KHN Morning Briefing

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Political Cartoon: 'Skunk Test?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Skunk Test?'" by Steve Kelley.

Here's today's health policy haiku:

IN CALIF. AND THE U.S., AN AGING ISSUE THAT REQUIRES PREVENTION

Who’s in the ER?
Sometimes it’s seniors who fell.
We have to ask why.

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Summaries Of The News:

Capitol Hill Watch

Don't Expect Any 'Bipartisan Kumbaya Moments' When It Comes To Repeal, McConnell Says

Senate Majority Leader Mitch McConnell says he does not expect any cooperation from Democrats as Congress works toward dismantling and replacing the health law. Meanwhile, The Associated Press breaks down what's in the Republicans' plans, and the intra-party divide on the right continues to grow.

The Associated Press: McConnell Intends To Replace 'Obamacare' Without Democrats
Republicans will repeal and replace the health care law and overhaul the tax code without Democratic help or votes, Senate Majority Leader Mitch McConnell said Friday. "It's clear that in the early months it's going to be a Republicans-only exercise," the Kentucky senator said at a news conference before lawmakers left for a weeklong President's Day recess. "We don't expect any Democratic cooperation on the replacement of Obamacare, we don't expect any Democratic cooperation on tax reform." (Werner, 2/17)

The Associated Press: GOP Health Plan: Lower Costs, Better Care, Or Road To Ruin?
Top House Republicans say their outline for replacing President Barack Obama's health care law is a pathway to greater flexibility and lower costs for consumers. Democrats see a road to ruin for millions who'd face lost coverage and higher medical expenses, particularly the poor. The plan "ensures more choices, lower costs and greater control over your health care," according to talking points GOP leaders handed lawmakers heading home to face constituents during this week's recess. (Fram, 2/20)

Modern Healthcare: GOP Anxiety Rises As Conservatives And Moderates Split On ACA Repeal 
Divisions sharpened last week between hard-right and more pragmatic Republicans over both policy and strategy for repealing and replacing the Affordable Care Act. Those differences—along with the apparently slow progress in drafting actual legislation that could be scored by the Congressional Budget Office on cost and coverage impact—underscore the tough struggle Republicans face in dismantling Obamacare and establishing an alternative system. (Meyer, 2/18)

Bloomberg: Conservatives Object To Obamacare Replacement's Tax Credits
Some conservative House Republicans are objecting to a major part of the Obamacare replacement outline presented to them by party leaders, underscoring the party’s continuing inability to agree on an alternative health plan. The proposal would allow Americans who lack insurance to buy coverage with refundable tax credits they can receive before the end of a tax year. House Ways and Means Chairman Kevin Brady said he and other leaders presented the idea during Thursday’s private conference of the House GOP. (Kapur and House, 2/17)

CQ Roll Call: Key Senator Sees Promise In House GOP Health Care Proposal
A key Republican senator on Friday said the House GOP's health care proposal was written with input from the Senate, and the House would ultimately pass a bill the upper chamber can accept.  Meanwhile, Democrats are spurring their allies to rally in support of President Barack Obama's 2010 health care law, which Republicans want to replace. House Republicans on Thursday began their recess with a committee document to help them respond to constituents’ questions about plans to repeal and replace the 2010 law. It outlines proposals for age-based tax credits, an expansion of health savings accounts and transitioning out the Medicaid expansion. (Siddons, 2/17)

CQ HealthBeat: GOP Leaps On Congressional Review Act To Kill Obama Rules
A law that's been successfully used only once until now is the conduit for a whole lot of action on Capitol Hill. Republicans in Congress are expected to send a stream of bills — most of which require a single sentence — to President Donald Trump’s desk, using a process to repeal agency rules known as the Congressional Review Act (PL 104-121). The act was tucked into 1996 legislation tied to former House Speaker Newt Gingrich’s famous “Contract With America.” So far, Trump has signed two of the rule repeals into law. (Mejdrich, 2/21)

Meanwhile, insurers weigh in on Republicans' replace plans and more —

The Wall Street Journal: Insurers Voice Concern Over House GOP’s Outline For Health Law Repeal
The new House Republican plan, whose backers include House Speaker Paul Ryan (R., Wis.), is far from a complete bill, and the limited summary highlighted many GOP divisions over the health overhaul’s future. President Donald Trump has promised to deliver an initial ACA replacement plan next month. Still, insures saw the House document as a key signal and parsed it closely. Many were concerned that they found no answers to some of their most important questions—and some of what they did find was alarming. For instance, insurers said, the outline promised to immediately end enforcement of the ACA’s coverage mandate but appeared to offer no replacement mechanism that would prod healthy consumers to purchase plans. (Wilde Mathews, 2/17)

Kaiser Health News: Health Law’s 10 Essential Benefits: A Look At What’s At Risk In GOP Overhaul
As Republicans look at ways to replace or repair the health law, many suggest shrinking the list of services insurers are required to offer in individual and small group plans would reduce costs and increase flexibility. That option came to the forefront last week when Seema Verma, who is slated to run the Centers for Medicare & Medicaid Services in the Trump administration, noted at her confirmation hearing that coverage for maternity services should be optional in those health plans. Maternity coverage is a popular target and one often mentioned by health law critics, but other items also could be watered down or eliminated. (Andrews, 2/21)

Lawmakers, Headed Home For Recess, Braced To Face 'Dam-Bursting Levels' Of Activism

Constituents are gearing up to flood town halls with questions about Republicans' plans on health care.

The New York Times: Congress Goes Home, And Constituents Fired Up Over Health Care Are Waiting
As Republican lawmakers prepare to leave Washington for a weeklong congressional recess, liberal groups and Democratic Party organizers are hoping to make their homecoming as noisy and uncomfortable as possible. But national organizers concede they are playing catch-up to a “dam-bursting level” of grass-roots activism that has bubbled up from street protests and the small groups that have swelled into crowds outside local congressional offices.  (Zernike and Burns, 2/17)

The Wall Street Journal: Lawmaker Answers To Hometown Critics At Town Halls
Rep. Tom Reed (R., N.Y.) easily won re-election last year after being one of the first congressional Republicans to endorse President Donald Trump. On Saturday, he drew huge, often angry crowds in this small-town area as he tried to sell a Republican agenda that the president’s victory made possible. At a veterans hall and senior citizens center along New York’s Southern Tier region, Mr. Reed made his pitch for repealing the Affordable Care Act and explained why he had cast a committee vote against allowing members of the panel to review Mr. Trump’s tax returns. (Hughes, 2/18)

NPR: New York Republican Rep. Tom Reed Faces Angry Crowds, Deep In Trump Country
New York GOP Rep. Tom Reed probably knew what kind of day he was in for when he arrived at the Ashville senior center for his first town hall on Saturday. The crowd was so large the gathering had been moved outside to a slushy parking lot. "First and foremost, we are going to repeal and replace the Affordable Care Act — Obamacare," Reed said at the outset, using a loudspeaker propped up on a ladder to try to reach the sprawling crowd. The response was loud and sustained boos. (Taylor, 2/19)

Georgia Health News: Protesters In Atlanta Urge Preservation Of ACA 
[Vicki Hopper] was among scores of people who gathered Monday across the street from the state Capitol in Atlanta to rally against Republican plans to repeal the ACA. The noon rally was part of the Save My Care Bus Tour, a two-month, cross-country effort to oppose repeal efforts. The tour is being led by the Alliance for Healthcare Security, a coalition of groups including Doctors for America and the Service Employees International Union, according to the Washington Post. (Miller, 2/20)

Atlanta Journal-Constitution: Rally To Maintain Affordable Care Act Draws Hundreds
Republican lawmakers in Washington, who for years derided the measure as coercive and expensive for healthy individuals, are now balancing campaign promises to repeal the plan with potential blame for disruptions or loss in coverage if no replacement plan is enacted. While Georgia Republicans took a wait-and-see approach after Donald Trump was elected president, Democrats have focused on Medicaid. (Baruchman, 2/20)

Administration News

Trump Promises Health Plan Will Be Coming 'In A Couple Of Weeks'

"Just so you understand, our plan will be much better health care at a much lower cost," President Donald Trump said. "OK? Nothing to complain about." Meanwhile, Tuesday is the deadline for the Trump administration to decide the actions it will take on controversial insurer bailouts.

The Hill: Trump: ObamaCare Replacement Coming In 'A Couple Of Weeks' 
President Trump said on Saturday that a plan to replace the Affordable Care Act will come "in a couple of weeks." "We are going to be submitting in a couple of weeks a great healthcare plan that's going to take the place of the disaster known as ObamaCare," he said at a campaign rally in Melbourne, Fla. "It will be repealed and replaced." "Just so you understand, our plan will be much better healthcare at a much lower cost," he added. "OK? Nothing to complain about." (Greenwood, 2/18)

CQ Roll Call: Appropriators Watch Trump's Next Move On Obamacare Lawsuit
The Trump administration faces a key legal deadline Tuesday in the push to repeal and replace the 2010 health care law — and it could prompt Republican lawmakers to appropriate funds for a part of the statute they once sued to stop. The Justice Department will tell a federal appeals court what it sees as the future of a lawsuit over appropriations for subsidy payments to health insurance providers under the law  (PL 111-148, PL 111-152), estimated at $175 billion over 10 years. House Republicans filed the lawsuit in 2014 to stop the payments, as a response to a series of President Barack Obama’s unilateral executive actions that they said were unconstitutional. (Ruger and Mejdrich, 2/21)

The Hill: Trump Officials Weigh Fate Of Birth-Control Mandate 
The era of free birth control for women could be coming to an end. The requirement that insurance companies cover contraception at no cost is believed to be on the chopping block now that Tom Price has taken over the Department of Health and Human Services (HHS). Price opposed the mandate as a member of Congress and could take aim at the regulation — and other rules related to ObamaCare — as Republicans in Congress move to repeal and replace the Affordable Care Act. (Hellmann, 2/21)

And in other news on Trump —

Stat: Trump Attends Controversial Dana-Farber Fundraiser At Mar-A-Lago
President Trump attended Saturday night’s fundraising ball for the Dana-Farber Cancer Institute, which was held at Mar-a-Lago — his Florida home and so-called winter White House. While the Harvard-affiliated Boston hospital has held the posh annual event at the private club since 2011, and in 2008, this year’s gala drew criticism from Dana-Farber’s staff and Harvard medical students, who saw Trump’s actions, especially his executive order on immigration, as in direct conflict with the hospital’s mission. Dana-Farber declined to cancel, saying it was too late to change plans, but said it would avoid “controversial venues” in the future. (Swetlitz, 2/19)

Health Law

As Health Law Debate Shifts From Theoretical To Tangible, Opponents No Longer Have Loudest Voices

Now that the spotlight is off of the president who created the law, the focus is on the care it provides. The shouts for repeal have quieted as those clamoring for answers about their coverage flood the space. Meanwhile, despite his vocal criticism of the Affordable Care Act, Mike Pence, while governor of Indiana, turned to it when his state was in a crisis.

Politico: How Mike Pence Used Obamacare To Halt Indiana's HIV Outbreak
When then-Gov. Mike Pence faced the worst public health crisis to hit Indiana in decades, he turned to Obamacare — a program he vilified and voted against. In 2015, as a rash of HIV infections spread through rural southern Indiana, state health officials parachuted into Scott County and enrolled scores of people into Obamacare's expanded Medicaid program so they could get medical care and substance abuse treatment. Many were addicted to opioids and had contracted HIV by sharing dirty needles. (Ehley, 2/20)

The Washington Post: Obamacare Launched A New Wave Of Start-Ups. Now They’re Bracing For What’s Next.
Four years ago, Noah Lang saw an opportunity in Obamacare. With an eye toward the millions of people set to purchase health insurance on their own for the first time, the 29-year-old Silicon Valley entrepreneur founded a start-up, Stride Health, that helps them compare and choose between plans — and do it all from a smartphone. Steadily and without fanfare, the Affordable Care Act has created a boom in Silicon Valley. (Dwoskin, 2/20)

The Wall Street Journal: The Affordable Care Act: The View From A Hospital CEO
Health care in the U.S. appears to be heading toward dramatic changes for the second time in less than a decade. As president and chief executive of New York-Presbyterian, Steven Corwin will have to maneuver a system with 10 hospitals and $7 billion in annual revenue through what may be years of regulatory uncertainty and upheaval for U.S. hospitals. (Evans, 2/20)

And in news from the states —

Nashville Tennessean: Amid Health Care 'Chaos,' Tennesseans Push Lawmakers For Assurances
With Tennessee's healthcare.gov market for 2018 at a breaking point, some are ramping up calls on federal lawmakers to take action to make sure people aren't without health insurance options next year. Since Humana’s decision last week to leave the federally run exchange, the Tri-Cities area is the only region of the state that will have two insurers from which residents can choose in 2018. The Greater Knoxville area will have none. Yet, without progress on repeal-and-replace or repair of the Affordable Care Act in Washington, D.C., the exchange's existence in the state beyond 2017 will depend on business decisions by insurers BlueCross BlueShield of Tennessee and Cigna. (Fletcher, 2/20)

Texas Tribune: UT/TT Poll: Texans Want A Health Care Program That’s Not Called Obamacare 
Texans want to dump the previous president’s signature health care program, but only a small minority want to move on without replacing it, according to the latest University of Texas/Texas Tribune Poll. If the Affordable Care Act, better known as Obamacare, were to be repealed and replaced, 68 percent of Texans said lawmakers should wait until they have a replacement plan worked out before they repeal the current law. A smaller group — 23 percent — would repeal Obamacare immediately and figure out the details of a replacement plan later. (Ramsey, 2/21)

The Philadelphia Inquirer: I Have Obamacare Insurance. What Do I Do Now?
If you are already enrolled in a plan through the ACA, there are ways to maximize your coverage before any changes happen.  Remember those labs, specialist referrals or imaging that your physician recommended, but maybe you’ve postponed?  Now is the time to follow through with them.  Also, talk to your physician about switching from brand-name medications to generics when possible to cut down on future co-pays.  There are many generics that work as well as brand names, and which certain pharmacies offer through discounted prescription plans. (Chan, 2/19)

Veterans' Health Care

Federal Officials Increase Scrutiny As Drug Thefts Plague VA Hospitals

Reported incidents of drug losses or theft at federal hospitals jumped from 272 in 2009 to 2,926 in 2015, before dipping to 2,457 last year, according to DEA data.

The Associated Press: Drugs Vanish At Some VA Hospitals
Federal authorities are stepping up investigations at Department of Veterans Affairs medical centers due to a sharp increase in opioid theft, missing prescriptions or unauthorized drug use by VA employees since 2009, according to government data obtained by The Associated Press. Doctors, nurses or pharmacy staff at federal hospitals — the vast majority within the VA system — siphoned away controlled substances for their own use or street sales, or drugs intended for patients simply disappeared. (Yen, 2/20)

The Associated Press: Cases Involving Alleged Drug Theft At VA Health Facilities
Government data obtained by The Associated Press show that incidents of drug loss or theft at federal hospitals have jumped nearly tenfold since 2009 to 2,457 last year, spurred by widespread opioid abuse in the U.S. Federal authorities report that doctors, nurses or pharmacy staff — mostly in the Department of Veterans Affairs health system — had siphoned away controlled substances, while in other cases, drugs intended for patients simply disappeared. (2/21)

Medicaid

The Uncertainty Of Future Medicaid Policies Rattles Many Who Want Coverage

Two articles about very different circumstances — a young child adopted out of foster care and a woman who was disabled after a work accident — illustrate the interest in the debate in Washington about the federal-state program that provides coverage for low-income residents.

Stat: A Boy Who Can’t Speak Depends On Medicaid. What Happens To Him If It’s Cut?
As the Rankins recast their lives as parents of a medically demanding infant, one reassurance was that Nathaniel’s health care would be covered; as an adopted foster child, he could stay on the state’s Medicaid program. The Rankins would have to monitor Nathaniel’s many health problems, but they wouldn’t have to worry about whether they could afford to do so. Now, though, the Rankins don’t feel so reassured. (Joseph, 2/21)

Salt Lake Tribune: Caught In Utah’s Medicaid Expansion Limbo: Homeless Woman Wants To ‘Try To Be Happy Again’
Kimberly Fox rolled her wheelchair through the hallways of the Road Home shelter in Salt Lake City last month, reflecting on the events of the past decade that left her homeless and alone. She used to be a photographer at a glossy magazine in Baltimore. She used to manage a record store. She used to be a productive member of society, she said. But when Fox, now 53, tripped on a pile of paint supplies in 2002 while working in a Baltimore shipyard, the fall wrecked her foot and her ability to work along with it. ... Just a few months ago, there was hope that Fox would get health insurance coverage from Medicaid this year. (Stuckey, 2/20)

Meanwhile, Ohio's governor and the Tennessee legislature respond to the debate in Washington, too —

The Hill: Kasich: House GOP Medicaid Plan 'Very Bad Idea'
Republican Ohio Gov. John Kasich on Sunday criticized the House Republicans’ plan to phase out ObamaCare’s expansion of Medicaid. “I'm in Munich, but I understand that there was an initial effort by House Republicans to, for example, phase out Medicaid expansion, which means phasing out coverage,” Kasich said on CNN’s “State of the Union.” “That is a very, very bad idea, because we cannot turn our back on the most vulnerable. We can give them the coverage, reform the program, save some money and make sure that we live in a country where people are going to say, ‘At least somebody is looking out for me.’” (Sullivan, 2/19)

Nashville Tennessean: Bill Would Smooth Tennessee Pursuit For Medicaid Block Grant If D.C. Signals OK
A new bill in the state legislature would help pave the way for Tennessee to pursue a Medicaid block grant if the incoming federal administration moves in that direction. The bill, SB0118 filed by Sen. Richard Briggs, would allow the Division of Health Care Finance and Administration to expand TennCare to include people up to 138 percent of the federal poverty line if President-elect Donald Trump and the Republican-led Congress move toward fewer federal regulations and block grants for Medicaid. Under a block grant, the state would get some fixed level of funding to provide care for eligible Medicaid enrollees. (Fletcher, 2/17)

Kansas Committee Narrowly Tables Bill To Expand Medicaid, Likely Dooming The Effort

After three days of testimony, the House committee was prepared to vote when one member called for putting the bill aside until the legislature finds out how the state Supreme Court rules in a school case that could be expensive for the state.

Kansas City Star: Medicaid Expansion Falls In Kansas House Panel, Likely Done For Year
Republicans and Democrats on the panel listened to three days of testimony on the proposal to expand coverage of KanCare, the state’s privatized Medicaid program. After debating the bill Monday afternoon, lawmakers were primed to vote on the legislation and consider moving it to the House floor for further discussion. That failed to happen after Rep. John Barker, an Abilene Republican, asked the panel to set the bill aside until April 3. Barker cited anxiety about the possible cost of an upcoming decision by the Kansas Supreme Court in a school finance case. (Woodall, 2/20)

Wichita (Kan.) Eagle: ‘It’s Dead’: Medicaid Expansion Tabled In Kansas Committee
Rep. John Barker, R-Abilene, asked to table the bill until April 3 or later to allow the Kansas Supreme Court more time to make its school finance ruling that could obligate the state to spend millions of dollars more on K-12 education. He called the impending ruling the “big elephant in the room.” “We could get a decision next week,” Barker said. “And then what are we going to do?” (Salazar, 2/20)

Topeka Capital Journal: Kansas House Committee Kills Medicaid Expansion Proposal In 9-8 Vote
A new contingent of moderate Republican and Democratic lawmakers backing expansion had raised the hopes of supporters. Some believe expansion could pass the House if put up to a vote. But President Donald Trump’s White House victory and the ascendance of congressional Republicans determined to repeal the Affordable Care Act has scrambled the Medicaid expansion discussion in Kansas and other states. Expansion opponents argue it will soon be a thing of the past, while supporters say expansion would put Kansas in a better position if the federal government converts Medicaid into a block grant program. (Shorman, 2/20)

Lawrence (Kan.) Journal-World: Kansas House Panel Tables Medicaid Expansion Bill Over Objections Of Hospital Supporters
State Medicaid officials estimated the expansion would have cost the state about $52 million a year once fully implemented, and that it would bring in nearly $1 billion in federal health care money. Supporters of the expansion said that money could help save many small hospitals in the state that are struggling financially because the state hasn’t expanded Medicaid. (Hancock, 2/20)

KCUR: House Committee Votes To Sideline KanCare Expansion Bill 
Rep. Susan Concannon, a Beloit Republican, said the move to table deceived new legislators, who may not have understood they were killing the bill. “I’m just speechless because it was such an underhanded move,” she said. Kansas limits eligibility for Medicaid to children, pregnant women, people with severe disabilities and parents earning less than a third of the federal poverty line, or about $9,200 annually for a four-person family. (Wingerter, 2/20)

And in other Kansas news —

KCUR: KU Economists: Medicaid Expansion May Have Reduced ‘Medical Divorces’ 
The Affordable Care Act has been credited – and blamed – for lots of things, but lowering the divorce rate generally hasn’t been one of them. Not until now, anyway. A paper co-authored by two KU economists suggests that states that expanded Medicaid saw fewer so-called medical divorces than states, like Kansas and Missouri, that didn’t expand Medicaid. How so? Used to be Medicaid had an asset limit. The program’s income eligibility requirements limited the maximum amount of assets and income individuals could possess. The Affordable Care Act, also known as Obamacare, did away with the asset requirement. (Margolies, 2/20)

Pharmaceuticals

Despite Costly Failures, Pharma Not Giving Up On Research For Alzheimer's Medication

Meanwhile, Stat reports on the future landscape for new diabetes treatments and KHN looks at the lethal drugs used in the aid-in-dying cases.

The Wall Street Journal: Alzheimer’s: Pharma’s Great White Whale Is Still Worth Hunting
Alzheimer’s disease is both the largest unmet medical need in the U.S. and the most frustrating challenge for the drug industry. Don’t expect pharma companies to get discouraged anytime soon. Last week marked the latest failed trial of an experimental Alzheimer’s disease treatment when Merck & Co. announced results for verubecestat. Eli Lilly’s solanezumab flunked a clinical trial last November, the third failed late-stage trial for the drug. (Grant, 2/20)

Stat: Where Are All The New Diabetes Drugs?
There are few new drugs on the horizon for diabetes, which affects about 29 million Americans. Most of the treatments in late-stage development are simply improved versions of what’s out there — taken weekly versus daily, or orally instead of by injection. So has pharma run out of ideas in diabetes?  Not exactly. But whether its ideas will ever get to market is another question. There’s plenty of promising science in the early stages of research. Available drugs, however, work pretty well. Given the cost of development and a high bar for approval, pharma can only afford to advance true-blue breakthroughs, and those are hard to come by. (Garde, 2/19)

Kaiser Health News: Docs In Northwest Tweak Aid-In-Dying Drugs To Prevent Prolonged Deaths
Two years after an abrupt price hike for a lethal drug used by terminally ill patients to end their lives, doctors in the Northwest are once again rethinking aid-in-dying medications — this time because they’re taking too long to work. The concerned physicians say they’ve come up with yet another alternative to Seconal, the powerful sedative that was the drug of choice under Death with Dignity laws until prices charged by a Canadian company doubled to more than $3,000 per dose. (Aleccia, 2/21)

Marketplace

War Of Words: Accusations Of Sabotage, Harassment Fly As Anthem-Cigna Feud Bubbles Over

The rift that began as the two companies sought federal approval for a mega-merger has grown only deeper since the deal was blocked.

Bloomberg: Anthem, Cigna Blast One Another Over Blocked Insurer Merger 
Cigna Corp. and Anthem Inc. traded accusations of harassment and sabotage in competing lawsuits as the two health companies feud publicly in the wake of a stalled $48 billion merger. Cigna accused Anthem of trying to undermine its business by stealing confidential information and harassing its customers. Anthem blamed Cigna for the deal’s failure, saying its Chief Executive Officer David Cordani sabotaged the companies’ merger when Anthem rejected his demand to be made chief executive officer of the combined entity. (McLaughlin, Harris and Feeley, 2/17)

In other health industry news —

The Philadelphia Inquirer: Horizon Blue Cross Blue Shield To Pay $1.1 Million For Data Breach
Horizon Blue Cross Blue Shield of New Jersey agreed to pay $1.1 million to settle allegations that it failed to encrypt the personal data of nearly 690,000 policyholders on two laptop computers that were stolen from the company's Newark, N.J., headquarters in November 2013, the New Jersey Division of Consumer Affairs said Friday. As part of the settlement, Horizon must hire an outside expert to analyze security risks associated with the storage, transmission, and receipt of electronic-protected health information and to submit a report of those findings to the Division of Consumer Affairs within 180 days of the settlement and then annually for two years. (Brubaker, 2/17)

USA Today: Business, Community Groups Boost Health Partnerships
The political divisions that characterize so much of Washington fell away this week, as representatives of business, public health organizations and government said they can work together to improve the health of Americans. Participants at the U.S. Chamber of Commerce Foundation’s Health Means Business summit agreed on several ways to boost health to prevent disease and save money, which showed reason for optimism, said Risa Lavizzo-Mourey, CEO of the Robert Wood Johnson Foundation. (O'Donnell, 2/17)

Public Health And Education

Decrease In Teen Suicide Attempts Linked To Same-Sex Marriage Laws

Laws that have the greatest impact on gay adults may make gay kids feel "more hopeful for the future," the study's lead author said. In other public health news, a nutrition pilot program, homeopathic remedies, the anti-vaccination movement and genomic medicine.

USA Today: Study: Teen Suicide Attempts Fell As Same-Sex Marriage Was Legalized
Fewer U.S. teens attempted suicide in states where same-sex marriage was legal in the years leading up to the 2015 Supreme Court ruling upholding gay marriage, according to a new study. Analyzing data from 1999 to 2015, researchers found a 7% reduction in suicide attempts among high school students in the 32 states that legalized same-sex marriage. (Solis, 2/20)

USA Today: Hospitals Target Nutrition, Other Social Needs To Boost Health
Tom Shicowich "really, really, really liked Coca-Cola" before he began a new nutrition program targeting his Type 2 diabetes and weight. Being on a "very tight budget," he couldn't afford the fruit and vegetables he cut up for a living at his part-time grocery store job. Dinner was often a pizza or fast food meal he picked up on the way home. Six months after getting free healthy groceries every week through the Geisinger hospital near his rural Pennsylvania home, Shicowich has cut his blood sugar level from nearly 11 to close to a normal level of 7. (O'Donnell, 2/17)

Stat: Homeopathic Remedies Harmed Hundreds Of Babies, Families Say
A review of FDA records obtained by STAT under the Freedom of Information Act paint a far grimmer picture: Babies who were given Hyland’s teething products turned blue and died. Babies had repeated seizures. Babies became delirious. Babies were airlifted to the hospital, where emergency room staff tried to figure out what had caused their legs and arms to start twitching.   Over a 10-year period, from 2006 and 2016, the FDA collected reports of “adverse events” in more than 370 children who had used Hyland’s homeopathic teething tablets or gel, a similar product that is applied directly to a baby’s gums. Agency records show eight cases in which babies were reported to have died after taking Hyland’s products, though the FDA says the question of whether those products caused the deaths is still under review. (Kaplan, 2/21)

The Washington Post: Trump Energizes The Anti-Vaccine Movement In Texas
The group of 40 people gathered at a popular burger and fish taco restaurant in San Antonio listened eagerly to the latest news about the anti-vaccine fight taking place in the Texas legislature. Some mothers in the group had stopped immunizing their young children because of doubts about vaccine safety. Heads nodded as the woman giving the statehouse update warned that vaccine advocates wanted to “chip away” at parents’ right to choose. But she also had encouraging news. “We have 30 champions in that statehouse,” boasted Jackie Schlegel, executive director of Texans for Vaccine Choice. “Last session, we had two.” Now they also have one in the White House. (Sun, 2/20)

Modern Healthcare: Genomic Medicine Goes Mainstream
After decades of work and ballyhoo, it's finally happening. Patients, as a regular part of their care, are getting their DNA sequenced, seeing it matched against known genetically related conditions and having their medications checked for genetic suitability. During the Healthcare Information and Management Systems Society convention this week in Orlando, Fla., Inova, several other healthcare delivery organizations and their technology partners will tout their pioneering work in clinically applied genomics. Presentations at the show include both full-day and half-day symposia on precision medicine as well as multiple stand-alone educational sessions. (Conn, 2/18)

In Midst Of Raging Opioid Epidemic, Some Turn To Marijuana As Alternative Pain Reliever

A 2016 study found that states with medical marijuana laws had 25 percent fewer opioid overdose deaths than states that do not have medical marijuana laws. Some remain cautious about swapping one drug for another. Media outlets also report more on the crisis out of Maryland, Montana, Ohio, New Hampshire, Minnesota, Wisconsin and Virginia.

Stateline: Can Marijuana Ease The Opioid Epidemic?
Nationwide, an estimated 1.4 million patients in 28 states and the District of Columbia use legal medical marijuana for a varying list of conditions. A much smaller number of patients in 16 states use limited extracts of the plant, primarily to treat seizure disorders. In the midst of an opioid crisis, some medical practitioners and researchers believe that greater use of marijuana for pain relief could result in fewer people using the highly addictive prescription painkillers that led to the epidemic. (Vestal, 2/21)

The Baltimore Sun: Number Of Maryland Babies Born With Drugs In Their System Growing 
Hospitals throughout the state are dealing with a sharp increase in the number of babies born exposed to drugs as the opioid epidemic grows and ensnares the youngest victims while they're still in the womb. These newborns suffer tremors, have trouble feeding and are not easily comforted — all signs of drug withdrawal. The number of babies born in Maryland with opiates, alcohol, narcotics or other drugs in their systems has increased 56.6 percent in the last nine years to 1,419 cases in 2015, the latest numbers available. (McDaniels, 2/17)

Cincinnati Enquirer: A Jail Where Women Go Willingly To Break Heroin's Grip
These half-dozen women, ages 18 to 38, are in jail for six months each. But they all want to be here. And once their sentences are over, they will continue being helped for as many as two more years with their addiction recovery. Welcome to the Recovery Unit of the Campbell County jail, a new addition, fashioned by social worker Kristie Blanchet, the jail's new chemical dependency program manager. (DeMio, 2/20)

The Baltimore Sun: Doctors Are Using Alternatives To Addictive Opioids To Help Patients Deal With Pain 
The change in procedures is occurring as doctors face pressure to prescribe fewer opioids and other narcotics that can lead to addiction in some patients. Opioid addiction is fueling what's become a nationwide heroin epidemic as addicts turn to the cheaper, more readily available street drug. The Department of Health and Mental Hygiene announced earlier this month that it was instituting new rules for prescribing opioids to Medicaid patients that would force doctors to consider alternative painkillers, start with low doses and better screen patients for risk of abusing prescription drugs. The new rules also encourage doctors to refer more addicted patients to treatment. (McDaniels, 2/18)

NPR: Drugs Should Be A Last Resort To Treat Acute Lower Back Pain
Most of us suffer back pain at some point in our lives. In fact, it's one of the most common reasons people go to the doctor. Many of us also probably reach for medication. Now, new guidelines from the American College of Physicians say try exercise, yoga, or massage first. That's a pretty big change for both doctors and patients, but a welcome one, some doctors say. (Neighmond, 2/20)

NH Times Union: Sununu, HHS Commissioner Detail Their Plan To Combat Opioid Crisis 
Gov. Chris Sununu and Health and Human Services Commissioner Jeffrey Meyers detailed their multi-prong strategy Friday to make use of $6.3 million in federal grants over the next two years to fight the opioid epidemic. State officials have already learned this is what New Hampshire should expect to receive under the 21st Century Cures Act that Congress passed late last year. Federal officials have to approve the applications of each state for how to use their money. (2/18)

The Star Tribune: Could Mandatory Database Curb Opioid Abuse? 
Doctors would be required to check up on most patients before prescribing opioid painkillers under a legislative proposal that will get a warm reception at a Capitol rally on Tuesday. From there, it may face a tougher reception from physicians who view it as overkill and a crimp on their ever-shrinking amount of time to treat patients. But national research suggests that requiring physicians to check state registries of patients' drug histories can help curb the painkiller epidemic by identifying patients who are abusing opioids and "shopping" among doctors for prescriptions. (Olson, 2/20)

Richmond Times Dispatch: Va. Board Creates New Opioid Prescription Guidelines 
Virginia’s Board of Medicine has approved new emergency regulations that will give it authority to specifically regulate the prescribing of opioids for pain. The board’s decision was made in response to the state’s ongoing opioid epidemic. Opioids are a type of drug that includes both prescription painkillers and illicit drugs such as heroin. (Demeria, 2/20)

Women's Heart Attacks Don't Look Like Men's

Women's symptoms during a cardiac event are quite different and less dramatic than men's, so they can be harder to detect by doctors and tests. The Washington Post offers a series on heart health.

The Washington Post: When It Comes To Heart Attacks, Women Are Different From Men
On that November Sunday in 2015, Stephanie Thomas Nichols was 40 miles into her drive home to Townsend, Del., from her vacation cabin in Western Maryland when she felt an odd sensation in her upper body. “No pain, just pressure, heaviness,’’ recalls Nichols, who owns a software company. She couldn’t catch her breath. Within minutes, her left arm went numb. (Cimons, 2/19)

The Washington Post: Cardiac Rehabilitation Helps Heart Patients, But Many Women Do Without It
Cardiac rehabilitation is a medically supervised program of helping heart attack patients and those who have had heart procedures or surgeries adopt behaviors to avoid a recurrence. These programs typically include exercise training, education and stress counseling. They usually are conducted in a clinic or hospital rehab center with input from doctors, nurses, exercise experts, physical and occupational therapists, dietitians and mental health professionals. (Cimons, 2/19)

The Washington Post: Mental Illness And Heart Disease Are Often Found In The Same Patients
Cardiovascular disease and mental illness are among the top contributors to death and disability in the United States. At first glance, these health conditions seem to lie at opposite ends of the medical spectrum: Treating the heart is often associated with lab draws, imaging and invasive procedures, whereas treating the mind conjures up notions of talk therapy and subjective checklists. Yet researchers are discovering some surprising ties between cardiac health and mental health. These connections have profound implications for patient care, and doctors are paying attention. (Morris, 2/18)

The Washington Post: Flabby Heart Keeps Pumping With Squeeze From Robotic Sleeve
Scientists are developing a robotic sleeve that can encase a flabby diseased heart and gently squeeze to keep it pumping. So far it’s been tested only in animals, improving blood flow in pigs. But this “soft robotic” device mimics the natural movements of a beating heart, a strategy for next-generation treatments of deadly heart failure. (Neergaard, 2/18)

State Watch

State Highlights: Ind. House Panel To Revisit Controversial 'Abortion Reversal' Bill; Mich. Whooping Cough Cases On The Rise

Outlets report on news from Indiana, Michigan, Connecticut, Illinois, Ohio, Kentucky, Florida, Texas and California.

Detroit Free Press: Whooping Cough Cases Keep Climbing In Michigan
Pertussis, or whooping cough, is on the rise in Michigan. The number of cases this year has surpassed 100  and continues to climb, according to preliminary data from the Michigan Department of Health and Human Services and the Oakland County Health Department. In 2016, there were about 448 cases of whooping cough in the state. In Oakland County last month, there were 31 confirmed and probable cases of the vaccine-preventable disease, compared with four cases in January 2016. (2/17)

The CT Mirror: Insurance Coverage Mandates Would Face More Analysis Under Malloy Proposal 
Patients who testify in support of proposed benefit mandates often share stories about struggles they faced getting needed care or medications. And critics warn legislators that adding mandates increases the cost of insurance premiums. In some cases, they also take issue with the merits of the particular service being considered for mandatory coverage. (Levin Becker, 2/20)

Chicago Tribune: School Workers In State Must Know How To Handle Asthma Crises, New Law Says
Under the new legislation signed by Gov. Bruce Rauner in August, all school personnel who work with students must be trained to handle asthma emergencies. School districts must adopt an emergency response protocol for asthma — similar to those used in the case of anaphylaxis or fire. And every child with asthma must have a written "asthma action plan" on file at the school to allow the most efficient and helpful treatment when needed. "Asthma has been a chronic problem for a long time; it did not just rear its ugly head," said Maureen Damitz, spokeswoman for the Illinois Asthma Consortium which lobbied to get the law passed. "But I think people are more aware that we need to change something." (Healy, 2/20)

The Associated Press: Doctor-Lawmaker Tries To Restrict Smoking In Tobacco Country
When Dr. Ralph Alvarado was elected to the Kentucky state Senate in 2014, he found his new colleagues had something in common with most of his patients: They knew smoking was bad, they just couldn't quit. For more than two years, Alvarado has led the effort to restrict smoking in a state with the highest smoking rate in the country. (2/19)

Orlando Sentinel: New Emergency Medical Campaign Aims To Save Lives
Community leaders on Monday announced the launch of a new campaign that they hope will teach bystanders how to intervene during the first crucial minutes to prevent injured people from bleeding to death. Orange County Mayor Teresa Jacobs and Orlando Mayor Buddy Dyer joined other medical leaders at Orlando Regional Medical Center to promote the national initiative. A person can bleed to death from a serious injury within five to 10 minutes, said Joseph Ibrahim, the trauma medical director. (Russon, 2/20)

WFAA: Doctor Convicted Of Botched Surgery Gets Life Sentence
Life in prison. Those were the words that Christopher Duntsch never wanted to hear. And the words that his patients and their families desperately wanted to hear. The one-time neurosurgeon was sentenced by the 12-member jury to spend the remainder of his life behind bars Monday afternoon. (Eiserer, 2/21)

St. Louis Post Dispatch: Mercy And St. Anthony's Enter Affiliation Agreement
Mercy and St. Anthony’s Medical Center have entered into an affiliation agreement, hospital officials said Monday. While details of the agreement are still being hashed out, Mercy has agreed to a “substantial capital commitment” at St. Anthony’s, Winthrop Reed, vice chair of St. Anthony’s board, told the Post-Dispatch. For St. Anthony’s, the agreement means one of the last remaining independent hospitals in the St. Louis area will become part of a much-larger health care system. For Chesterfield-based Mercy, with 43 hospitals in four states, the move grows its market share in St. Louis, where it already has four hospitals. (Liss, 2/21)

Arizona Republic: Bleeding, Talking Mannequins Prep Health-Care Workers For Patient Crisis
Volunteers and anatomically correct mannequins that bleed, breathe and talk helped health-care professionals strengthen their lifesaving skills recently in Phoenix. Seventy-five health professionals participated in the intensive two-day training that simulated patients in crisis at the University of Arizona College of Medicine-Phoenix Center for Simulation and Innovation. (Borgelt, 2/20)

Cleveland Plain Dealer: Report: Northeast Ohio Ranks Fourth In Midwest Biomedical Investments
Last year was a big one for the biomedical industry in the Midwest. In the first half of 2016, healthcare startups in the Midwest brought in a record-breaking $1.04 billion. By the end of the year, Midwest healthcare startups brought in $1.7 billion. And Cleveland is near the top of the Midwest, according to a report from BioEnterprise, a Northeast Ohio biomedical business accelerator. Cleveland brought in $198 million dollars in biomedical investments last year, just behind Minneapolis, Chicago and St. Louis. (Bamforth, 2/20)

Cincinnati Enquirer: Disabled Ludlow Teen's Death From Bedsores, Neglect 'Makes No Sense'
There was just no holding him back, Terrie Collins-Laytart said last week just days after Joey [Bishop]'s mother and grandparents were charged with manslaughter in his death. The neglect, charges allege, was so severe it led to bed sores that pumped toxins through Joey's body eventually killing him. The case has seasoned investigators shaking their heads and wondering – like Collins-Laytart – how the 18-year-old became a prisoner in the Ludlow home he shared with his mother and grandparents, why no one seemed to know he lived there and what could have been done to protect him. (Graves and Vogel, 2/20)

Miami Herald: UM's New LGBTQ Clinic Focuses On Transgender Patients 
UM opened its LGBTQ center in January to serve the needs of the growing population. The new clinic brings together specialists in urology, endocrinology and psychiatry, as well as a team of surgeons to accompany the patient into the operating room. [Christopher] Salgado and other doctors can even perform multiple surgeries on a patient simultaneously, so after a marathon session the patient can emerge with everything done at once. (Harris, 2/20)

Editorials And Opinions

Different Takes On Inside-The-Beltway Health Policy Developments

Opinion writers offer a variety of views on how the plans being advanced by the Trump administration and GOP Congress will shape a range of health concerns — from the effort to repeal, replace or repair the health law to federal health programs and Planned Parenthood's future.

The Washington Post: Obamacare’s Enduring Victory
What’s the holdup, House Republicans? During the Obama administration, you passed literally dozens of bills to repeal all or part of the Affordable Care Act — knowing that none had any chance of being signed into law. Now that Donald Trump is in the White House, why can’t you seem to pull the trigger? (Eugene Robinson, 2/20)

The New York Times: Ryancare: You Can Pay More For Less!
President Trump promised to replace the Affordable Care Act with something that is better, is cheaper and covers more people. Scratch that. Republican leaders in the House and Mr. Trump’s secretary of health and human services released a plan last week that would provide insurance that is far inferior, shift more medical costs onto families and cover far fewer people. (2/19)

Los Angeles Times: 'Death Spirals,' Deceit And Pampering The Rich: The Republicans Face High Noon On Repealing Obamacare
Congressional Republicans who have visited their home districts over the last few weeks have gotten a faceful of constituent rage about their plans to eviscerate the Affordable Care Act, which brings health coverage to more than 20 million Americans. If past is prologue, those heading home now for the Presidents Day recess are likely to feel a lot more heat. That may be why House Republicans this week rushed out a “policy brief” on “Obamacare Repeal and Replace.” Unfortunately for the poor souls who will be meeting with constituents, the brief answers none of the key questions about the GOP’s plans for the ACA. (Michael Hiltzik, 2/17)

The Washington Post: Republicans Are Selling Health-Care Reform That People Don’t Want 
House Speaker Paul Ryan (R-Wis.) says Obamacare is failing. Club for Growth president David McIntosh warns that voters “gave Republicans the charge to repeal and replace Obamacare,” so the “delays and discussions about repairing Obamacare need to stop.” The problem is that voters fear disruption, don’t want to lose what they have and won’t find what Republicans are selling very attractive. (Jennifer Rubin, 2/20)

Modern Healthcare: Give Seema Verma A Chance
Seema Verma, the Indiana consultant who injected personal responsibility requirements and health savings accounts into that state's Medicaid program, deserves a shot at working with other states that want to redesign their programs. She repeatedly testified last week that her main goal for the program, if confirmed as CMS administrator, will be to achieve better outcomes for the vulnerable populations served by the program. “This shouldn't be about kicking people off,” she said. (Merrill Goozner, 2/18)

Fox News: Seema Verma For Medicaid/Medicare Czar Is The Final Piece In The Health Care Puzzle
Seema Verma is a bold pick by President Trump to head the Centers for Medicare and Medicaid Services. She should be approved without further delay. During a hearing by the Senate Finance Committee this week she appeared confident and informed, refusing to take positions on raising Medicare’s eligibility age, price negotiation with drug companies, or caps on Medicaid allotments to the states. She stated that these decisions are up to Congress, showing an understanding of her role’s limits. (Marc Siegel, 2/20)

The Washington Post: Staffing, Budget Shortages Put Indian Health Service At ‘High Risk’
There’s a sliver of good news for a stricken federal agency during the first alarming month of President Trump’s administration: relief from Trump’s hiring freeze for the Indian Health Service (IHS). “This exemption is a step in the right direction,” seven Democratic senators said in a statement Friday. “Indian Health Services facilities face staff vacancy rates of 20 percent or higher, and a hiring freeze would make these challenges even more severe, further impacting access to health care and even patient health.” (Joe Davidson, 2/20)

Stat: Vaccine Programs Threatened By Exemptions, ACA Repeal
Our highly successful vaccination programs will be in danger if they are not factored into the current discussion of the repeal of the Affordable Care Act (ACA). There’s a clear connection between having health insurance and getting vaccinated, so reducing the number of people with health insurance, which could likely happen if the ACA is repealed, will translate into fewer children and adults who get their recommended vaccines. (John Auerbach, 2/17)

Los Angeles Times: An Attack On Abortion Rights And A Handout To The Rich: The Republicans' New Plan For Repealing Obamacare
Congressional Republicans who have visited their home districts over the last few weeks have gotten a faceful of constituent rage about their plans to eviscerate the Affordable Care Act, which brings health coverage to more than 20 million Americans. If past is prologue, those heading home now for the Presidents Day recess are likely to feel a lot more heat. (Michael Hiltzik, 2/17)

Viewpoints: How Technology Is Advancing Wellness; Moral Questions About Gene Editing

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

The Wall Street Journal: Health-Care Innovations Are Coming To Your Digital Device
Mobile phones and tablets have pushed themselves to the center of modern life. Instead of going to the bookstore, readers download the latest novel direct to their devices. Online shopping has left malls quieter than ever. Video chatting helps far-flung families stay in touch. Health care needs this same kind of disruption. ... Personal technology can make routine medical care and healthy living easier. (Regina Benjamin and Andrew Thompson, 2/20)

The Washington Post: If We’re Going To Play God With Gene Editing, We’ve Got To Ask Some Moral Questions
The past 30 days have seen several unheralded but consequential strides in the scientific quest for god-like control of our destiny. Last week, the National Academy of Sciences and the National Academy of Medicine published a report on human genome editing that allows the manipulation of sperm and egg cells to create changes that could be passed down to offspring. In January, scientists for the first time grew a part-pig, part-human “chimera,” a step toward developing animal embryos with functioning human organs for interspecies transplantation. With Tesla chief executive Elon Musk hinting last month at having made progress on a brain-computer interface, injectable electronics and other forms of human augmentation have clearly entered mainstream discussion as a way for humans to keep up with quickly advancing artificial intelligence. (Christine Emba, 2/20)

Indianapolis Star: Invest In Health, Raise Cigarette Tax
Once again the General Assembly considers raising the cigarette tax. This time the proposal is to increase the tax by a $1.50 per pack. ... Unquestionably, Indiana is one of the unhealthiest states in the country.  We rank near the bottom in public health funding; we have one of the highest smoking rates; we have an infant mortality rate that rivals some third world countries; and, Indiana ranks as one of the worst in rates of obesity, cancer, and most measures of the chronic diseases that plague our nation. Despite the great advances in tobacco control that have occurred over the past half-century, tobacco still remains our number one public health issue; tobacco use remains the leading cause of preventable disease and premature death. (Richard Feldman, 2/20)

Sacramento Bee: Living And Thriving With A Dementia Diagnosis 
About 80 percent of people with dementia develop Alzheimer’s disease, a particularly insidious form of dementia that leads to death. I am in the early stages of dementia, and they tell me my tests currently clear me of Alzheimer’s, so my experiences have been far less scary by comparison to many others’. My prognosis is for continued regression with no reversal. Otherwise, I am a healthy and physically active guy rapidly approaching 70 and generally enjoying retirement along with my wife of 49 years. (Kent Pollock, 2/20)

San Jose Mercury News: Bring Sanity To Gun Policy For The Mentally Ill
Part of the stigma associated with mental illness is the notion that the mentally ill are uniformly dangerous. It doesn’t help that any time there is a mass shooting, the immediate response is the perpetrator must be crazy. This sad lack of knowledge about the mentally ill is perhaps only eclipsed by our lack of understanding of the underlying causes of gun violence. When the two issues collide, the result is legislative mayhem. (2/20)

Boston Globe: Listening To A Doctor About His Pain 
The opioid epidemic has led to what [Paul] Konowitz believes is a well-intentioned but misguided change in the way doctors prescribe pain medication. Or, more specifically, the way they avoid prescribing pain medication. He thinks there has been an overreaction, an overcorrection, so that many people who really need medication for pain are not getting it. There is evidence backing his theory. (Kevin Cullen, 2/20)