organizational changes." The company did not detail the types of employees who would be affected. Its reduction falls below the state labor department's threshold of 50 layoffs, which would require it to provide more details. The company reports having 60,000 beneficiaries in southeast Louisiana who receive Medicare-supported services from affiliated physicians and health care providers. The leadership of Peoples Health wasn't immediately available for an interview, but their communications director issued a statement in response to questions about the job cuts. (LaRose, 4/26)

Chicago Sun Times: Family Members Get Prison Time For Running Health Fraud Scheme 
A Wheeling chiropractor and two of his relatives have been sentenced to prison time for bilking insurance carriers out of more than $10.8 million. Dr. Vladimir Gordin Jr., 46; his father Vladimir Gordin Sr., 70; and his brother Alexsander Gordin, 34, pleaded guilty earlier this year to healthcare fraud, according to a statement from the U.S. Attorney’s office. The trio operated Gordin Medical Center S.C., a chiropractic group at 350 E. Dundee Rd. in Wheeling, according to prosecutors. They billed insurance carriers for services that were either never performed or were medically unnecessary. (4/26)

The Star Tribune: Chaska Nursing Home Ruled Negligent After Resident Fell Into 155-Degree Water, Died 
An elderly resident at a Chaska nursing home suffered severe burns and died after falling into a tub of scalding laundry water, according to a state Health Department report that faults the home’s staff for leaving a laundry door open and unattended... State Health Department investigators concluded that the operators of Auburn Manor were negligent when the 90-year-old resident, known to wander throughout the facility, ended up on her back in a few inches of 155-degree waste water on Dec. 31. (Walsh, 4/26)

Weekend Reading

Longer Looks: Black Market Insulin; Opioid Deaths; Birth Control Access

Each week, KHN's Shefali Luthra finds interesting reads from around the web.

The Atlantic: How To Make Primary Care Transgender-Friendly
The medical knowledge needed to provide transgender-affirming care is not particularly complex — “it’s about as difficult as managing menopause,” says Madeline Deutsch, the clinical leader of the University of California, San Francisco (UCSF) Center of Excellence for Transgender Health and and the author of the center’s transgender-care guidelines.Yet physicians often perceive transgender care as hopelessly enigmatic. (Keren Landman, 4/21)

Vox: The Opioid Epidemic May Be Even Deadlier Than We Think
he opioid epidemic has led to the deadliest drug crisis in US history — deadlier than the crack epidemic of the 1980s and 1990s. Drug overdoses now cause more deaths than gun violence and car crashes. They even caused more deaths in 2015 than HIV/AIDS did at the height of the epidemic in 1995.A new study, however, suggests that we may be in fact underestimating the death toll of the opioid epidemic and current drug crisis. And we don’t even know by how much. (German Lopez, 4/26)

FiveThirtyEight: Some States Are Making It Easier To Get Birth Control
Two months into the Trump presidency, the fate of the Affordable Care Act’s contraceptive mandate is still undecided. But although the Trump administration hasn’t yet changed or removed the controversial regulation that requires insurance companies to cover birth control without making patients share the cost, many states are introducing or revising legislation to shore up or expand access to birth control. And if the federal mandate changes, that could mean that access to contraception could vary more and more widely between states. (Amelia Thomson-Deveaux, 4/24)

Vox: America’s Health Care Cost Problem Might Shut Down Hollywood
If you miss out on the last few episodes of Saturday Night Live this summer, blame America’s decades-long struggle to bring its health care costs under control. The Writers Guild of America, the union that represents television and film writers, could go on strike as early as May 2 — and a big reason why is the cost of health care. (Dylan Scott, 4/24)

Editorials And Opinions

Contemplating Health System Reform: Trump Could Save Obamacare; Anthem's Earnings Alter The Narrative

Opinion writers offer their thoughts on what is happening with efforts to repeal and replace the health law as well as other steps that could result in meaningful health care change.

The New York Times: How Trump Could Save Obamacare, And Help Himself
In this case, improving the Affordable Care Act would not only be good policy for millions of Americans but would also be farsighted politics for Mr. Trump. The obvious obstacles are his repeated claim that the law is a “disaster” and internal Republican Party dynamics. But his endorsement of the House Republican bill last month ended in one of the biggest embarrassments of his first 100 days. And the new attempt this week to revive the effort might have a similar fate. So he shouldn’t let his past criticisms preclude him from pivoting from “repeal and replace” to “repair and rebrand.” A rebranded Affordable Care Act would be consistent with the vision Mr. Trump offered during the campaign. Then, he promised that everyone would be “beautifully covered,” with “much lower deductibles,” and “taken care of much better than they’re taken care of now.” He said he wouldn’t cut Medicaid and would provide coverage for those who can’t afford care.(Nanacy-Ann DeParle and Phil Schiliro, 4/27)

Bloomberg: Anthem Shakes Up The Obamacare Narrative 
At a time of extreme uncertainty in the health-insurance market, Anthem Inc. just posted its best quarterly earnings since 2013. The company's first-quarter results, announced Wednesday morning, beat analyst expectations on just about every measure, driven by growth in its Medicare and Medicaid businesses and a lot of new and healthier-than-expected patients enrolled via the Affordable Care Act's individual exchanges. Anthem says it intends to stay in the exchanges in 2018 -- something I (mea culpa) previously thought unlikely -- though that is based on a risky assumption Congress will fund payments to insurers that lower costs for people insured under the ACA. (Max Nisen, 4/26)

USA Today: Both Parties Can Win If We Cut Health Care Costs
Largely absent from the current health-care debate in Washington is one astonishing number: We waste fully one-third of our medical care dollars, about $1 trillion out of $3 trillion annually, according to a paper by Donald Berwick and Andrew Hackbarth that was published in The Journal of the American Medical Association. After practicing medicine for almost 40 years, including 20 in health policy, I’ve become convinced that to achieve adequate, affordable health care for all Americans, the cost of care must be reduced. (Arthur Garson Jr., 4/26)

RealClear Health: How Congress Can Get Health Reform Right
When the One Nation Health Coalition launched we argued that Congress has a once-in-a-generation opportunity to get health reform right. That is still the case. Congress can get this done. And they must get it done. As Congress returns this week they have the opportunity to restart the work of reform. The task has been challenging because the issue is so complex. But there has also been movement on key issues. For instance, giving states flexibility and letting the market define essential health benefits can give patients more choices at a lower cost. (Dave Hoppe and David Wilson, 4/27)

JAMA Forum: Where Does The Health Insurance Premium Dollar Go?
In early March, America’s Health Insurance Plans (AHIP), the national association of private US health insurers, released an interesting report that presents, for insured patients younger than 65 years, financial statistics for 2014 of commercial and nonprofit health insurance companies. According to the report, “Where Does Your Premium Dollar Go?,” an average of 79.7 cents per premium dollar is spent by insurers on health care proper and 17.8 cents on the insurers’ “operating costs,” leaving only 2.7 cents per premium dollar as profits. (Uwe Reinhardt, 4/25)

RealClear Health: The Path To Health Care Reform Starts With Health Savings Accounts
Congress left Washington last week without passing a plan to repeal and replace Obamacare. They are now back with an amendment to the failed American Health Care Act. A growing number of Americans aren't waiting for lawmakers to figure out how to make health insurance more accessible and affordable. They're reclaiming control of their health care dollars from their insurers and assuming responsibility for spending that money themselves. (Sally Satel, 4/27)

Arizona Republic: Try Actually Legislating For A Change
Take the issue of health care. Few doubt that the individual health insurance market is in serious trouble under Obamacare. Yet Republicans can’t agree on the extent to which they want to repeal Obamacare or what they want to replace it. Democrats get to criticize Republicans for wanting to repeal Obamacare, but face no pressure, and have no incentive, to advance serious proposals to fix it. (Robert Robb, 4/26)

Louisville Courier-Journal: Fix Health And Pension Plans For Retired Miners
Time is running out for retired coal miners and their dependents, again. If Congress fails to act this week, the beleaguered miners and dependents will be without health insurance, something that came perilously close to happening in December 2016. Sen. Mitch McConnell engineered a short-term deal then, kicking the can down the road until the end of April. (4/26)

Cincinnati Enquirer: Don’t Take Away Subsidies That Make Health Care Affordable
House Republicans are suing to stop the federal government from paying subsidies that substantially cut the deductibles and out-of-pocket costs of 7 million low-wage Americans with Obamacare silver plans. President Trump, who promised to cover all Americans, threatens to join them in attacking these life-saving subsidies. As a volunteer Certified Application Counselor in Cincinnati, I meet many working people who are able to get the care they need because of the cost-sharing these Republicans want to end. (Ariel Miller, 4/26)

Seattle Times: The Affordable Care Act Has Been Good For Washington State
Enrollment data released last week shows a record number of people bought health insurance through Washington’s insurance marketplace, Washington Healthplanfinder, during the open enrollment period that ended Jan. 31. Washington has more than 38,000 new people buying insurance through the exchange this year and an additional 60,000 getting free insurance through Washington Apple Health. Under the Affordable Care Act, nearly 2 million people in Washington state and tens of millions more across the country have health insurance coverage. (4/25)

Viewpoints: Reducing Harm Reduces Overdose Deaths; Trump Undermines Women's Access To Health Care

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

Chicago Tribune: A Bold Remedy For Overdose Deaths
Addiction to opioids is hazardous to your health. This may sound like an obvious and inescapable reality. If your chief priority is staying cool, the thinking goes, you don't move to Phoenix. If you really want to stay alive, you don't use heroin. But humans have created innumerable places in Phoenix where it's possible to minimize personal contact with searing heat. Humans have also created places where it's possible to inject opioids at relatively low risk. (Steve Chapman, 4/26)

Alaska Dispatch News: Medicaid Helps Alaska Fight Opioid Addiction
Medicaid expansion under the Affordable Care Act has been working in Alaska. Since implemented in 2015, more than 30,000 Alaskans previously shut out from routine and necessary care are now eligible to receive it. Not only does expansion make treatment possible for lower income Alaskans suffering with addiction, it makes it possible earlier in their illness, when treatment is typically less expensive, more effective and has the most potential to prevent the kinds of harm that can accompany addiction, such as homelessness, incarceration, or even death. (Tom Chard, 4/26)

Roll Call: A Disturbing Trend Against Women’s Health
Despite the fact that most Americans want their leaders focused on creating jobs and boosting the economy, in his first 100 days in office, President Donald Trump has spent significant time and effort attacking women’s access to critical health care services and it is clear that women should expect even more harmful policies in the future. (Rep. Carolyn B. Maloney (D-N.Y.), 4/27)

USA Today: Democrats' Foolish Abortion Orthodoxy
The contest for mayor of Omaha seems an unlikely place for a fight to break out among Democrats over the issue of abortion rights. For one thing, mayors have very little influence on abortion policies. Such matters are most commonly debated in state legislatures and the U.S. Congress or mulled over by the U.S. Supreme Court. Nonetheless, the Democrats, with their penchant for finding issues to battle over, have been feuding over whether to support the Democratic candidate for mayor of Obama, Heath Mello, who, as a practicing Catholic, opposes abortion. He has also pledged not to use his office to obstruct the access of women to reproductive health care. Nonetheless, pro-choice group NARAL Pro-Choice America and the news website Daily Kos have called upon Senator Bernie Sanders and Democratic National Committee chair Tom Perez to withdraw their support of Mello. This is left-wing sectarianism at its most suicidal and an inauspicious sign for the hope of the party to regain the many offices it has lost. (Ross K. Baker, 4/27)

Bloomberg: Pelosi Makes Shrewd Case For Pro-Life Democrats
Democrats have made health care a moral issue, based on a compelling argument, passionately held, that everyone deserves access to care by virtue of being human. That's one context to keep in mind as the party's powerful pro-choice contingent attempts to transform a morally contentious issue, abortion, into a health-care issue that -- unlike the party's approach to health care generally -- is stripped of moral content. (Francis Wilkinson, 4/26)

Chicago Tribune: Tax Dollars And Abortions: When Politics And Scare Tactics Roil A Difficult Debate
You can't count on the Illinois General Assembly to pass a balanced budget. But you can count on lawmakers to pass heater bills that are sure to show up in campaign materials during the next election cycle. And so on Tuesday, House lawmakers passed a bill that would significantly shift long-standing state policy on taxpayer funding of abortions. The bill, now headed to the Senate, would include abortions as covered procedures in the health plans of Medicaid recipients and state workers. (4/26)

The New York Times: Spreading Plan C To End Pregnancy
After lunch on a Saturday in late January at her home in Los Angeles, Francine Coeytaux, 63, an abortion rights activist, retrieved a Priority Mail envelope from her office and announced to her guests, a group of young women she had recruited to her cause, the results of a recent experiment. “A couple weeks ago, we Googled ‘abortion pills’ and tried ordering from a few of the sites that came up,” she said. (Patrick Adams, 4/27)

JAMA: Navigating Transitions And Charting New Paths
A career in medicine creates an identity and a defining sense of purpose in life. I love being a physician and relish the planned and unexpected challenges and opportunities that have unfolded over time—which for many years seemed endless. But I also observed early in my career what can happen if one doesn’t anticipate transitions, especially in midlife and beyond. While I have come to know this as a physician, I have learned it is also true for individuals in other walks of life, as choices, options, and opportunities become altered and sometimes appear constrained and truncated by physical and cognitive changes or because one has become burned out and needs a change of direction or new path to pursue. (Philip A Pizzo, 4/25)

JAMA: Single IRBs in Multisite Trials: Questions Posed by the New NIH Policy
On June 21, 2016, the US government announced changes that are arguably the most significant of the last quarter century concerning the protection of human research participants—a requirement for use of central or single institutional review boards (IRBs) in multisite National Institutes of Health (NIH)–funded research. Specifically, the NIH announced a new policy (effective September 25, 2017) to mandate that nonexempt multisite research with humans funded by the NIH be reviewed by a single IRB. (Robert Klitzman, Ekaterina Pivovarova and Charles W. Lidz, 4/26)

The Des Moines Register: The Strange Iowa Political Trip For Medical Marijuana
Two state senators, one Republican and one Democratic: One voted in favor of the medical cannabis bill that passed in the final hours of the legislative session, one voted against it. Both are unhappy. In a legislative session that tended to defy prediction, perhaps it shouldn’t be surprising that medical marijuana was the issue that kept lawmakers up all night as they tried to adjourn. It created odd, bipartisan political alliances as well as conflicts among lawmakers who support medical marijuana. (Kathie Obradovich, 4/26)