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Political Cartoon: 'Reflexologist?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Reflexologist?'" by Patrick Chappatte, The New York Times.

Here's today's health policy haiku:

Nonprofit’s Ties To Drug Maker Questioned

Safe Medicines is
A PhRMA Chameleon.
(Pardon to Boy George)

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Summaries Of The News:

Health Law

Eager For A Victory, Trump Hypes Renewed GOP Health Plan; Lawmakers Remain Skeptical

The deal, which is being hashed out between Rep. Tom MacArthur (R-N.J.) and Freedom Caucus leader Rep. Mark Meadows (R-N.C.), would let states seek waivers on preexisting conditions and to set their own list of essential health benefits. Republican congressional aides, however, are throwing cold water on the optimism coming out of the White House.

The New York Times: White House Officials, Craving Progress, Push Revised Health Bill
White House officials, desperate to demonstrate progress on President Trump’s promise to repeal the Affordable Care Act, are pushing to resurrect a Republican health care bill before his 100th day in office next week. Some members of the president’s team have grown consumed by that deadline, worrying that appraisals of the president’s tenure will be brutal and hoping that a last push on health care might bring a measure of salvation. (Flegenheimer and Abelson, 4/20)

The Associated Press: White House Pushes Uncertain Bid To Revive Health Care Bill
The White House optimism is driven largely by a deal brokered by leaders of the conservative Freedom Caucus and the moderate Tuesday Group aimed at giving states more flexibility to pull out of "Obamacare" provisions. A senior White House official acknowledged that it was unclear how many votes Republicans had, but said House Speaker Paul Ryan, R-Wis., has told the White House that a vote could come together quickly. Yet GOP lawmakers and aides to party leaders, conservatives and moderates alike were skeptical that the House would vote next week on the health legislation. (Fram and Pace, 4/20)

The Washington Post: White House Turns Up Heat On Congress To Revise The Affordable Care Act
The fresh hopes for resuscitating the American Health Care Act are pegged to an amendment being offered by Rep. Tom MacArthur (R-N.J.) that aims to attract enough conservatives and moderates that the measure can pass in the House. White House officials said language would be circulated among members in the next few days, and the modifications will be discussed Saturday in a conference-wide call as Republicans prepare to return to Washington next week. The MacArthur amendment would allow states to obtain permission from the federal government to write their own list of essential health benefits and allow insurers to charge people with preexisting conditions higher premiums, as long as they also make a high-risk pool available to those patients — a change conservatives have demanded. As a concession to moderates, the amendment would also add back federal requirements for essential health benefits, which the measure’s current version instead leaves up to states. (Winfield Cunningham, Snell and Wagner, 4/20)

Los Angeles Times: Trump Is Trying To Repeal Obamacare Again, But He Still Doesn't Have The Votes
Rep. Tom MacArthur (R-N.J.), a centrist who has been working on the new language, said in a Facebook post that sick patients would still be able to get coverage because states would be required to offer a special health plan, known as a high-risk pool, for people unable to get other coverage. “This amendment will make coverage of preexisting conditions sacrosanct for all Americans,” he said. But these high-risk pools were almost universally unsuccessful before the advent of Obamacare, and the new GOP proposals drew swift criticism from many patient advocates and others. (Levey, 4/20)

Politico Pro: Inside The Latest GOP Offer On Obamacare Repeal 
The GOP’s latest proposal is a concept called “invisible risk sharing,” which would effectively create a federal backstop for health insurers. The idea — modeled after a similar program in Maine — aims to keep everyone covered while lowering premiums and freeing states to eliminate key Obamacare insurance protections. “There’s no magic here,” said Rep. Tom MacArthur (R-N.J.), who is pushing the idea as a way to bridge the divide between GOP conservatives and moderates. “Either policyholders have to pay the bills or taxpayers have to pay the bills.” (Demko and Cancryn, 4/20)

NPR: GOP Health Proposal Could Ditch Protections For People Who Are Sick
The plan "would make coverage unaffordable for many older consumers and would segregate high-cost consumers in coverage that would likely be inadequate," says Timothy Jost, a professor emeritus at Washington and Lee Law School who writes a health policy blog for Health Affairs. The proposal could also cause premiums to spike for people with medical issues, according to comments posted on Twitter by Topher Spiro, vice president for health policy at the left-leaning Center for American Progress. (Kodjak, 4/20)

The Hill: Trump On ObamaCare Repeal And Preventing Shutdown: 'I Want To Get Both' 
[A] number of GOP aides have suggested it might not be enough to get the bill through the House because of continued opposition from centrists. Rep. Dan Donovan (R-N.Y.), a moderate lawmaker, said on MSNBC Thursday that he is still opposed to the bill despite the latest changes. “It doesn’t actually address the concerns I have for the people I represent, the people of New York City,” Donovan said. “But I suspect it might get some folks on board that maybe weren’t before. But the hope is that they don’t lose other people.” (Fabian and Easley, 4/20)

The Hill: ObamaCare Replacement Deal Hits Major Speed Bumps 
“The question is whether it can get 216 votes in the House, and the answer isn't clear at this time,” said a senior GOP aide, referring to the number of votes likely necessary to pass the legislation. “There is no legislative text and therefore no agreement to do a whip count on.” “I don’t know that the state of play has really changed over the recess,” said another House GOP aide. (Sullivan and Hellmann, 4/20)

CQ HealthBeat: Republicans Have No Deal On Obamacare Repeal But Talks Continue
"Republicans’ latest plan is to expose Americans with pre-existing conditions to staggering new health costs," House Minority Speaker Nancy Pelosi, D-Calif., said in a statement. "Now, by gutting protections for people with pre-existing conditions, Republicans will make it all but impossible for millions of Americans fighting illness to afford the health coverage they desperately need." (Williams, 4/20)

Politico: White House Pressures GOP Leaders On Obamacare Showdown Next Week
The White House does not schedule House floor votes. And while some senior administration officials suggested Thursday that a vote will occur next week, multiple House GOP sources told POLITICO that is unlikely. Indeed, the vote is not currently on the calendar. Nor do Republican insiders think it’s even possible, as Congress will reconvene Tuesday after a two-week Easter recess. That would leave them with one day to whip votes — an unlikely time frame for such a heavy legislative lift. (Bade, Dawsey and Cancryn, 4/20)

The Wall Street Journal: Trump, GOP Race To Avoid Government Shutdown As They Juggle Health-Care Revamp
The White House has thrust a new set of proposals into talks to avoid shutdown of the government next week, while also seeking to revive a health-care overhaul that had collapsed last month. With less than a week to pass legislation funding the government for the rest of the fiscal year, negotiations are beginning to take shape. Democrats are demanding that the legislation include money for insurance companies, without which fragile insurance markets could implode, while the White House in return wants additional money for defense, the border wall and border enforcement. (Radnofsky, Hughes and Peterson, 4/20)

The Baltimore Sun: Maryland Democrats Resist Latest Obamacare Repeal Effort 
Four Democratic members of the state's congressional delegation told voters gathered at a town hall meeting in Baltimore on Thursday that they will continue to push back on Republican efforts to repeal Obamacare, including a new plan expected in coming days. "I don't know that we're going to be able to avoid to fight this every single month," said Rep. John Sarbanes of Baltimore County, a member of the House Energy and Commerce Committee. "I pledge to you [that] we're going to fight as hard as we can." (Fritze, 4/20)

Politico Pro: Texas Lawmakers Weigh Reopening High-Risk Pool
Republican state lawmakers, closely tracking Obamacare repeal efforts in Washington, may look to reopen the state's shuttered high-risk pool to insure Texans who can’t get coverage elsewhere. Bills in the Texas House and Senate would allow the state insurance commissioner to set up a temporary high-risk pool if federal funds become available. (Rayasam, 4/20)

A Tale Of Two Republican States: One That Embraced Health Law And One That Resisted Every Step Of Way

The New York Times examines exactly why New Mexico's marketplaces have remained steady, while Oklahoma's have spiraled.

The New York Times: How G.O.P. In 2 States Coaxed The Health Law To Success Or Crisis
When President Trump describes the Affordable Care Act as “imploding,” Lori Roll, an insurance agent here, does not consider it hyperbole. Only one health insurer in Oklahoma is left selling coverage through the federal marketplace, and the hospital in this city of 36,000 is not in the network. Premiums are among the highest in the country, and while most marketplace customers qualify for the Affordable Care Act’s income-based subsidies that lower the cost, many of Ms. Roll’s middle-class clients do not. (Goodnough and Abelson, 4/20)

In other health law news —

Modern Healthcare: Amid Growing Uncertainty, States Extend Deadlines To File 2018 Rates
With time running out to set insurance prices and still no sign of whether the Trump administration will continue funding cost-sharing subsidies for low-income Americans, several states are giving health insurers a little more wiggle room to file 2018 rates. State insurance regulators hope an extra few weeks to price plans will be enough to ease the insurance industry's jitters created by efforts to repeal and replace the Affordable Care Act and keep insurers from bailing on the exchanges. (Livingston, 4/20)

Administration News

FDA Adjusts Warnings Due To Codeine's Rare But Life-Threatening Side Effects On Kids

The agency identifies two dozen cases where drugs containing codeine lead to death, and 40 instances of it causing serious breathing difficulties.

The New York Times: F.D.A. Strengthens Warnings For Painkillers In Children
The Food and Drug Administration announced on Thursday that any child younger than 12 should not take the opioid codeine and that those 18 and younger should not take tramadol, another painkiller, after certain types of surgery. In addition, nursing mothers should avoid both opioids because they pose dangers to breast-feeding babies, the agency said. (Saint Louis, 4/20)

The Washington Post: FDA Warns Of Dangers Of Codeine And Tramadol For Children And Breast-Feeding Mothers
The Food and Drug Administration on Thursday warned parents against giving their children prescription medicines with codeine and tramadol, saying the drugs could lead to severe breathing problems and death. The agency said it would require manufacturers to make label changes to warn that the drugs shouldn't be used for anyone under 12 and should be restricted in older children. The FDA also warned breast-feeding mothers to avoid using the medicines while nursing their babies. (McGinley, 4/20)

Stat: Codeine Cough Syrup Should Not Be Given To Kids, FDA Warns
The finding comes after a safety review the FDA launched in 2015 to investigate the risks of these two opiate drugs. Presently, codeine is approved to treat pain and cough — including as a frequent ingredient in prescription cough syrups — and tramadol is approved to treat pain. (Sheridan,  4/20)

The Wall Street Journal: FDA Expands Warnings On Codeine And Tramadol For Children
The federal agency said it identified 64 cases of serious breathing problems, including 24 deaths, with codeine-containing medicines in children younger than 18, in reports from 1969 through May 2015. The FDA said it also found nine cases of serious breathing problems, including three deaths, with the use of tramadol medicines in children under 18, from 1969 through March 2016. (Burton, 4/20)

NPR: Don't Give Kids Cough Syrup That Contains Codeine, FDA Says
Multiple prescription drugs contain codeine or tramadol. For example, the painkiller Tylenol 3 contains acetaminophen and codeine. Drugs containing codeine already carry a black-box warning against using it to treat pain in children who have their tonsils removed. (Hersher, 4/20)

Fear Of Deportation May Be Affecting Immigrants' Willingness To Seek Out Health Care

Physicians report that they're seeing an uptick in immigrant patients canceling appointments and not coming in for follow-ups.

Modern Healthcare: Tougher Immigration Enforcement Is Taking A Toll On Healthcare
The Trump administration's more aggressive policy of detaining and deporting undocumented immigrants is posing new challenges for healthcare providers who serve immigrant communities. While there is no definitive proof yet, leaders of community health centers and hospital emergency physicians say they see anecdotal evidence that immigrant patients are making fewer appointments and not coming in for follow-up care. They worry chronic conditions will worsen and infectious diseases will go untreated. (Meyer, 4/21)

In related news —

Kaiser Health News: Clamping Down On Visas Could Leave Some Areas Underserved By Doctors
Limiting the number of foreign doctors who can get visas to practice in the United States could have a significant impact on certain hospitals and states that rely on them, according to a new study. The research, published online in JAMA this week, found that more than 2,100 U.S. employers were certified to fill nearly 10,500 physician jobs nationwide, in 2016. That represents 1.4 percent of the physician workforce overall. There were wide variations by state and employer, however. (Andrews, 4/21)

Medicaid

HHS, Lawmakers Weigh Work Requirement For Medicaid, But Many Enrollees Already Have A Job

Republican legislation to replace the health law could include the provision and Secretary of Health and Human Services Tom Price has told states he is open to them adding work requirements to their programs. Also in the news: funding for the CHIP program is on the line this year, Florida lawmakers are wrestling with funding for hospitals that have large numbers of uninsured or Medicaid patients and Tufts Health Plan will manage a Medicaid program in Rhode Island.

The Associated Press: Lawmakers Revisiting Requiring Those On Medicaid To Work
A simple question — should adults who are able to work be required to do so to get taxpayer-provided health insurance? — could lead to major changes in the social safety net. The federal-state Medicaid program for low-income and disabled people covers more than 70 million U.S. residents — about 1 in 5 — including an increasing number of working-age adults. n a break from past federal policy, the Health and Human Services Department under Secretary Tom Price has already notified governors it stands ready to approve state waivers for "meritorious" programs that encourage work. (Alonso-Zaldivar, 4/21)

Modern Healthcare: States May End Coverage For Kids As Federal Funds Dry Up 
Several states may soon have to suspend programs that provide healthcare coverage for children unless Congress reauthorizes funding for the Children's Health Insurance Program, according to a government agency. Arizona, California, Minnesota, North Carolina and the District of Columbia will run out of CHIP funding by December 2017 unless Congress approves additional funds for the program, according to a report by the Medicaid and CHIP Payment and Access Commission (MACPAC) discussed during a Thursday panel meeting. By March 2018, more than half of states are projected to exhaust their federal CHIP funds. (Dickson, 4/20)

Public Health And Education

Despite Notable Silence From White House, Anti-Vaccine Advocates Keep Hopes High

The CDC continues to promote immunizations just as it did under the Obama administration, but vaccine skeptics still feel emboldened by having the new president in the White House. In other public health news: a diet soda link to dementia risk; anxiety in students; a rare tick-borne disease; dietary supplements; and Henrietta Lacks' cells.

Morning Consult: Despite Campaign Rhetoric, Trump Mostly Silent On Vaccine Policy
On the campaign trail, President Donald Trump met with prominent vaccine skeptics and ranted about the debunked theory that vaccines cause autism. But as the administration approaches its 100-day mark, the White House has given few indications about the direction of its vaccine policy. That vacuum has left experts drawing their own conclusions, fueling the hopes of vaccine skeptics and the fears of advocates. (Reid, 4/20)

CNN: Diet Sodas May Be Tied To Stroke, Dementia Risk
Gulping down an artificially sweetened beverage not only may be associated with health risks for your body, but also possibly your brain, a new study suggests. Artificially sweetened drinks, such as diet sodas, were tied to a higher risk of stroke and dementia in the study, which published in the American Heart Association's journal Stroke on Thursday. (Howard, 4/20)

Columbus Dispatch: US Students More Anxious Than Global Average In Survey
U.S. teens rank around average for life satisfaction and academic achievement, according to a new international survey. But students in this country, more than their foreign counterparts, feel compelled to compete and are anxious about schoolwork and testing. A larger-than-average percentage of American students also feel like outsiders at school. (Gilchrist, 4/21)

The Washington Post: A Rare Tick-Borne Disease Infected A Baby, The First Case In A New State
It started with fever and vomiting. Then the 5-month-old baby developed facial twitching, stiffening of his right arm and seizures. The family rushed him to Connecticut Children’s Medical Center. Clinicians there performed tests, including a brain MRI that showed clear signs of a serious infection. The testing showed that the baby didn’t have meningitis, an infection in the tissues surrounding the brain. But he did have an unusual pattern of inflammation in the very deep parts of his brain. (Sun, 4/20)

Los Angeles Times: Venture Capitalists Look Beyond Tech To The Dietary Supplements Market
How do you stay sharp and fit despite fatigue and age? By consuming substances extracted from blueberries, flowers and algae, say the makers of a new group of unregulated and unproven health pills. Trusting natural chemicals to solve inevitable ailments is familiar to anyone who has visited a GNC store or contributed to the $30 billion spent annually in the U.S. on dietary supplements. (Dave, 4/21)

The Baltimore Sun: HBO Movie On Henrietta Lacks Puts Spotlight On Johns Hopkins 
As a movie starring Oprah Winfrey about Henrietta Lacks and her groundbreaking cells hits television screens Saturday, one major character in her story has remained muted. Johns Hopkins Medicine, whose doctors took Lacks' cells without her consent during a diagnostic procedure in 1951, has kept a low profile amid the fanfare surrounding the HBO movie, based on the bestselling book "The Immortal Life of Henrietta Lacks" by Rebecca Skloot. (McDaniels, 4/20)

Drug Companies Turned 'Blind Eye' To Opioids Flooding Community, Cherokee Nation's Suit Claims

“Today, we are facing another challenge, a plague that has been set upon the Cherokee people by these corporations,” said Todd Hembree, attorney general for the Cherokees. “Their main goal is profit, and this scourge has cost lives and the Cherokee Nation millions.”

The Washington Post: Cherokee Nation Sues Drug Firms, Retailers For Flooding Communities With Opioids
Lawyers for the Cherokee Nation opened a new line of attack against the pharmaceutical industry Thursday, filing a lawsuit in tribal court that accuses the nation’s six top drug distributors and pharmacies of flooding communities in Oklahoma with hundreds of millions of highly addictive pain pills. The suit alleges that the companies violated sovereign Cherokee laws by failing to prevent the diversion of pain pills to the black market, profiting from the growing opioid epidemic and decimating communities across the nation’s 14 counties in the state. (Higham and Bernstein, 4/20)

Stat: Cherokee Nation Sues Pharmacies Over Tribal Opioid Crisis
“These drug wholesalers and retailers have profited greatly by allowing the Cherokee Nation to become flooded with prescription opioids,” the lawsuit alleges. “They have habitually turned a blind eye to known or knowable problems in their own supply chains.” (Thielking, 4/20)

The Hill: Cherokee Nation Sues Drug Firms Over Opioid Epidemic: Report
The suit lists AmerisourceBergen, Cardinal Health and McKesson Corp., which are reportedly three of the nation’s largest drug distributors, controlling almost 85 percent of the country’s prescription pill distribution. The suit also names major corporations who sell drugs including CVS, Walgreens and Wal-Mart. (Beavers, 4/20)

In other news on the opioid crisis —

The Washington Post: The DEA Warned NFL Doctors About Drug Laws In 2011. It Didn’t Go Well.
On a cold day in February 2011, doctors and athletic trainers from the NFL’s 32 teams gathered at a hotel ballroom in downtown Indianapolis. Under scrutiny for its handling of prescription drugs, the league had invited the Drug Enforcement Administration , and an official named Joseph T. Rannazzisi made the trip from Washington armed with more than 80 slides of charts, photographs and bullet points about federal laws that govern how the doctors can medicate professional football players suffering from pain and injuries. (Maese, 4/20)

Kaiser Health News: What Doesn’t Kill You Can Maim: Unexpected Injuries From Opioids
The trouble started for Lisa when she took a blood pressure pill and one to control seizures, along with methadone, a drug used to help wean patients off heroin. “I inadvertently did the methadone cocktail and I went to sleep for like 48 hours,” Lisa said, rolling her eyes and coughing out a laugh. “It kicked my butt. It really kicked my butt.” (Bebinger, 4/21)

Courier-Journal: Drug Increases In Austin As Families Struggle To Survive 
The Courier-Journal spent six months examining how [Johnathon] Cooke, the rest of the community and the larger world has responded to this singular outbreak, interviewing dozens of health workers and experts, patients, community members, state officials and others; examining state, federal and community records; and witnessing the start of the city's recovery. What happened here provides lessons for the entire country about preventing a deadly epidemic and stopping its spread. (Ungar, 4/21)

Report Provides Blueprint Of How Memory Can Be Improved When It's Lagging

A new study looks at the effects of electrical stimulation on the brain, and how those pulses can improve and impair memory.

NPR: Clues To Failing Memory Found In Brain Stimulation Study
"When memory was predicted to be poor," he explains, "brain stimulation enhanced memory, and when it was predicted to be good, brain stimulation impaired memory. "In other words, on a bad memory day, stimulation helped. On a good day, it hurt. When stimulation was delivered to the right place at the right time, the researchers found, it could improve memory performance among the patients by as much as 50 percent. (Hamilton, 4/20)

State Watch

Two Democratic Lawmakers Work To Bring Universal Health Care To California

In Hawaii, lobbyists push back against part of a bill that would cover fertility treatments for some LGBT couples. Meanwhile, California, Arizona and Colorado legislatures consider other measures that would impact the health or safety of residents.

Sacramento Bee: Single-Payer Health Care Up For Debate In California 
While Republicans in Washington are seeking to resurrect their plan to dismantle Obamacare and replace it with a market-based approach, a pair of Democratic California lawmakers are plotting to go in the opposite direction. Lara, of Bell Gardens, and Sen. Toni Atkins of San Diego, with backing from National Nurses United and the Bernie Sanders wing of the Democratic Party, are working to create a universal, government-run health care system. (Hart, 4/21)

The Associated Press: Health Care Lobby Pushes Back On Hawaii LGBT Fertility Bill
Health care lobbyists in Hawaii are pushing lawmakers to kill part of a bill that would expand access to fertility treatments to same-sex couples who want to have a child. They're saying requiring insurers to cover fertility treatments for gestational carriers that male couples rely on could lead to legal problems. (Bussewitz, 4/20)

KQED: Another Year, Another Effort To Expand Disability Benefits For Federal Firefighters 
Rep. Salud Carbajal (D-Santa Barbara) has introduced legislation that would make it easier for tens of thousands of federal firefighters, many of them in California, to get disability benefits. Firefighters for the federal departments of Defense, Interior, and Agriculture have to prove exactly what job-related experience made them sick to get coverage from the federal government. (Goldberg, 4/20)

Arizona Republic: Lawmakers Approve Arizona's First Texting While Driving Ban
Arizona lawmakers on Thursday approved the state's first ban on texting while driving, limiting it to beginning drivers for the first six months they have a driver's license. The vote came after Sen. Karen Fann, R-Prescott, pledged to hesitant lawmakers that this was not the start of a path to a universal texting ban. (Pitzl, 4/20)

The Cannabist: Amended Colorado PTSD Medical Marijuana Bill Advances To House Vote
Colorado doctors should be allowed to recommend medical marijuana in treating PTSD symptoms of adults, but there should be additional guardrails when it comes to children, state lawmakers decided Thursday. An amended Senate Bill 17, which would add post-traumatic stress disorder to Colorado’s list of qualifying conditions for medical marijuana, passed a second reading Thursday in the state House. (Wallace, 4/20)

State Highlights: California Fines Hospital For Mistakenly Removing Patient's Ovaries; Movement To Hire Ex-Offenders For Health Jobs Takes Off In States

Media outlets report on news from California, Minnesota, Ohio, Illinois, Pennsylvania, Missouri, Texas and Florida.

Stateline: Matching Ex-Offenders With Hard-To-Fill Health Care Jobs
With unemployment falling and workers hard to find, a growing number of health care employers are following Johns Hopkins’ lead and giving people with criminal records a second chance — hiring them mainly into entry-level jobs in food service, janitorial services and housekeeping. Studies show that employees with records stay in their jobs longer and are no more likely to commit workplace crimes than hires without them. (Quinton, 4/19)

KQED: Judge Threatens To Fine California Prisons For Delayed Mental Health Treatment 
California prison officials could face hundreds of thousands of dollars in fines a day if they can’t comply with a federal court order to eliminate delays in treatment for the most severely mentally ill inmates. U.S. District Judge Kimberly Mueller this week threatened to fine prison officials to get them to meet the terms of a 1995 settlement of a decades-old class-action lawsuit. (Pickoff-White and Small, 4/20)

The Star Tribune: Six Mumps Cases Confirmed At University Of Minnesota 
An outbreak of the mumps has sickened six students at the University of Minnesota Twin Cities campus, according to an e-mail sent to students and staff Thursday. Dr. Brooks Jackson, vice president for health sciences and dean of the medical school, said the cases had been confirmed by state health officials and that all of them “have been mild.” (Howatt, 4/20)

Chicago Tribune: Lurie Children's Hospital CEO Deals With Huge Demand For Services, Funding Woes 
Patrick Magoon never planned to stay in Chicago, and he never thought he'd work in hospital administration.Yet this month, Magoon is marking 40 years at Lurie Children's Hospital, including 20 as CEO. Instead of resting on his accomplishments over four decades, Magoon, 64, is working to gain state approval to add another 48 beds to the esteemed hospital. And he's continuing to advocate for pediatric patients as congressional Republicans talk of reviving their bid to replace the Affordable Care Act. (Schencker, 4/20)

Modesto Bee: Five Modesto Doctors Faces Charges In Broad Fraud And Kickback Scheme
Five Modesto doctors are among more than two dozen physicians, pharmacists, business owners and a physician assistant charged in a $40 million fraudulent medical billing and kickback scheme, authorities announced Thursday. State Insurance Commissioner Dave Jones and Orange County District Attorney Tony Rackauckas said a Beverly Hills couple are accused of masterminding a complex insurance fraud scheme of recruiting doctors and pharmacists to prescribe unnecessary treatment for workers compensation insurance patients. (Valine and Farrow, 4/20)

The Star Tribune: STDs Hit Another Record High In Minnesota In 2016 
Sexually transmitted diseases rose to another record high in Minnesota last year, with double-digit increases in syphilis and gonorrhea, two infections that can have severe health consequences if left undetected, state health officials said Thursday. The increases come at time when teen pregnancy rates are on the decline and the number of new HIV infections has fallen slightly — suggesting that sexually active Minnesotans are taking some precautions but lack awareness about the dangers of some commonly spread STDs. (Howatt, 4/20)

California Healthline: Hospital Ratings Sites Give Consumers Something To Go On
One in 25 patients develop an infection while in the hospital, according to federal estimates. Many of those infections and other medical mistakes are preventable. Nationally, an estimated 440,000 people die each year from hospital errors, injuries and infections. A recent report card from the nonprofit Leapfrog Group showed there’s plenty of room for improvement by California hospitals on a wide range of patient safety measures. Nearly half of the 271 California hospitals that were reviewed received a grade of C or lower. (4/21)

Los Angeles Times: University Of California Officials Will Ask Judge To Halt Alleged Health Fraud Scheme They Claim Stole Millions
The University of California is alleging that it’s uncovered a scheme that targeted hundreds of students through its student healthcare plan and cost the UC almost $12 million. In a complaint filed Thursday in Los Angeles County Superior Court, the UC said the scheme used information from more than 500 students enrolled in its systemwide Student Health Insurance Plan that allowed doctors to write fraudulent medical prescriptions. The UC is seeking a temporary restraining order hoping to halt the practice and the people behind it. (Landa, 4/20)

The Philadelphia Inquirer: Penn Health Professionals Pitch Med-Free Treatment Tweaks
High-tech, minute-by-minute tracking and care management clearly can improve patients’ medical treatment and recovery, project presenters testified this week at the University of Pennsylvania Health System’s annual Innovator Accelerator Pitch Day. Better crunching of big data and small weans patients off feeding tubes and out of intensive-care units more quickly, and makes sure they’re getting enough nourishment. Smarter apps connect them when needed with the most appropriate doctors and test trials, and look for signs of excess consumption of meds. Sharper tracking tools also send patients home sooner, significantly lower readmissions rates, cut whopping bills, and save lives. (Takiff, 4/20)

KQED: Decades Later, Industry And Regulators Fail To Clean Up Former Rocket Test Site
Santa Susana was founded in the mid-1940s at what was then the remote fringe of a largely rural San Fernando Valley. The laboratory developed and tested 10 nuclear reactors for the federal government and tested rocket engines for half a century. The 1959 meltdown was just one mishap in decades of pollution left by atomic research, the open-air burning of toxic wastes and thousands of NASA rocket engine tests. (Richard, 4/21)

Texas Tribune: FDA Officially Bans Texas' Attempted Import Of Execution Drugs 
Almost two years after Texas tried to import an execution drug from overseas, the U.S. Food and Drug Administration ruled Thursday that the drug can’t be admitted into the United States. In July 2015, the Texas Department of Criminal Justice tried to import 1,000 vials of sodium thiopental, an anesthetic that the state has previously used in executions, but the FDA seized the drugs at a Houston airport and has held them ever since. (McCullough, 4/20)

Weekend Reading

Research Roundup: Unnecessary Care; Medicaid And Marijuana; Workplace Wellness Programs

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

JAMA Internal Medicine: Association Of Primary Care Practice Location And Ownership With The Provision Of Low-Value Care In The United States
Question: What is the influence of practice location and ownership on the provision of low-value care? Findings: In this nationally representative sample of primary care visits, hospital-based outpatient practices used more low-value computed tomography and magnetic resonance imaging, radiographs, and specialty referrals for common conditions than community-based office practices, particularly during hospital-based visits with someone other than the patient’s primary care provider. Hospital-owned community-based practices made more specialty referrals than physician-owned community-based practices but were otherwise similar. (Mafi et al., 4/10)

JAMA Internal Medicine: Low-Value Medical Services In The Safety-Net Population
Question: How often do patients with Medicaid or without insurance receive low-value care compared with privately insured patients; are there any differences related to the physicians treating these patient groups? Findings: Analyses of nationally representative survey data from 2005 to 2013 show that low-value care was delivered in nearly 1 in 5 visits, with no overall difference between Medicaid or uninsured patients vs privately insured patients. Rates of low-value care were similar between safety-net physicians and non–safety-net physicians. Meaning: Overuse of low-value care is just as common among patients with Medicaid or without insurance as among privately insured patients. (Barnett et al., 4/10)

Health Affairs: Medical Marijuana Laws May Be Associated With A Decline In The Number Of Prescriptions For Medicaid Enrollees
In the past twenty years, twenty-eight states and the District of Columbia have passed some form of medical marijuana law. Using quarterly data on all fee-for-service Medicaid prescriptions in the period 2007–14, we tested the association between those laws and the average number of prescriptions filled by Medicaid beneficiaries. We found that the use of prescription drugs in fee-for-service Medicaid was lower in states with medical marijuana laws than in states without such laws in five of the nine broad clinical areas we studied. If all states had had a medical marijuana law in 2014, we estimated that total savings for fee-for-service Medicaid could have been $1.01 billion. (Bradford and Bradford, 4/12)

Avalere: Medicaid Funding Reform: Impact On Dual Eligible Beneficiaries
New modeling from Avalere finds that proposals to limit per capita federal Medicaid funding growth based on medical inflation could lead to a $44 billion spending cut for dual eligible beneficiaries—or people who qualify for both Medicaid and Medicare—over the next 10 years. (Pearson and Meyer, 4/20)

The Kaiser Family Foundation: Changing Rules For Workplace Wellness Programs: Implications For Sensitive Health Conditions
The Affordable Care Act (ACA) sets standards for a certain type of wellness program, called health contingent programs .... Health contingent wellness programs vary health plan premiums or cost sharing based on whether a person achieves a biometric target, such as for blood pressure. ... Two other laws – the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA) – govern all workplace wellness programs that ask workers and their family members to disclose health information, including genetic information. ... Under [legislation pending in Congress], any wellness program in compliance with ACA requirements would be deemed compliant with ADA and GINA wellness program standards. As a result, for the vast majority of workplace wellness programs today, there would be no limit on inducements that could be used to encourage workers and their family members to provide personal health information. (Pollitz and Rae, 4/7)

Urban Institute: Urban Blight And Public Health
The health impacts from blighted properties—substandard housing, abandoned buildings, and vacant lots—are often not immediately visible or felt. This report—Urban Blight and Public Health—synthesizes recent studies on the complexities of how blight affects the health of individuals and neighborhoods while offering a blend of policy and program recommendations to help guide communities in taking a more holistic and coordinated approach, such as expanding the use of health impact assessments, tracking health outcomes, and infusing public health into housing policies, codes and practices. (de Leon and Schilling, 4/11)

Heritage Foundation: Assessing The American Health Care Act: Moving Toward A Fair Federal Tax Treatment Of Health Insurance
If congressional leaders are serious about controlling the growth of health care costs, and thus making insurance premiums more affordable for millions of Americans, they must reform the health insurance markets. Congress cannot accomplish that goal effectively, and lay the groundwork for a genuine consumer-driven market in health insurance and health care, unless it reforms the tax treatment of health insurance. That begins with capping the exclusion, and creating an equitable system of individual tax relief. (Robert Moffit, 4/18)

Editorials And Opinions

Different Takes On The GOP's Latest Health Plan; A Status Report On The ACA

Opinion writers review "the 2.0 version" of the American Health Care Act, examine what's happening so far with the Affordable Care Act and take a look at the current state of the individual insurance market.

The Washington Post: Trumpcare 2.0 Won’t Go Anywhere, Either
The GOP 2.0 version of the American Health Care Act has about as much appeal as the original AHCA, or maybe less. It’s still a big tax cut for the rich, a hit to pocketbooks of older and more rural voters, and less generous than what recipients had received under Obamacare. Would a moderate in a district Hillary Clinton carried overwhelmingly go for this? It’d be a high-risk proposition. (Jennifer Rubin, 4/20)

Bloomberg: Republican Health-Care Policy: Trial And Error 
The current plan is apparently not to get rid of “Essential Health Benefits,” (a big talking point for the conservative part of the coalition), but instead to use waivers that would give states broad latitude to pare them back, if they wanted to. (Very sick people, whose insurance bills might spike under this scenario, are to be taken care of via “high-risk pools,” a remedy which liberals say is inadequate, because premiums in those pools can be quite high if they’re underfunded.) This is no way to build a health-care plan. (Megan McArdle, 4/20)

The Washington Post: The GOP’s Latest Health-Care Plan Is Comically Bad
House Republicans are apparently ready for yet another attempt to snatch health insurance away from constituents who need it. Someone should remind Speaker Paul Ryan of a saying often attributed to his legendary predecessor Sam Rayburn: “There’s no education in the second kick of the mule.” (Eugene Robinson, 4/20)

The New York Times: A New G.O.P. Health Proposal Evokes The Old Days
In the days before Obamacare, applying for health insurance meant filling out dozens of pages of forms and submitting medical records. It was almost impossible to compare prices. Your premium might be set higher for a large number of reasons, including if your child was overweight. This could be the future in some states under the latest Republican proposal to overhaul the health law. (Margot Sanger-Katz, 4/20)

The New York Times: The Balloon, The Box And Health Care
Imagine a man who for some reason is determined to stuff a balloon into a box — a box that, aside from being the wrong shape, just isn’t big enough. He starts working at one corner, pushing the balloon into position. But then he realizes that the air he’s squeezed out at one end has caused the balloon to expand elsewhere. So he tries at the opposite corner, but this undoes his original work. If he’s stupid or obsessive enough, he can spend a long time at this exercise. ... Now you understand what’s happening to G.O.P. efforts to repeal and replace the Affordable Care Act. (Paul Krugman, 4/21)

Vox: The GOP’s Biggest Health Care Achievement Has Been Making Obamacare More Popular
It is bizarre watching House Republicans persuade themselves that the problem they face on health care is cutting a deal between the Freedom Caucus and the Tuesday Group rather than crafting legislation that people actually like, and that will actually make some part of the health care system noticeably better. But the GOP’s refusal to take public opinion even mildly into account has put them in a disastrous position. (Ezra Klein, 4/20)

JAMA Forum: Is The Affordable Care Act Imploding?
Insurers have to make initial decisions about whether they will participate in the marketplaces in 2018 and what premiums they will charge by June 21. Ambiguity over how the Trump administration will operate the program and what Congress may do could lead insurers to leave the marketplaces or raise premiums significantly as a hedge against the uncertainty. ... Widespread insurer exits—which could leave counties with no insurers and therefore no ability for people to obtain coverage or premium tax credits—would no doubt lead to finger pointing and debate about who is to blame: former President Obama and Democrats or President Trump and congressional Republicans. Kaiser Family Foundation polling suggests that President Trump and Republicans would get the short end of that stick, with 61% of Americans holding them responsible for any future ACA problems. (Larry Levitt, 4/17)

The New England Journal of Medicine: Good Riddance To Big Insurance Mergers
Eighteen months after four of the five largest U.S. health insurers announced multibillion-dollar merger deals, federal judges, siding with the Department of Justice (DOJ), have issued preliminary injunctions halting the two transactions. These decisions will cost the insurers: they spent over $2 billion trying to get the deals done, and the would-be acquirers are due to pay $2.85 billion in breakup fees — and possibly billions more in damages. Moreover, the parties’ conduct has further damaged the public’s view of the insurance industry. Having suffered similar defeats at the hands of the Federal Trade Commission (FTC), hospitals are enjoying a moment of revenge. But the decisions actually provide more precedent to support challenges of mergers between competitors in health care markets — whether payers or providers. (Leemore S. Dafny, 4/19)

Viewpoints: A Plea For Medical Research Funding; The Politics Of Planned Parenthool

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

St. Louis Post-Dispatch: Increase Funding For Medical Research
As doctors who treat patients devastated by cancer, Alzheimer’s disease and infectious diseases, we urge Congress and the White House to adopt a budget for the 2017 fiscal year before government funding expires at the end of this month, and to increase, not slash, funding for fiscal 2018 for the National Institutes of Health so that the incredibly important work the NIH supports can move forward. (Timothy J. Eberlein, Victoria J. Fraser and David M. Holtzman, 4/21)

The New York Times: Science Needs Your Cells
It’s often portrayed as a story of exploitation. In the early 1950s, Henrietta Lacks, a poor, young African-American woman, learned she had terminal cancer. Cells collected from a biopsy of her cancer were cultured without her knowledge or permission to develop a cell line, called HeLa. Over the ensuing decades, research using HeLa cells led to scores of medical advances, saving lives — and making a lot of money for a lot of people, though not for Ms. Lacks’s family. (Holly Fernandez Lynch and Steven Joffe, 4/21)

The New England Journal of Medicine: Reevaluating Eligibility Criteria — Balancing Patient Protection And Participation In Oncology Trials
Eligibility criteria for clinical trials are designed to protect patients from undue harm, define the study population, and permit collection of safety and efficacy data specific to the intended population. But too frequently, eligibility criteria are simply duplicated from protocol to protocol without due consideration of differing drug classes or patient populations; investigators thus lack a sound clinical rationale for excluding certain patients. Unnecessarily restrictive inclusion and exclusion criteria limit accrual and access to trials and result in studies that fail to capture the heterogeneity of the patient population that will use the drug after approval. (Julia A. Beaver, Gwynn Ison and Richard Pazdur, 4/20)

Detroit Free Press: Hey, GOP: Your Constituents Use Planned Parenthood
Michigan Republicans hot to defund Planned Parenthood should slow their roll. At least long enough to understand exactly who they’ll be sticking it to if their persistent efforts are successful: Their own constituents, women in small Michigan cities or rural Michigan counties with few options for care, tens of thousands of whom who visit Planned Parenthood – in Petoskey or Brighton or Big Rapids or Jackson or Livonia – each year. (Nancy Kaffer, 4/20)

Stat: Successful Teen Pregnancy Prevention Program Threatened By Funding Cuts
Many teens want to avoid getting pregnant. Thanks to supportive communities and innovative programs, many are succeeding. The birth rate among teens in the United States is at an all-time low. But one key federal program, whose work has driven some of this progress, is now in danger of losing half of its funding. The program is the Teen Pregnancy Prevention (TPP) Program, which lives within the little-known Office of Adolescent Health. The Obama administration established this pregnancy prevention program in 2010 as part of its broader, unprecedented embrace of evidence-based initiatives. (Christine Dehlendorf, 4/20)

Chicago Tribune: Rauner Has His Finger To The Political Winds On Abortion
Three years ago this month, private equity investor Bruce Rauner, then running for governor as a socially liberal Republican, underscored his commitment to abortion rights when filling out a candidate questionnaire. "I dislike the Illinois law that restricts abortion coverage under the state Medicaid plan and state employees' health insurance because I believe it unfairly restricts access based on income," he wrote when submitting answers to Personal PAC, a leading abortion rights organization. "I would support a legislative effort to reverse that law." Rauner, who was elected governor that fall, is now under fire for doing a complete 180 on this point. (Eric Zorn, 4/20)

Kansas City Star: There's No Silver Bullet For Kansas City's Violent Crime Problem 
Don’t think that just one part of the community needs to shape up and suddenly fly right to curb the crime rate. No, to “solve” the issue of violence, Kansas City first must approach it as a public health issue. And the challenge must be embraced by everyone: civic leaders and average folks, white and black, gay and straight, rich, poor and those whose finances fall somewhere in the middle. (4/20)