KHN Morning Briefing

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Political Cartoon: 'A Life Of Its Own?'

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Fed’ral government
is not the health solution
that many believe.

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Summaries Of The News:

Health Law

Intraparty Struggles On Display As GOP Leaders Concede Health Care Vote Won't Come This Week

An amendment on preexisting conditions and essential health benefits was added to the legislation to woo conservatives, but now leaders aren't sure if they have enough moderate votes. The White House had been pushing for a vote before President Donald Trump's milestone of 100 days in office.

The New York Times: Health Law Repeal Will Miss Trump’s 100-Day Target Date
An 11th-hour White House push to give President Trump a major legislative victory in his first 100 days in office broke down late Thursday as House Republican leaders failed to round up enough votes for their bill to repeal the Affordable Care Act. ... [S]eesawing commitments and the reservations from numerous lawmakers throughout Thursday laid bare the difficulty that Republican leaders faced in trying to push through a repeal bill. (Kaplan and Pear, 4/27)

The Associated Press: Trump Won't Get House OK Of Health Bill Before His 100th Day
The House won't vote on a reworked health care overhaul until at least next week, Majority Leader Kevin McCarthy, R-Calif., told reporters late Thursday. Party leaders made that decision after spending all day pressuring moderate GOP lawmakers to back that bill, but fell short of the votes they'd need to prevail. "As soon as we have the votes, we'll vote on it," McCarthy said after leaving a nearly two-hour meeting of the House GOP leadership. (Fram, 4/28)

CQ HealthBeat: McCarthy: No Health Care Vote Friday Or Saturday
"We've been educating people on health care," McCarthy said. "It's not tomorrow. I never said it was going to be tomorrow. ... We are not voting on health care tomorrow." When asked about Saturday, he said, "No. We never put it out there." He didn't make any further comments about timing. (Mershon and McPherson, 4/27)

Politico: House Delays Obamacare Vote, Denying Trump 100-Day Win
White House officials, after striking a deal with conservatives, had publicly raised expectations that the vote would occur this week. And they privately pushed Ryan (R-Wis.) to hand Trump something he could tout as a major legislative victory before Saturday, his 100th day in office. (Cheney, Bade and Bresnahan, 4/27)

The Washington Post: House Republicans Fall Short In Scramble For Vote On New Health-Care Proposal
Outside of the Freedom Caucus, Republicans who had opposed the American Health Care Act grappled with the revised text. Most were still opposed or undecided on Thursday. “We’re taking a trillion bucks out and saying, ‘Good luck, states,’” said Rep. Mark Amodei (R-Nev.), whose district covers Reno and most of rural Nevada. “That may provide money to do tax reform, but what you leave in my state is that when the legislature meets, it’s got about a quarter-of-a-billion-dollar shortfall.” (Eilperin and Weigel, 4/27)

The Washington Post: House Will Not Vote On Affordable Care Act Rewrite, Smoothing Way For Government To Stay Open
As many as 15 or so House Republicans have publicly said they will not support the latest GOP proposal, which was crafted among the White House, the hard-line House Freedom Caucus and a leading moderate lawmaker. That leaves House Speaker Paul D. Ryan (R-Wis.) and the White House an incredibly narrow path for passage. The speaker can lose only 22 Republicans on a health-care vote because Democrats have fiercely opposed any attempt to repeal the ACA. (Snell and Kane, 4/27)

Modern Healthcare: House Delays Planned Vote On Revised ACA Repeal And Replace Bill 
The latest version of Obamacare repeal and replace would leave it up to the states on how much insurers can charge older customers beginning next year. In 2020, it would allow states to apply for a waiver to change the 10 essential health benefits now required to be part of nearly all health insurance plans. The goal of any of these changes, according to the bill's authors, is to reduce healthcare premiums for the majority of customers. (4/27)

Bloomberg: House GOP ‘Struggling To Get To Yes’ On Revived Obamacare Repeal 
[S]everal moderate Republicans are visibly frustrated about the renewed push to pass the bill after leaders made changes aimed at winning over conservatives. "We’ve been through this before,” Republican Representative Charlie Dent of Pennsylvania said Thursday. "The business model around here is to load the bill up, make it as conservative as possible, send it to the Senate and have the Senate clean it up and send it back, and the very people who are placated on the first launch won’t be there on the final. And that dog ain’t hunting anymore." (Edgerton and House, 4/27)

The Hill: CBO Won't Have Score On Revised ObamaCare Bill Next Week 
The budget scorekeeper for Congress is apparently a few weeks away from releasing an analysis of the GOP's revised ObamaCare repeal-and-replace bill.  The nonpartisan Congressional Budget Office (CBO) told House Minority Leader Nancy Pelosi's (D-Calif.) office Thursday that a score of the bill would not be ready this week or next. (Hellmann, 4/27)

CQ Roll Call: Ryan: No Obamacare Repeal Could Cost GOP In 2018
House Speaker Paul D. Ryan fired warning shots to his fellow Republicans on Thursday that not repealing the 2010 health care law could have significant political consequences in the midterm elections. The comments come as leadership attempts to corral support for legislation (HR 1628) that would remove large portions of the health law. While a scheduled vote on the bill was pulled last month amid infighting between conservative and moderate Republicans, the effort has gained new momentum in recent days due in large part to an amendment from GOP Reps. Tom MacArthur of New Jersey and Mark Meadows of North Carolina that would allow states to apply for exemptions from key mandates in the law. (Williams, 4/27)

Politico: 4 Key Questions Surrounding Obamacare Repeal
House Republicans are mounting yet another effort to tear down Obamacare and remake the health care system — but the path to delivering on one of the GOP's longest-standing priorities remains complicated and fraught with uncertainty. (Cancryn, 4/27)

Atlanta Journal Constitution: Jody Hice Gets To ‘Yes’ On Health Care Overhaul
The lone Georgia Republican congressman to reject an earlier iteration of the GOP’s Obamacare replacement plan said he’s now on board after conservatives struck a deal with a moderate leader. Rep. Jody Hice, R-Monroe, said he’ll support the GOP’s American Health Care Act, or AHCA, after the chairman of the House Freedom Caucus and moderate New Jersey Republican Tom MacArthur negotiated changes to the legislation that would allow states to opt out Obamacare’s basic coverage requirements as long as they first get a waiver. (Hallerman, 4/27)

Meanwhile, if it does get through the House —

Morning Consult: Democrats Poised For Health Care Fight Over Arcane Byrd Rule
Even if House Republicans manage to get enough members of their party on board with the latest version of their health care bill, they will face another battle in the Senate: whether the bill complies with the chamber’s arcane budget rules. But experts say that’s one battle Democrats have a chance of winning — unless the Senate pulls another “nuclear option.” (Reid, 4/27)

Moderates Balk At Undermining Coverage For Those With Preexisting Conditions

Negotiations to bring conservatives on board with the Republican health care plan have brought coverage for people with preexisting conditions -- an issue that's plagued both sides of the aisle when it comes to making health care affordable -- back into the spotlight.

Politico: Pre-Existing Conditions Drive Moderates' Concern Over Repeal Bill
Moderate Republicans are largely withholding their support for the Obamacare repeal bill, arguing it would hurt people with pre-existing conditions. House Republican leaders hoped that the House Freedom Caucus’s endorsement of the latest Obamacare repeal bill would light a fire under enough moderates to get their whip count to the 216 votes needed to pass the measure. Instead, the holdouts are digging in, saying that the latest changes only moved the bill to the right and could put more Americans at risk of losing their health insurance. (Haberkorn, 4/27)

The Hill: New Bill Tests GOP Promise On Pre-Existing Conditions 
The revised Republican ObamaCare replacement bill is testing the party's pledge to preserve protections for people with pre-existing health conditions. House Republicans' own website states that people should "never" be charged more for having a pre-existing condition, but the revised bill would allow just that in states that are granted a waiver from ObamaCare’s protections. (Sullivan, 4/28)

Marketplace: For People With Pre-Existing Conditions, The Republican Health Care Plan Contains Plenty To Worry About
Before the Affordable Care Act, if you were living with a pre-existing condition, it usually meant you'd pay through the nose for coverage, your condition might not get covered or you'd have no insurance at all... In the House Republicans' most recent effort to repeal the health law, a new amendment would allow states to charge the sick higher rates — if those people dropped their coverage. (Gorenstein, 4/27)

Kaiser Health News: 2 Health Care Issues Collide On Capitol Hill And The Result Is Confusion
Julie Rovner, KHN’s chief Washington correspondent, was interviewed on Here & Now by WBUR’s Robin Young Thursday. They discussed changes approved by Republican conservatives for the House bill to replace the Affordable Care Act — which would give states the option to loosen provisions in the health law requiring insurers to offer coverage to people with preexisting conditions and guaranteeing that policies cover essential health benefits — and the debate between the parties over whether the government will continue to fund subsidies that help pay for many out-of-pocket expenses for low-income people who purchase coverage on the health law’s marketplaces. (4/27)

Health Care Groups Tell House Republicans That Revisions 'Make Bad Bill Even Worse'

Organizations representing doctors, hospitals and older Americans each came out against the latest version of the GOP plan to replace the federal health law.

Bloomberg: Doctor, Hospital Groups Say GOP's Health Bill Worse With Changes 
The U.S.’s biggest groups representing doctors, hospitals and older Americans came out against changes Republicans have proposed to get their health-care bill more support from conservatives, saying the amendments make the proposal worse. The groups, which opposed the original GOP bill, said the alterations will make it harder for people with pre-existing conditions to buy coverage and will raise insurance costs for older Americans. (Edney, 4/27)

The Hill: Healthcare Groups Denounce Revised GOP Health Bill 
Leading healthcare and advocacy groups are urging Congress not to pass the revised Republican ObamaCare replacement bill, fearing that changes could harm those with pre-existing conditions. The American Hospital Association (AHA), American Medical Association (AMA) and American Association of Retired Persons (AARP) all denounced the revised bill on Thursday. The groups were already opposed to the American Health Care Act (AHCA), saying that millions would lose coverage, but raised new concerns about an amendment from Rep. Tom MacArthur (R-N.J.). (Sullivan, 4/27)

Los Angeles Times: GOP Shuts Out Doctors, Experts, Democrats — Pretty Much Everybody — As They Work On Obamacare Repeal
The White House and its House GOP allies are hoping to reschedule a vote on their overhaul plan in the coming days, following last month’s embarrassing retreat when the bill was pulled shortly before a vote. But they continue to refuse to reach out to Democrats. Even Senate Republicans have been largely sidelined, though their support will be crucial to putting a measure on Trump’s desk. And senior House Republicans and White House officials have almost completely shut out doctors, hospitals, patient advocates and others who work in the healthcare system, industry officials say, despite pleas from many healthcare leaders to seek an alternative path that doesn’t threaten protections for tens of millions of Americans. (Levey, 4/27)

Insurers Left In Limbo As Deadline To File 2018 Rates Draws Ever Closer

"So basically we've got four to six weeks to figure out some basic things that will help all of us in the industry to have more surety and stability, so we can price our premiums lower," says Tom Policelli, CEO of Minuteman Health. At the very least, many insurers want to know if the subsidy payments Trump used as a negotiating threat will continue.

NPR: Health Insurers Try To Plan Ahead As Congress Deliberates On Health Law
As Republicans in Congress debate changes to the Affordable Care Act, insurance executives across the country are trying to make plans for next year. Companies that sell policies on the exchanges created by the Affordable Care Act, also known as Obamacare, face fast-approaching deadlines to inform states about what plans they want to sell, and what they intend to charge. "Insurance companies need to file rates in 2 1/2 months," says Tom Policelli, CEO of Minuteman Health, which sells Obamacare policies in Massachusetts and New Hampshire. (Kodjak, 4/27)

Politico Pro: Insurers Still Panicking Over Fate Of Obamacare Subsidies 
The Trump administration’s decision to back down on its threats to pull crucial subsidies for Obamacare’s low-income customers has alleviated the immediate threat to the ACA markets. But insurers and regulators say the persistent uncertainty surrounding the $7 billion in payments is causing massive headaches as health plans rapidly approach deadlines for the 2018 enrollment season. (Demko, 4/27)

In other health law news —

The Wall Street Journal: ‘Skinny’ Plans Can’t Trim The Real Fat Under New GOP Health Bill: Experts
In the latest version of their plan to repeal large portions of the Affordable Care Act, Republicans are proposing letting states opt out of the requirement that insurance plans cover a specific set of benefits. Republicans hope consumers could save money by buying “skinny” plans, excluding items they may not need such as maternity care. But many experts and studies indicate such changes might not drive down premiums very much, since insurance plans would still cover big, necessary items like hospital stays and doctor’s visits. (Hackman, 4/28)

Modern Healthcare: ACA Repeal, Regulatory Reform Take Hold During Trump's 100 Days 
Trump's pledge to repeal and replace the Affordable Care Act by April 29—day 100—has dominated the political landscape and eclipsed virtually all other issues on the healthcare agenda. The president and GOP leadership suffered a major setback last month House Speaker Paul Ryan (R-Wis.) opted to withdraw  the American Health Care Act before a scheduled vote. Although House leadership hoped a revised version of the AHCA would reach the floor for a vote on Friday or Saturday, House Majority Leader Kevin McCarthy (R-Calif.) said late Thursday night that wouldn't happen. The fractured GOP House majority will continue to negotiate a version of the AHCA they hope will be palatable to both moderates and the conservative Freedom Caucus, which supported the latest iteration. (Weinstock, 4/27)

San Francisco Chronicle: Covered California Premiums Could Soar If Feds Stop Enforcing ACA 
Premiums for health plans sold on Covered California, the insurance exchange created under the Affordable Care Act, could spike nearly 50 percent if the federal government stops enforcing two of the law’s key provisions that have been put in question under President Trump, according to a new analysis by Covered California and PricewaterhouseCoopers. The projected increase would apply to all health plans in California’s individual insurance market, which includes 1.3 million people who buy plans through Covered California as well as 1.1 million people who buy plans directly from insurers outside of the exchange. (Ho, 4/27)

Capitol Hill Watch

Spending Negotiations Hit Snag Over Medicaid Funding For Puerto Rico, Abortion Regulations

Puerto Rico is projected to exhaust a $6.4 billion Medicaid grant before the end of the year and has been struggling without replacement funding.

The Wall Street Journal: Puerto Rico Emerges As Sticking Point In Government Funding Showdown
Securing additional Medicaid dollars from Washington has been a priority for Puerto Rico as it sits on the verge of an unprecedented court-supervised bankruptcy. Mr. Trump weighed in after Democratic and GOP leadership reached an agreement to provide incremental assistance to Puerto Rico ahead of an impending health-care funding cliff on the island, according to people familiar with the matter. (Scurria, 4/27)

CQ Roll Call: Omnibus Talks Tangled Up In Puerto Rico Medicaid Shortfall
The details of the negotiations remain murky but disagreement was noted Thursday by both White House Press Secretary Sean Spicer and Sen. Robert Menendez, a New Jersey Democrat who has been an outspoken advocate on Puerto Rico’s financial troubles and participated on a congressional task force on the issue. (Mejdrich, 4/27)

Administration News

Trump's FDA Pick, Scott Gottlieb, Clears Committee And Heads To Full Senate Vote

Democrats have voiced concerns about Gottlieb's ties to the pharmaceutical industry, but the nominee has had a fairly smooth confirmation process thus far.

The Washington Post: Trump Nominee To Head FDA Clears Key Panel, Moves To Full Senate For Vote
The Senate health committee voted 14-9 Thursday to approve physician Scott Gottlieb to be the next commissioner of the Food and Drug Administration, sending the nomination to the full Senate. All 12 Republicans on the committee voted in favor of Gottlieb, a former venture capitalist who served as an FDA deputy commissioner during the George W. Bush administration. Two Democrats, Michael F. Bennet of Colorado and Sheldon Whitehouse of Rhode Island, also voted yes. (McGinley and Bernstein, 4/27)

Stat: Senate Committee Votes To Advance Scott Gottlieb's Nomination To Lead FDA
The vote was originally scheduled for Wednesday, but Senator Patty Murray of Washington, the committee’s ranking Democrat, asked for a 24-hour postponement after receiving responses to paperwork relating to Gottlieb’s financial holdings less than an hour before the vote was to take place. Murray had previously complained of Gottlieb’s slow pace in responding to committee members’ questions for the record — a separate set of written clarifying questions they submitted after Gottlieb’s first hearing before the committee. (Facher, 4/27)

CQ Roll Call: Health Panel Approves FDA Nominee For Senate Floor
Gottlieb was an FDA official during the George W. Bush administration. Since leaving the agency, he has worked for numerous pharmaceutical companies and biotechnology startups with interests in FDA policies and approvals. He has promised to resign from and divest from companies he currently works for or has a financial stake in, and said he will recuse himself from decisions involving any companies he’s been tied to for a year after confirmation. The Office of Government Ethics signed off on his nomination. (Siddons, 4/27)

Veterans' Health Care

Trump Issues Order To Protect VA Whistleblowers, But Some Say Changes Are 'All Hot Air'

The president says the new Office of Accountability and Whistleblower Protection will make clear “that we will never, ever tolerate substandard care for our great veterans.” Some in Veterans Affairs are worried though that it will simply be more failed bureaucracy.

USA Today: VA Whistle-Blowers Leery Of Donald Trump Order Creating Accountability Office To Protect Them
As President Trump signed an executive order Thursday seeking to provide more protections to whistle-blowers at the Department of Veterans Affairs, the very people he's trying to protect are leery. In locations spanning from Arizona to Delaware, and Florida to Wisconsin, current and former employees who endured retaliation from superiors after they reported abuses have watched as those managers retained their positions — and were even promoted in some cases. (Slack, 4/27)

The Associated Press: Trump Signs Order Creating Accountability Office At VA
Trump, who made improving veterans’ care a prominent issue in his presidential campaign, said the Office of Accountability and Whistleblower Protection will make clear “that we will never, ever tolerate substandard care for our great veterans.” VA Secretary David Shulkin said the office will help identify “barriers” that make it difficult for the department to fire or reassign bad managers or employees. (Superville and Yen, 4/27)

In other veterans' health care news —

CQ Roll Call: Opioid Abuse And Veteran Suicides Probed At Hearing
Lawmakers demanded answers from the Department of Veterans Affairs and federal watchdogs Thursday as to why veteran suicides haven’t decreased despite increased funding to prevent them. Appropriators have injected new money into suicide prevention programs, a dedicated crisis line and mental health care. But despite that, veteran suicides have increased 32 percent since 2001, according to a sweeping report on veteran suicide published by the VA in August.The phenomenon isn’t limited to veterans. The civilian population’s suicide rate also shot up 23 percent over the same time period. (Mejdrich, 4/27)

The Associated Press: VA Limiting New Hiring As It Aims To Widen Private Care
Despite the lifting of a federal hiring freeze, the Department of Veterans Affairs is leaving thousands of positions unfilled, citing the need for a leaner VA as it develops a longer-term plan to allow more veterans to seek medical care in the private sector. The order by VA Secretary David Shulkin is described in an internal April 14 memorandum obtained by The Associated Press. (Yen, 4/26)


Key Florida Lawmaker Says State, Federal Cuts To Medicaid Will Reach $650 Million

But state Sen. Anitere Flores says the effect on hospitals may be mitigated by other federal funding that is expected. News outlets also report on Medicaid news in Wisconsin, Mississippi and Minnesota.

Tampa Bay Times: Florida Medicaid Cuts Will Hit $650 Million, Senate Chair Says 
As part of a broad budget deal, House and Senate leaders have agreed to roughly $650 million in cuts to hospital payments through Medicaid. Sen. Anitere Flores, R-Miami, the Senate's health care budget chairwoman, confirmed that the state would cut its share of Medicaid payments by $250 million in the upcoming budget, which reduces federal matching dollars by more than $400 million. That's more than was proposed by either the House or Senate in their original budgets. (Auslen, 4/27)

Madison (Wis.) Capital Times: Madison Disability Advocates Speak Out Against Proposed Medicaid Changes
[Anna] Moffit and other disability advocates in Madison say that restructuring Medicaid could lead to drastic cuts to crucial programs that help individuals with intellectual and developmental disabilities thrive and contribute to their communities. ... The way Medicaid is currently set up, the federal government pays 60 percent of Wisconsin’s Medicaid costs. There’s no limit in this system; the more the state spends, the more the federal government supplements that spending. But the proposed American Health Care Act (AHCA) would put a cap on federal funds. (Speckhard, 4/27)

Wisconsin State Journal: Medicaid, Health Care System Confronting High Cost Of Specialty Drugs
Spending on specialty drugs for cancer, hepatitis and other conditions in Wisconsin’s Medicaid program is up 40 percent the past four years, a trend that could continue as more specialty drugs are approved, a state administrator said Thursday. Medicaid spending on prescription drugs overall is relatively flat, largely because drug companies are required to give Medicaid programs rebates, said Rachel Currans-Henry, director of Medicaid benefits management for the state Department of Health Services. But the rebates could be in jeopardy under Medicaid block grants being considered as part of federal health care reform, Currans-Henry said. (Wahlberg, 4/27)

Jackson (Miss.) Clarion-Ledger: Watchdog: Miss. Made $21M Medicaid Mistake, Owes Refund
The state Division of Medicaid could face an unwelcome expenditure, following a federal audit’s findings that the agency, in error, claimed $21.2 million in unallowable reimbursements from the U.S. Department of Health and Human Services over a three-year period. The report released by the Office of Inspector General last month recommends the state refund that amount to the federal government. (Harris, 4/27)

Minnesota Public Radio: Medica Slashes Jobs As It Quits Most Medicaid Business 
Health insurer Medica is cutting about 110 jobs and not filling about 140 more vacant positions because of its decision to get out of Minnesota's Medicaid program serving children and families, the company announced Thursday. Late last year, Medica said it would no longer manage the care for more than 300,000 MinnesotaCare and other Medicaid customers effective May 1. (Zdechlik, 4/27)

Public Health And Education

Biotech Firm Sees Option For Home Addiction Treatment Similar To Giving Insulin For Diabetes

Brady Granier, the CEO of California-based BioCorRx, says that he hopes to develop a low-dose, injectable-form of naltrexone that uses a small needle so that people could administer it at home. Also, another company, Aware Recovery Care, is providing in-home addiction therapy in some areas of the country.

Stat: Company Hopes To Make Addiction Treatment For Home Use
A California-based addiction treatment company hopes to change the way patients struggling with substance abuse disorder receive a popular form of medication-assisted treatment. If approved, patients could self-administer naltrexone, an opioid antagonist, in the comfort of their own homes — like insulin, but for recovering addicts. The promise of this advancement has some addiction experts excited about a product that could reduce the stigma surrounding recovery. Others, though, remain wary of moving such treatment out of a doctor’s office and away from wraparound services seen as essential for staying clean. (Blau, 4/28)

Kaiser Health News: Try This At Home: Program Brings Drug Addiction Treatment To Patients
Hannah Berkowitz is 20 years old. When she was a senior in high school, her life flew off the rails. She was abusing drugs. She was suicidal. She moved into a therapeutic boarding school to get sober, but she could stay sober only while she was on campus during the week. “I’d come home and try to stay sober really hard — really, really hard,” said Berkowitz, who had trouble staying away from old friends and bad habits. ... But Berkowitz did have luck. She had private health insurance and lived in Connecticut, where a startup company, Aware Recovery Care, had begun treating clients in the very environment where Hannah struggled to stay sober: her home. (Rodolico, 4/28)

Bones From 3D Printers And Other Developments Bring Us Step Closer To Making Sci-Fi A Reality

Bloomberg looks at companies pushing the boundaries of medical development, and what that means for the future of diseases. In other public health news: calorie counts, peer reviews, police and mental illness, infertility treatments and more.

Bloomberg: We’re Getting Closer To Mass Production Of Bones, Organs, And Implants
Medical researchers have been able to create certain kinds of living cells with 3D printers for more than a decade. Now a few companies are getting closer to mass production of higher-order tissues (bone, cartilage, organs) and other individually tailored items, including implants. This kind of precision medicine, treating patients based on their genes, environment, and lifestyle, could herald the end of long organ donor lists and solve other problems, too. (Popescu, 4/27)

The Washington Post: Wait For Calorie Count On Burgers, Pizza May Get Longer
Consumers hoping to consistently find out how many calories are in that burger and fries may have to wait — again. New government rules to help people find out how many calories are in their restaurant meals are set to go into effect next week after years of delays. But they could be pushed back again if grocery stores, convenience stores and pizza delivery chains get their way. (Jalonick, 4/28)

Stat: Phony Peer Review: The More We Look, The More We Find
An unknown number of published studies have a hidden flaw: The “peers” who supposedly vouched for their publication are phonies. And the closer publishers look, it seems, the more rotten studies they find. Now, in the biggest haul to date, publisher Springer has announced that it’s retracting 107 papers from a single journal over concerns that authors had cheated the peer review process — some perhaps unintentionally. (Marcus and Oransky, 4/28)

Austin American-Statesman: A Question Of Restraint: When Policing The Mentally Ill Turns Deadly
[Tom] Klessig is one of at least 33 people with histories of mental illness who died after being restrained by police in Texas over the past decade, according to a first-of-its-kind investigation by the American-Statesman of in-custody deaths. Six of those people wielded weapons; the rest were unarmed, records with the Texas Attorney General indicate. Because the reports that law enforcement agencies must file on in-custody deaths do not track information about the decedent’s mental health, the numbers are likely an undercount of those with a psychiatric disorder who die in police custody. (Ball and Schwartz, 4/27)

The New York Times: Baby-Making By Lottery At A Manhattan Clinic
John Zhang, a well-known specialist in reproductive medicine who runs the New Hope Fertility Center out of a vast and science-fiction-looking office on Columbus Circle, believes he has played a singular role in the fiscal health of New York City. Patients come to him from around the world, from the Middle East, from Kenya, from Nigeria, Spain and China. Perhaps especially from China. (Bellafante, 4/27)

Kaiser Health News: ‘Center Of Excellence’ Designation Doesn’t Rule Out Complications Of Bariatric Surgery
Getting bariatric surgery at a “center of excellence” doesn’t mean that patients can be assured that they will avoid serious complications from the weight-loss procedure at the facility, according to a recent study. Even though facilities that have been accredited as centers of excellence must all meet minimum standards, including performing at least 125 bariatric surgeries annually, the risk of serious problems varied widely among centers, the study found. (Andrews, 4/28)

The Plain Dealer: Cleveland Clinic Research Shows Link Between Gut Bacteria, Meat-Heavy Diets, And Risk Of Blood Clots
Cleveland Clinic researchers have established another connection between heart disease and foods, the bacteria in the intestine that digest them, and the substances these bacteria end up creating during digestion. Choline, naturally found in red meat and egg yolks, but in this case administered in a supplement -- increased the production of a gut bacteria byproduct called trimethylamine N-oxide, or TMAO, a chemical the group had previously found to be a strong predictor of heart disease risk. (Zeltner, 4/27)

State Watch

Buyouts Offered To 1,600 Brigham and Women's Hospital Workers To Control Costs

The move to reduce 9 percent of the prestigious teaching facility's workforce signals that few health institutions are immune from the current climate of economic uncertainty. Meanwhile, other hospital news is reported out of California, Kansas, Pennsylvania, Maryland, Colorado and Wisconsin.

Boston Globe: Brigham Hospital Offers Voluntary Buyouts To 1,600 Workers
Brigham and Women’s Hospital, one of Boston’s largest employers, said Thursday that it is offering voluntary buyouts to 1,600 workers to rein in costs, a sign of financial stress in one of the region’s bedrock business sectors. The hospital is profitable, Brigham officials said, but is being squeezed as payments from insurers and the government flatten while labor and other costs grow. (Dayal McCluskey, 4/27)

Los Angeles Times: Under Fire From Hospitals, Legislator Drops Measure Requiring Reports Of Superbug Deaths
After complaints from California hospitals and physicians, a state legislator has stripped his bill of a measure that would have required doctors to record deadly infections on death certificates. The California Hospital Assn. and the California Medical Assn. wrote letters saying they opposed the plan by state Sen. Jerry Hill (D-San Mateo). The measure would have required physicians to include drug-resistant bacterial infections on the death certificate if in their opinion it helped cause a person’s death. (Petersen, 4/27)

KCUR: Kansas Lawmakers Balk At Brownback’s $24M Plan For Gun Security At State Hospitals 
Lawmakers signaled Thursday that they could exempt Kansas psychiatric hospitals from a law requiring them to allow concealed handguns. Gov. Sam Brownback has requested an additional $24 million in spending over the next two budget years on upgrades needed to provide security at state mental health hospitals and facilities for people with developmental disabilities. A state law taking effect July 1 will allow people to carry concealed guns into any public building that is not secured by armed guards and mental detectors. (McLean and Wingerter, 4/27)

The Baltimore Sun: Hopkins Adds Pennsylvania Hospital To Research Network 
Allegheny Health Network in Pennsylvania has joined a research network run by Johns Hopkins that aims to accelerate the pace that new treatments are discovered. The network developed by the Johns Hopkins Institute for Clinical and Translational Research connects researchers from academic institutions with those who work in community settings to collaborate on research and share findings. (McDaniels, 4/27)

The Philadelphia Inquirer: Jefferson And National Jewish Health Form New Respiratory Institute In Philly
Jefferson Health and Denver-based National Jewish Health, a leading respiratory hospital, on Thursday announced the creation of a new respiratory institute in Philadelphia. The Jane and Leonard Korman Respiratory Institute will adopt the centralized, streamlined care model used at National Jewish Health. Patients will see specialists and receive tests during one visit, rather than making multiple trips to various locations, said Gregory Kane. chair of Jefferson's department of medicine. (McCullough, 4/27)

State House News Service: Partners HealthCare, Brigham Hospital Pay $10M In Medical Research Fraud Case 
Partners HealthCare and Brigham and Women's Hospital have agreed to pay $10 million to settle a medical research fraud case involving three doctors who are no longer affiliated with the companies. The U.S. attorney's office in Boston announced Thursday that the settlement resolves allegations that a Brigham and Women's stem cell research lab run by Dr. Piero Anversa fraudulently obtained grant funding from the National Institutes of Health by using improper protocols, inaccurately characterized cardiac stem cells, recklessly kept records, and fabricated data and images included in applications. (Norton, 4/27)

Milwaukee Journal Sentinel: Kenosha's United Hospital System To Become Froedtert South
Froedtert Health and United Hospital System in Kenosha would work more closely together and United Hospital System would operate under the Froedtert & the Medical College of Wisconsin brand name in a tentative agreement announced Thursday. The two health systems would not merge under the proposed agreement but would share a system for electronic health records and the same protocols for quality. (Boulton, 4/27)

State Highlights: Texas Lawmakers Take Aim At Insurers And Drug Coverage Practices; Fla. House Poised To Approve Trauma Center Deregulation Bill

Media outlets report on news from Texas, Florida, Minnesota, California, Georgia, Massachusetts and Maryland.

Houston Chronicle: Lawmakers Take Aim At Insurance Plan Changes To Patients' Medications
Health insurers are under pressure from Texas legislators to halt a practice that allows them to change the terms of coverage for prescription drugs with a pair of bills in the House and Senate that would extend earlier protections. Patient advocacy groups and doctor and nurse associations long have been opposed to the practice known as "non-medical switching," which allows insurers to drop medications from their plans, raise co-pays, or add other restrictions and requirements, typically for financial, as opposed to medical, reasons. (Canaves, 4/27)

Tampa Bay Times: Watered-Down Deregulation Of Trauma Care On Tap In Florida House 
The Florida House is expected to pass watered-down legislation meant to increase the number of trauma centers in the state on Friday. Trauma centers, which handle the worst, most time-sensitive injuries like gunshot wounds and violent car crashes, are limited under state law based on the need in each part of the state. State Rep. Jay Trumbull, R-Panama City, had proposed to get rid of limits statewide. (Auslen, 4/28)

Pioneer Press: Minnesota Measles Outbreak Grows To 29 Cases, Spreads To Stearns County
A measles outbreak that began last month in Hennepin County has grown to 29 confirmed cases and has spread to Stearns County, according to the Minnesota Department of Health. The outbreak’s victims have all been children age 5 and younger, and only one is known to have been vaccinated against measles, the MDH said. Twenty-five have been unvaccinated Somali-Minnesotan children, while the vaccination status and ethnicity of the others is not yet known. Twenty-eight of the cases are located in Hennepin County, while one is in Stearns County. (Woltman, 4/27)

The Star Tribune: 5 More Cases Of Measles Include First Outside Hennepin County 
State health officials reported five more cases of measles Thursday, including one in Stearns County that marked the first time the current outbreak has spread beyond Hennepin County. A total of 29 children have now been sickened since the end of March, making it the largest measles outbreak in Minnesota since 1990. (Howatt, 4/27)

Sacramento Bee: Doctor Shortage At CA State Prison Sacramento Hurts Care 
A summary of the unidentified inmate’s death is included in the latest report by a state inspector general calling attention to “inadequate” health services at a prison with a difficult population of 2,400 inmates that sits next door to Folsom State Prison. The new report, released in late March by the state Office of Inspector General, faulted a “critical shortage” of doctors at the prison and a “seemingly unprecedented ability to recruit and retain” primary care providers. (Ashton, 4/27)

Boston Globe: UMass Boston Nursing Program Faces Uncertain Future 
The nursing school at the University of Massachusetts Boston, one of the campus’s most successful programs, faces an uncertain future because of a logistical snafu caused by the myriad construction projects underway at the same time. The program is housed in a building set to be demolished in the next few years, but the Baker administration has nixed a plan to fund a replacement building, leaving the nursing program looking for a new home. (Krantz, 4/28)

California Healthline: California Proposes Stringent Cap On Toxic Chemical In Drinking Water
California regulators are proposing a strict limit on a toxic man-made chemical that has contaminated water supplies throughout the state, particularly in its vast agricultural heartland. California would be the second state, after Hawaii, to establish a threshold for the former pesticide ingredient and industrial solvent known as TCP (1,2,3-trichloropropane) in drinking water. The chemical compound, identified in California as a human carcinogen, is no longer in wide use but has leached over the years into many wells and reservoirs in California and other states. (O'Neill, 4/27)

Miami Herald: Partners Of Florida Medical Marijuana Grower Fight In Court Over Pending Sale 
A lucrative deal that would place a private Fort Lauderdale equity firm at the center of Florida’s fast-growing medical marijuana market is at risk of collapsing amid allegations of “ransom demands” and a corporate coup inside a state-licensed pot dispensary. According to the details of a lawsuit brought by politically connected Panhandle developer Jay Odom against his partners, the shareholders of the Chestnut Hill Tree Farm cannabis nursery in Alachua have splintered over the pending sale of the company’s assets to a new operator. (Smiley, 4/27)

The Baltimore Sun: Keswick Campus To Get Center For Healthy Living 
Keswick, which provides long-term care and other services to seniors, plans to open a Center for Health Living housed on its campus in Baltimore's Roland Park-Hampden area.The center will connect older adults in the community to health and wellness services that can help them stay fit and in their own homes. Keswick residents and community members will have access to programs focused on socialization, education, arts, lifelong learning and exercise. There will also be information on chronic disease and care management. The center, spanning more than 10,000 square feet, is currently being designed and will be located inside Keswick's Bauernschmidt Building. (Cohn, 4/27)

Health Policy Research

Research Roundup: Price Transparency; Cost Of Not Expanding Medicaid; Coverage In Rural Areas

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

JAMA Internal Medicine: Effect Of A Price Transparency Intervention In The Electronic Health Record On Clinician Ordering Of Inpatient Laboratory Tests
Question: Does increasing price transparency for inpatient laboratory tests in the electronic health record at the time of order entry influence clinician ordering behavior? Finding: In this year-long randomized clinical trial including 98 529 patients at 3 hospitals, displaying Medicare allowable fees in the electronic health record at the time of order entry did not lead to a significant change in overall clinician ordering behavior. Meaning: These findings suggest that price transparency alone may not lead to significant changes in clinician behavior, and future price transparency interventions may need to be better targeted, framed, or combined with other approaches. (Sedrak et al., 4/21)

Urban Institute/Robert Wood Johnson Foundation: The Cost Of Not Expanding Medicaid
Nineteen states have not expanded Medicaid eligibility under the Patient Protection and Affordable Care Act (ACA). We estimate that from 2018 through 2027, expansion in these states would increase nominal state costs and federal spending by $59.9 billion and $427.5 billion, respectively, if enrollment is moderate and by $62.9 billion and $487.0 billion if enrollment is high. Each state dollar would thus draw down between $7.14 and $7.75 in net federal funding. (Dorn and Buettgens, 4/27)

Kaiser Family Foundation: The Role Of Medicaid In Rural America
This brief describes Medicaid’s role for 52 million nonelderly children and adults living in the most rural areas in the United States and discusses how expansions or reductions in Medicaid could affect rural areas. ... Although private insurance accounts for the largest share of health coverage in rural areas, nonelderly individuals in rural areas are less likely to have private coverage compared to those in urban and other areas (61% vs. 64% and 66%, respectively). Medicaid helps fill this gap in private coverage, covering nearly one in four (24%) nonelderly individuals in rural areas. Further, in many states, Medicaid coverage rates are higher in rural areas than in urban or other areas of the state. (Foutz, Artiga and Garfield, 4/25)

JAMA Internal Medicine: Association Of Donor Age And Sex With Survival Of Patients Receiving Transfusions
In this binational cohort study, which included 968 264 patients who received transfusions, there was no association between age and/or sex of blood donors and survival of patients. Even among the patients who received multiple units of blood from very young or very old donors, absolute mortality differences compared with patients who received no such units of blood were consistently below 0.5%. (Edgren et al., 4/24)

Urban Institute: Shared Decisions In Cancer Care: Is Medicare Providing A Model?
Medicare’s Oncology Care Model (OCM) is designed to incentivize providers to reduce unnecessary spending, improve care, and involve patients more closely in decisions about the use of chemotherapy. The model includes a 13-point care plan recommended by the Institute of Medicine (IOM) that represents a significant step toward making patients partners in their own care; in particular, it aims the volume of OCM episodes by reducing overly aggressive use of chemotherapy and underuse of hospice services among patients who are close to death. However, IOM recommendations since 1999 and recent medical literature suggest that a formal shared decision-making process (SDM) remains vitally important. This paper discusses the rationale for and barriers to adopting a more formal SDM. (Millenson and Berenson, 4/23)

Preventing Chronic Disease/CDC: Quit Methods Used by US Adult Cigarette Smokers, 2014–2016
To quantify the prevalence of 10 quit methods commonly used by adult cigarette smokers, we used data from a nationally representative longitudinal (2014–2016) online survey of US adult cigarette smokers (n = 15,943). Overall, 74.7% of adult current cigarette smokers used multiple quit methods during their most recent quit attempt. Giving up cigarettes all at once (65.3%) and reducing the number of cigarettes smoked (62.0%) were the most prevalent methods. Substituting some cigarettes with e-cigarettes was used by a greater percentage of smokers than the nicotine patch, nicotine gum, or other cessation aids approved by the US Food and Drug Administration. (Caraballo et al., 4/13)

Morbidity and Mortality Weekly Report/CDC: Trends In Repeat Births And Use Of Postpartum Contraception Among Teens — United States, 2004–2015
From 2004 to 2015, the number and percentage of teen births that were repeat births decreased 53.8% and 16.9%, respectively; in 2015, the percentage of teen births that were repeat births varied by state from 10.6% to 21.4%. Among teens with a recent live birth, use of the most effective contraceptive methods postpartum increased substantially, from 5.3% in 2004 to 25.3% in 2013; however, in 2013, approximately one in three teens with a recent live birth reported using a least effective contraceptive method or no method postpartum. (Dee et al., 4/27)

Editorials And Opinions

Perspectives On Obamacare's Resiliance, The Insurance Market And Access To Care

Editorial writers review the goings on in Washington regarding health policy and the GOP's repeal-and-replace effort as well as other issues in the health system.

RealClear Health: ACA Favorability Stays Positive As Trump Nears 100th Day In Office
With an increase of nearly 10 points in public approval polls over the past year, the Affordable Care Act has grown more popular as Donald Trump approaches the 100-day milestone of his presidency. In the RealClearPolitics polling average of public approval of the health care law, it sits at 6.7 percent favorability, with 49.1 percent approving to 42.4 percent disapproving. By contrast, Trump’s job approval rating is a -9.8 percent in the RCP average. (Ford Carson, 4/28)

The New York Times: Trumpcare 2.0: It’s Even Worse Than The Original
The original Trumpcare bill, whose spectacular failure embarrassed the White House, had a public approval rating of just 17 percent because it would have taken health insurance away from 24 million Americans, many of them poor, sick and elderly. The new version would further tighten the screws on vulnerable Americans by letting insurance companies charge older people and people with pre-existing conditions much higher premiums than they charge younger and healthier people. It would also give insurers the freedom not to cover essential health services like maternity care and cancer treatment. (4/28)

Arizona Republic: A Guide For The 'Resistance': How To Hold Your Own Raucous Town-Hall Meeting
In another twist not included in the national guide, "Indivisible" members in Arizona created an anti-Flake "theme song," a parody of pop star Taylor Swift's hit "Shake It Off." Flake, a first-term senator, is up for re-election in 2018 and has been the target of much of the local "Indivisible" movement's ire. Flake got blistered at his two-and-a-half-hour town hall in Mesa, which ran about an hour longer than scheduled. He got hammered over his opposition to Obama's signature health-care-reform law, the Affordable Care Act, his vote to confirm Betsy DeVos as Trump's Education secretary and a host of other issues. (Don Nowicki and Ronald J. Hansen, 4/27)

Los Angeles Times: He's Covered, He Makes His Payments And His Insurer Still Drags Its Feet
Most attention on the healthcare front has been focused on Republicans’ single-minded efforts to eviscerate Obamacare. Largely overlooked has been the frustration Americans with employer-based coverage often face in dealing with tight-fisted insurers. For the roughly 150 million workers and family members covered by employers, healthcare all too frequently is an obstacle course of denied claims, bureaucratic headaches and go-slow tactics intended only, or so it seems, to boost insurers’ bottom line. (David Lazarus, 4/28)

USA Today: Medicaid Cuts Are The Real 'Death Panels'
When the Affordable Care Act was debated in Congress, many falsely characterized as "death panels" the once-bipartisan idea of voluntary consultations about hospice and other end-of-life care options. Sarah Palin popularized the term, writing that "the sick, the elderly and the disabled” — including her own child with Down Syndrome — would have to prove they were “worthy of health care.” (Brendan Williams, 4/28)

Viewpoints: Effectiveness Should Guide Doctors' Prescribing; Climate Change And Medicine

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

Stat: Drug Effectiveness Should Influence What Doctors Prescribe
Physicians and payers have called for more outcomes-based drug pricing arrangements. These tie reimbursements to innovation and the value the drug provides, such as how well a drug reduces hemoglobin A1c (a measure of blood sugar) among people with diabetes, or alleviates skin plaques among people with psoriasis, or reduces fracture rates among those with osteoporosis, to name a few examples. Yet the execution of such programs is limited to a handful of agreements between payers and drug makers, each one unique to the parties involved. (Larry Blandford, 4/27)

The Des Moines Register: Saving Medicines, Saving Money, Saving Lives
After the rough, recently-concluded legislative session, you might need a reason to feel good about our state's priorities. Fortunately, if you were tuned in to NPR’s Morning Edition on Thursday, you would have gotten a strong dose of Iowa pride. Iowa, it turns out, is the envy of the nation for a unique lifesaving, cost-saving and environmentally friendly approach to providing no-cost medicines to people in need. It's based on reclaiming and redistributing unused prescription drugs through a drug donor repository. (Rekha Basu, 4/27)

The New England Journal Of Medicine: Preventive Medicine For The Planet And Its Peoples
For many Americans, the effects of climate change seem distant: island nations will sink beneath rising seas, areas of the Middle East will become uninhabitable because of extreme heat. But though the worst effects will be felt by poorer people in poorer countries that are less resilient to droughts, floods, and heat, climate change already affects the health of vulnerable U.S. populations, and U.S. health professionals see these effects. (David J. Hunter, Howard Frumkin and Ashish Jha, 4/27)

Cincinnati Enquirer: How The Trump Administration Is Fighting The Opioid Epidemic
One of the most exciting lines of work we get to support at the U.S. Department of Health and Human Services is the development of new drugs to combat deadly diseases. America’s scientists are constantly pushing the boundaries of what is possible, solving or ameliorating conditions we once thought incurable. So it is both heartening and heartbreaking that one of our top priorities in that work is now fighting a disease that is largely of our own making: opioid addiction. (Secretary of Health and Human Services Tom Price, 4/27)

The Washington Post: If Abortions Become Illegal, Here’s How The Government Will Prosecute Women Who Have Them
You’ve heard the stories of the coat hanger and the back alley, those bloody days before Roe v. Wade. Sen. Patrick Leahy told one recently at the Supreme Court confirmation hearings for Judge Neil Gorsuch. As a state prosecutor in 1968, three years before the court struck down state abortion bans, cops woke him up in the middle of the night, because “a young co-ed nearly died from bleeding from a botched abortion.” The senator from Vermont’s drift was clear: If confirmed, Gorsuch could cast a vote, or several, to bring back those horrors (if not the archaic phrase “co-ed”). (Irin Carmon, 4/28)

The New England Journal Of Medicine: Bridging The Data-Sharing Divide — Seeing The Devil In The Details, Not The Other Camp
The movement toward sharing data from clinical trials has divided the scientific community, and the battle lines were evident at a recent summit sponsored by the Journal. On one side stand many clinical trialists, whose lifeblood — randomized, controlled trials (RCTs) — may be threatened by data sharing. On the other side stand data scientists — many of them hailing from the genetics community, whose sharing of data markedly accelerated progress in that field. (Lisa Rosenbaum, 4/26)

The New England Journal Of Medicine: Learning What We Didn’t Know — The SPRINT Data Analysis Challenge
On January 28, 2016, the International Committee of Medical Journal Editors (ICMJE) posted for public comment a proposed plan on sharing clinical trial data. The response was starkly divided: data analysts called for immediate and open access to all clinical trial data; clinical trialists were convinced that investigators should hold data closely. Trialists argued that they would have no incentive to conduct trials if they weren’t given the opportunity to publish all their findings, while data analysts countered that data obtained under federally funded programs belonged to the public and should be available for examination. Ideally, at the center of the debate are patients who participate in clinical trials, often at great risk to themselves, who expect researchers and analysts to use the data in a responsible way to advance medicine. Although much subjective input was obtained, few respondents offered concrete examples on which to base directive action. (Nancy S. Burns and Pamela W. Miller, 4/26)