KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

In Sunlit Paradise, Seniors Go Hungry

Even in what look like middle class enclaves in Florida, a growing number of seniors are having trouble keeping food on the table. The rate of food insecurity across the country more than doubled among seniors between the years 2001 to 2013. (Sarah Varney, 5/26)

Political Cartoon: 'I Smell A Rat?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'I Smell A Rat?'" by Mike Baldwin.

Here's today's health policy haiku:


Disputed text was
a mistake, health law writers
say, as case nears end.

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

Health Law Issues And Implementation

Staffers Say Disputed Text At Center Of Health Law Case Was Result Of Politics, Sloppiness

The New York Times interviews two dozen congressional staffers about the four words that have propelled the latest health law challenge to the Supreme Court. As a court decision grows closer, other news outlets examine the political and financial repercussions the decision could bring.

The New York Times: Four Words That Imperil Health Care Law Were All A Mistake, Writers Now Say
They are only four words in a 900-page law: “established by the state.” But it is in the ambiguity of those four words in the Affordable Care Act that opponents found a path to challenge the law, all the way to the Supreme Court. How those words became the most contentious part of President Obama’s signature domestic accomplishment has been a mystery. Who wrote them, and why? Were they really intended, as the plaintiffs in King v. Burwell claim, to make the tax subsidies in the law available only in states that established their own health insurance marketplaces, and not in the three dozen states with federal exchanges? The answer, from interviews with more than two dozen Democrats and Republicans involved in writing the law, is that the words were a product of shifting politics and a sloppy merging of different versions. (Pear, 5/25)

The Associated Press: GOP Likely To Feel The Heat If Court Decision Guts Obamacare
A Supreme Court ruling due in a few weeks could wipe out health insurance for millions of people covered by President Barack Obama's health care law. But it's Republicans — not White House officials — who have been talking about damage control. A likely reason: Twenty-six of the 34 states that would be most affected by the ruling have Republican governors, and 22 of the 24 GOP Senate seats up in 2016 are in those states. (Alonso-Zaldivar, 5/26)

Politico: Republicans Grope For Obamacare Replacement
Preparing for a Supreme Court decision that could strike down Obamacare’s subsidies for nearly 7.5 million people this summer, Senate Republicans are coalescing around a plan to resurrect them — at a steep price for the White House. With several Senate Republicans facing tough reelections, and control of the chamber up for grabs, 31 senators have signed on to a bill written by Sen. Ron Johnson (R-Wis.) that would restore the subsidies for current Obamacare enrollees through September 2017. But the administration would have to pay a heavy price — the bill would also repeal Obamacare’s individual and employer mandates and insurance coverage requirements. ... But even if Johnson could somehow persuade Obama and Senate Democrats to accept his plan — a herculean task — the bigger problem will be his Republican colleagues in the House. (Haberkorn and Bade, 5/26)

The Wall Street Journal: Health Costs Hinge On Supreme Court Ruling
The court is expected by the end of June to rule on a lawsuit seeking to invalidate subsidies to more than 7.5 million people who bought plans on the federal exchange. If the court upholds the lawsuit, those people will land in the same boat as their more well-heeled compatriots. People with individual coverage in 2010 and 2012 who bought silver and bronze plans on the exchange after the law took effect saw total premiums and out-of-pocket payments rise an estimated 14% to 28%, according to a study last year by the National Bureau of Economic Research. (Armour, 5/25)

Also, some Democrats are looking at another problem for consumers.

The Associated Press: Democrats See Skimpy Insurance As The Next Health Care Issue
A different health care issue has emerged for Democrats, in sync with the party's pitch to workers and middle-class voters ahead of next year's elections. It's not the uninsured, but rather the problem of high out-of-pocket costs for people already covered. Democrats call it "underinsurance." After paying premiums, many low- and middle-income patients still face high costs when trying to use their coverage. There's growing concern that the value of a health insurance card is being eaten away by rising deductibles, the amount of actual medical costs that patients pay each year before coverage kicks in. (Alonso-Zaldivar, 5/23)

'Cadillac Tax' On Expensive Health Plans Raising Concerns Among Business Leaders

The tax, which goes into effect in 2018, is expected to help fund the health law. In other news, Republicans weigh whether to set up new oversight of the health law and an Arkansas congressman wants to use some health law money to shore up the Highway Trust Fund.

The Wall Street Journal: CFOs Seek To Avoid Bite Of Health Law’s ‘Cadillac Tax’
Finance chiefs grappling with rising health-care costs face a new dilemma: how to avoid paying hefty taxes on generous employee health-care plans. The Affordable Care Act calls for an excise tax on high-cost health plans, starting in 2018. The tax is meant to help fund insurance for previously uncovered Americans through the new health law. The levy, often called the “Cadillac tax,” is 40% a year on the amount by which employer-sponsored plans exceed government-set thresholds. (Johnson and Murphy, 5/25)

The Fiscal Times: The GOP Wants A Watchdog for Obamacare
In perhaps one of the most telltale signs that Republicans are starting to accept that Obamacare isn’t going away anytime soon, GOP lawmakers are rolling out legislation that would create a new independent agency to keep tabs on how the law is administered. (Ehley, 5/22)

Arkansas News/Times Record: Westerman Proposes Putting Medicaid Expansion Money Into Highways
An Arkansas congressman has set his sights on the Affordable Care Act’s Medicaid expansion to shore up an insolvent federal Highway Trust Fund that has required nearly 30 short-term extensions since 2009. U.S. Rep. Bruce Westerman, R-Hot Springs, filed his Prioritizing American Roads and Jobs Act of 2015 on Thursday as a long-term solution to help fund a nearly $16 billion annual shortfall with the Highway Trust Fund and pay down some of the national debt. (Lovett, 5/22)

The Philadelphia Inquirer: Convincing Young 'Invincibles' To Enroll In Healthcare
When Ilana Valinsky got her 2015 calendar, she flipped to May and circled the 18th, the day she would receive her master's degree in social work from the University of Pennsylvania. Valinsky's focus shifts this week to finding a job and health insurance. Covered by a school plan through July 31, Valinsky doesn't want to risk being uninsured for a day. And for good reason: seven years ago, her mother died from breast cancer. (Calandra, 5/24)

USA Today reports on the difficulties doctors and other health providers have found in moving to electronic health records.

USA Today: Government Backs Down On Some Requirements For Digital Medical Records
Government regulators are backing down from many of their toughest requirements for doctors' and hospitals' use of digital medical records, just as Congress is stepping up its oversight of issues with the costly technology. Under Obamacare, doctors and hospitals are being pushed to switch from paper to electronic records or be penalized. ... Now the Department of Health and Human Services is proposing a series of revisions to its rules that would give doctors, hospitals and tech companies more time to meet electronic record requirements and would address a variety of other complaints from health care professionals. (O'Donnell and Ungar, 5/25)

USA Today: Patient Advocate Fights For Access To Digital Records Through Her Art
Regina Holliday was a toy store clerk and preschool art teacher when her husband died of kidney cancer in 2009. Despite her grief and background, Holliday has emerged as a colorful patient advocate with a command of electronic health record rules to rival any button-downed lobbyist. The color comes in the form of more than 330 pictures she's painted on jackets to tell the stories of patients, doctors and others involved in health care. Those who get the free paintings agree to wear them to at least two medical conferences a year, which creates a "Walking Gallery of Healthcare" that 43 other artists have joined. (O'Donnell, 5/25)

Fla. Speaker Says Federal Funds Won't End Medicaid Crisis; Alaska Lawmakers Wrestling With Issue

Florida Speaker Steve Crisafulli says the pressure that created the state's budget impasse is not over. In Alaska, the legislature is not making inroads in the controversy over Medicaid expansion. Other reports look at the issue in North Carolina and Kansas.

Alaska Dispatch News: Legislative Inaction Draws Public's Ire
Alaskans unleashed a month's worth of pent-up opinions on their state legislators Friday, giving them an earful about what they think has happened since the last time a legislative committee heard public testimony. “Shame on this legislative body,” said George Pierce of Kasilof. ... The Legislature is now in its second special session after adjourning the first, which had been called by the governor. The main business of lawmakers has been to pass a funded budget, which they failed to do in their regular session even when they went beyond their 90-day limit. The Legislature has also declined to consider Medicaid expansion or Erin’s Law, an effort geared toward preventing sexual abuse of children. (Forgey, 5/22)

Some news outlets also examine other state Medicaid issues -

The Boston Globe: Amendment Incites Medicaid Fight
A proposal aimed at promoting new ways to pay for the health care of low-income patients has spurred a fierce political fight between insurers, consumer advocates, and one of the state’s largest hospital systems. (Dayal McCluskey, 5/26)

Los Angeles Times: Medi-Cal Director Talks Shortages And Modernization
Since California's health insurance program for the poor was expanded under the Affordable Care Act last year, enrollment has exploded, with more than 3.5 million people signing up for the first time. Almost 1 in 3 Californians — a total of 12.2 million people — now receive coverage through Medi-Cal. But the sudden growth has raised questions about how state officials will serve millions of new beneficiaries and continue paying for the program, which currently costs the state $18 billion a year. There are also other big changes afoot as Medi-Cal switches patients into managed care — a system in which plans coordinate patients' care to keep costs down — and tries to move beyond its reputation as a health program of last resort. (Karlamangla, 5/24)

Providence Journal: R.I.Home-Care Program Predicts Medicaid Cost Savings Exceeding $2.7M
[W]ith Governor Raimondo pushing her cost-cutting Reinventing Medicaid initiative, Neighborhood Health Plan of Rhode Island is eagerly touting what it says is the early success of a program begun just five months ago to address Medicaid subscribers with frequent and hefty medical bills. In January, the insurer, aware that 7 percent of the Medicaid enrollees in the state account for two-thirds of spending, identified 450 of its "frequent utilizers" using advanced data and analytics. It then formed a couple of caregiver teams to visit patients at their homes with the aim of reducing their otherwise frequent — and costly — visits to the hospital. The Health@Home program has been so successful that already Neighborhood is predicting savings of at least $2.7 million in its first year. (Salit, 5/26)

The Associated Press: Court: Nebraska Wrongly Ended Girl's Home Care Benefits
The Nebraska Department of Health and Human Services was wrong to end Medicaid benefits that had helped a woman care for her profoundly disabled daughter at home for more than a decade, the Nebraska Supreme Court ruled Friday, in a case that could affect how the department determines the eligibility of other children with long-term care needs. (Beck, 5/22)

Minn. Marketplace Having Trouble Getting Small Businesses To Join

Insurance brokers say the cumbersome workings of the exchange are partly to blame. Also, the outgoing CEO and the chairman of MNsure were on Minnesota Public Radio to talk about the marketplace's problems.

The Minneapolis Star-Tribune: For MNsure, Attracting Small Businesses Is A Big Problem
MNsure has missed big on one of its original selling points: getting more small businesses to offer insurance to employees. The government-run marketplace was expected to cover 155,000 people in small group plans by next year. That number was 1,405 earlier this month. Insurance agents who connect small firms with coverage say several factors are at play, including a MNsure system they call slow and cumbersome. Steps that still can’t be done online are burdensome. (Snowbeck, 5/24)

The Associated Press: Kansas Lawmakers Review Tax On Exchange Health Policies
A Kansas Senate committee has reviewed a proposal to impose a new fee on insurance policies sold through an online marketplace set up under the federal health care overhaul. But The Topeka Capital Journal reports that representatives of insurance companies and the Kansas Chamber of Commerce provided testimony against the bill to the Ways and Means Committee. (5/22)

Meanwhile, The Associated Press examines health care lobbying in Massachusetts.

The Associated Press: Mass. Health Care Industry Spent $19M Lobbying Lawmakers
Hospitals, insurers, doctors, unions and pharmaceutical companies spent a record $19 million trying to sway Beacon Hill lawmakers last year, a reflection of the industry's political and economic muscle and a rapidly changing health care landscape. ... The group that spent the most on health care lobbying last year was the Massachusetts Association of Health Plans, which represents 17 insurers providing coverage to more than 2.6 million Massachusetts residents. It reported spending more than $1 million. MAHP President Lora Pellegrini said the industry has faced a number of challenges, from grappling with last year's failed launch of the new Health Connector website to the implementation of a 2012 law designed to overhaul the state's health care payment system. (LeBlanc, 5/23)


California's Exchange Will Be First To Cap Patient Costs For Pricey Medications

Most consumers with Covered California plans will have a $250-a-month limit, per prescription, on out-of-pocket costs. The cap goes into effect in January.

Los Angeles Times: Obamacare: California Exchange Caps Specialty Drug Costs For Patients
Tackling the high price of specialty drugs, California's Obamacare exchange capped what consumers will have to pay for expensive medications each month. The new limits, set to go into effect in January, mark a first for state exchanges nationwide, according to Covered California. The exchange's four-member board approved the changes unanimously Thursday. (Terhune, 5/22)

Sacramento Bee: Covered California To Cap Patient Costs For High-Priced Specialty Drugs
Covered California board members voted Thursday to become the first state health care exchange in the nation to impose price caps on high-cost specialty drugs to treat conditions such as hepatitis C and HIV. The four board members unanimously agreed to impose $250 monthly limits on out-of-pocket prescription costs for most patients, creating a precedent that other government health exchanges could follow. (Sangree, 5/21)

NPR/KQED: Covered California Votes To Cap What Patients Pay For Pricey Drugs
In recent years, expensive specialty medicines used to treat cancer and chronic illnesses have forced some very ill Americans to choose between getting proper treatment and paying their rent. To ease the financial burden, the California agency that governs the state's Obamacare plans issued landmark rules Thursday that will put a lid on the amount anyone enrolled in one of those plans can be charged each month for high-end medicine. (Dembosky, 5/22)

The Hill: Calif. ObamaCare Exchange Caps Patient Drug Costs
California’s ObamaCare exchange is announcing a cap on patients’ costs for high-priced specialty drugs, the first state in the country to do so. The announcement, which comes after a unanimous vote by the exchange’s board Thursday, would cap the cost for most enrollees on the insurance exchange at $250 per prescription per month. (Sullivan, 5/22)

A new multiple sclerosis drug -- which can cost $66,000 a year -- is one of the expensive, next-generation medications that is proving unaffordable for some patients -

NPR: Multiple Sclerosis Patients Stressed Out By Soaring Drug Costs
American medicine is heading into new terrain, a place where a year's supply of drugs can come with a price tag that exceeds what an average family earns. Pharmacy benefit manager Express Scripts says last year more than half a million Americans racked up prescription drug bills exceeding $50,000. Barbara Haedtke of Portland, Ore., knows this all too well. When she was diagnosed with multiple sclerosis in 2001 at the age of 35, she was prescribed Avonex, at a cost of around $10,000 a year. ... She's now taking a new drug, Tecfidera, that's priced even higher — $66,000 a year, according to her pharmacy receipt. (Harris, 5/25)

Critics of the  "21st Century Cures" bill, set for a House vote next month, are voicing concerns about drug and device safety testing and the cost of the measure -

The Wall Street Journal: Proposed Medical-Research Law Raises Safety Concerns
Legislation aimed at boosting U.S. medical research funding and revamping some rules over drug and medical-device safety is headed toward a vote in the full House of Representatives, likely in June. But while the bill, known as the 21st Century Cures Act, passed the House Energy & Commerce Committee unanimously last week and opposition has been muted, some critics are beginning to question whether it would open the way for companies to sell drugs and devices that aren’t fully tested. (Burton, 5/25)

In other pharmaceutical news, a court tells Actavis it can't pull its top-selling Alzheimer's drug in favor of a new, pricier one. Meanwhile, two innovative cholesterol drugs may soon come to market that are similar in make up but differ in dosage. And cancer patients in Charlotte, N.C. who want some say in where they are treated form an advocacy network -

Reuters: Actavis Cannot Drop Old Version Of Alzheimer's Drug-Appeals Court
Actavis Plc cannot pull its top-selling Alzheimer's drug from the market in favor of a pricier extended-release version, a federal appeals court in New York ruled on Friday. The decision from the 2nd U.S. Circuit Court of Appeals is a win for New York State Attorney General Eric Schneiderman, who sued to block the switch, arguing that Actavis was trying to stifle competition from generic drugmakers. A three-judge panel upheld an order by U.S. District Judge Robert Sweet in December requiring Actavis to keep the older drug, Namenda IR, on the market. (Ax and Pierson, 5/22)

Reuters: Fight Over Hot New Cholesterol Drugs May Be Won In Milligrams
Two powerful and innovative cholesterol drugs likely to be approved this summer both target the same protein and have been shown to sharply lower LDL in high-risk patients. But there is at least one significant difference between the two offerings: the dosages in which they will be sold. Assuming approval from the U.S. Food and Drug Administration, Amgen Inc. will offer its drug, Repatha, as a biweekly 140 mg injection or a monthly injection of 420 mg, while Praluent, from Regeneron Pharmaceuticals Inc and Sanofi, will be offered in biweekly injections of 75 mg or 150 mg. The difference in dosages is likely to lead to very different sales strategies for the two drugs, in what could be a fierce competition for market share. (Beasley, 5/26)

The Charlotte Observer: Cancer Patients Form Advocacy Group For Doctor Pay
Many cancer patients get their chemotherapy in the offices of oncologists who own their practices, unaffiliated with large hospital systems. Oncology Specialists of Charlotte is one of those clinics, and earlier this month, it hosted a meeting for patients and health care professionals who want to ensure that cancer specialists who want to remain independent can do so. One of the issues of concern is reimbursement. Doctors employed by hospitals, even if they work in clinics separate from those hospitals, get paid more for providing chemotherapy than independent doctors. The lower rate is set by Medicare, the government’s health program for seniors, and most private insurance plans follow suit. Nationally, chemotherapy costs 24 percent more in hospital-based outpatient clinics than in private doctor’s offices, according to a study by Avalere Health. Hospital officials say their charges are justifiably higher because they must cover the cost of non-paying patients and maintain around-the-clock emergency care. (Garloch, 5/25)

More Nurses Allowed To Practice Without Doctor's Oversight

Nurse practitioners can order tests, prescribe drugs and administer treatments in 20 states. Groups representing doctors are fighting the laws that expand this autonomy, saying nurses don't have the proper training. In another effort to innovate care, hospitals are turning to technology to monitor patients around the clock.

The New York Times: Doctoring, Without The Doctor
There are just a handful of psychiatrists in all of western Nebraska, a vast expanse of farmland and cattle ranches. So when Murlene Osburn, a cattle rancher turned psychiatric nurse, finished her graduate degree, she thought starting a practice in this tiny village of tumbleweeds and farm equipment dealerships would be easy. It wasn’t. A state law required nurses like her to get a doctor to sign off before they performed the tasks for which they were nationally certified. ... But in March the rules changed: Nebraska became the 20th state to adopt a law that makes it possible for nurses in a variety of medical fields with most advanced degrees to practice without a doctor’s oversight. ... The laws giving nurse practitioners greater autonomy have been particularly important in rural states like Nebraska, which struggle to recruit doctors to remote areas. About a third of Nebraska’s 1.8 million people live in rural areas, and many go largely unserved as the nearest mental health professional is often hours away. (Tavernise, 5/25)

The Wall Street Journal: Hospitals Find New Ways To Monitor Patients 24/7
Hospitals are trying new early-warning systems to monitor patients for subtle but dangerous signs of a worsening condition. After surgery or during hospitalization for illness, patients are at risk for complications that can quickly turn fatal, such as a depressed breathing rate that can lead to cardiac arrest caused by over-sedation or an adverse reaction to narcotic pain medications. ... Among the strategies hospitals are adopting is a wireless monitor that slips under a mattress and alerts nurses to changes in breathing and heart rate. Another approach rates a patient’s risk of serious deterioration in real time based on lab results, vital signs and nurses’ assessments gathered from electronic medical records. (Landro, 5/25)

Meanwhile, new polls examine the lifesaving-value of seeking a second medical opinion. And researchers question the efficacy of corporate wellness programs  -

Kaiser Health News: Second Opinions Often Sought But Value Is Not Yet Proven
KHN consumer columnist Michelle Andrews writes: "When confronted with the diagnosis of a serious illness or confusing treatment options, everyone agrees it can be useful to seek out another perspective. Even if the second physician agrees with the first one, knowing that can provide clarity and peace of mind. A second set of eyes, however, may identify information that was missed or misinterpreted the first time. ... But here’s the rub: While it’s clear that second opinions can help individual patients make better medical decisions, there’s little hard data showing that second opinions lead to better health results overall." (Andrews, 5/26)

Los Angeles Times: A Second Opinion Could Save Your Life
Second opinions are valuable for a number of reasons, experts say. Several recent studies found that as many as 60% of patients who sought a second opinion received a major change in their diagnosis or treatment. Yet according to a 2010 Gallup Poll, 70% of Americans don't feel the need to ask for one — most said they feel confident in their doctor's advice and saw no need to gather additional information. (Zamosky, 5/24)

Veterans' Health Care

Wounded Veterans Seek To Get VA Ban On IVF Coverage Lifted

For 23 years, the Veterans Administration has been barred from covering in vitro fertilization but some returning combat veterans with serious wounds say they need that help. Also in news about veterans care are several stories about legislation on Capitol Hill and the funding problems for the new Denver hospital.

The Washington Post: For Combat Veterans, VA Ban On IVF Coverage Adds Insult To Injury
After Army Staff Sgt. Alex Dillman was paralyzed from the abdomen down in a bomb blast in Afghanistan, the Department of Veterans Affairs paid to retrofit his Chevy Silverado truck so he could drive it and bought him a handcycle so he could exercise. But the agency ... won’t pay for what the onetime squad leader and his wife, Holly, ache for most: a chance to have children. VA will not pick up the bill for in vitro fertilization .... Under a 23-year-old law, VA is prohibited from covering IVF. ... Now, however, veterans and lawmakers from both parties are pushing to overturn the ban. (Wax-Thibodeaux, 5/25)

The Associated Press: Senate Tweaks Veterans Health Law To Boost Specialized Care
Veterans would get specialized medical care from private doctors more easily under a bill the Senate approved Friday. The measure relaxes a rule that makes getting specialized care from local doctors difficult for some veterans, especially those in rural areas. Senators approved the bill by voice vote as they rushed to wrap up legislative work before a weeklong Memorial Day recess. ... Senators said the measure was needed because some veterans were unable to get federally paid medical care from private doctors under the new Veterans Choice Act. The law blocks veterans from getting private care if they live within 40 miles of a VA medical facility, even if the veteran needs specialized care that is farther away. (Daly, 5/22)

The Washington Post: Money And Time Are Running Out For VA’s Denver Hospital
The Senate passed a measure Friday afternoon to keep the construction of the $1 billion over budget Denver Va hospital going after Congress reached a deal Thursday that would raise the spending cap by $100 million. But that deal only allows work at the site to continue for three weeks. ... House Veterans Affairs Committee Chairman Jeff Miller (R-Fla.) says he can’t believe that the department has yet to fire those responsible for the cost overruns. “America’s patience is running out,” Miller said Thursday, after the deal was reached. The VA says it needs another $830 million to finish the project. (Wax-Thibodeaux, 5/22)

The Washington Post: Senate Committee Backs Measure To Allow VA To Recommend Medical Pot
Last week, the Senate Appropriations Committee voted to back the Veterans Equal Access Amendment. Under the measure, Veterans Affairs (VA) would be allowed to recommend medical marijuana to patients for medicinal purposes for everything from back pain to depression to flashbacks. Veterans who support the proposal say that it is safer and helps more than the addictive and debilitating painkillers that are often prescribed. They say using medical cannabis can help combat PTSD’s insomnia and panic attacks. The legislation would overturn VA’s policy that forbids doctors from talking to patients about medical pot use. (Wax-Thibodeaux, 5/25)

Capitol Hill Watch

Democrats, GOP Lawmakers Rallying Around Efforts To Stem Drug Overdoses

The increasing number of deaths around the country is raising alarms. Also on Capitol Hill, a new bill to move money from an asbestos trust fund is being criticized by public health advocates, and The Washington Post Fact Checker looks at a controversy about an abortion bill and new science on when a fetus can be delivered successfully.

The Hill: Lawmakers Sound Alarm On Drug Overdose Deaths
Members of both parties are turning their attention to fighting an alarming increase in the number of drug overdose deaths, in particular from heroin and prescription painkillers. The issue has united Senate Majority Leader Mitch McConnell (R-Ky.) with Democrats. And presidential contender Hillary Clinton is also putting a new focus on drug abuse. (Sullivan, 5/25)

The Hill: Asbestos Bill Roils Public Health Groups
GOP-backed legislation touted as necessary to keep lawyers from raiding funds set up for people suffering from asbestos poisoning is coming under fire from public health advocates who say the proposal will only create hurdles for victims of diseases like Mesothelioma. The dispute centers on roughly 60 trusts with nearly $40 billion in assets set up to compensate people sickened by the mineral fiber linked to cancer. (Wheeler, 5/24)

The Washington Post Fact Checker: Setting The Record Straight On Measuring Fetal Age And The ’20-Week Abortion’
New research confirmed that 22-week fetuses, measured from the first day of the pregnant woman’s last menstrual cycle, can survive. Babies born before that age did not survive. So, [Hal] Lawrence is correct that 20-week fetuses, measured from the first day of the pregnant woman’s last menstrual cycle, are not viable. He is incorrect when using the definition in the Pain Capable Unborn Child Protection Act. The Fact Checker takes no stance on which definition should be used. However, we want to set the record straight for the public and the media. This is a technical point over how gestational age is calculated. (Lee, 5/26)

Public Health And Education

Demand For Care Spikes With New York's Maternal Depression Law

Meanwhile, other mental health issues are posing challenges for law enforcement: In Illinois, an inmate who "cracked" is eating metal and leather -- and costing $1 million in medical treatment. Elsewhere, the shortage of opiate treatments is bringing calls for reform. A narrowed measure passed in Connecticut, aimed at helping police officers with PTSD, is generating criticism. And alternatives to jail for the mentally ill are explored in North Carolina.

The Wall Street Journal: Law Spurs Interest In Helping New Moms Deal With Depression
Until this year, the Seleni Institute, a nonprofit center devoted to women’s mental health and wellness, held only small, private training sessions on postpartum depression. But after New York state’s maternal depression law went into effect in January, the agency trained 67 nurses, social workers and other providers on how to identify the condition and connect women with services at a public session in Brooklyn, in April. And the organization has had so much interest that another public training has been set, with more than a dozen others in the works. “We never expected the growth that’s been happening, and it’s kind of our scramble on the back end to meet demand,” said Rebecca Benghiat, Seleni’s executive director. (Machalinski, 5/25)

Chicago Tribune: Inmate Who Is 'Eating The Jail' Costs Cook County $1 Million In Health Care
Lamont Cathey was a promising Chicago basketball prospect, a dominating 6-8 center who had the potential to play at a Division II college until he was arrested and charged in the theft of money from a pizzeria safe more than a year ago. Unable to post a $5,000 cash bond, the West Englewood 17-year-old languished in Cook County Jail as legal wrangling over his low-level burglary charge dragged on. Eventually, after months stuck in limbo when a plea deal fell through, something inside the teen cracked. He began to swallow anything he could get his hands on in his cell — screws, needles, a thumbtack, a 4-inch piece of metal, even strips of leather from restraints, according to jail officials. ... According to jail officials, at least $1 million has been spent so far on Cathey's medical care — more than any other inmate in recent history. (Schmadeke, 5/24)

USA Today: Addiction Treatment Hard To Find, Even As Overdose Deaths Soar
With nearly 44,000 deaths a year, more Americans today die from drug overdoses than from car accidents or any other type of injury. Many of these deaths could be prevented if patients had better access to substance abuse therapy, experts say. Yet people battling addiction say that treatment often is unavailable or unaffordable. Only 11% of the 22.7 million Americans who needed drug or alcohol treatment in 2013 actually got it, according to the Substance Abuse and Mental Health Services Administration. While some of those who went without care did so by choice, at least 316,000 tried and failed to get treatment. (Szabo, 5/24)

The Connecticut Mirror: Mental Health Experts Question Police PTSD Compromise
A controversial proposal to allow police officers to qualify for workers’ compensation for post-traumatic stress passed the state Senate last week after being narrowed with a key distinction: It would apply to police officers whose mental or emotional problems stem from responding to a death caused by a person, but not those rooted in handling a fatal car accident or any other part of the job. The distinction might be politically expedient, allowing the bill to move forward after years of unsuccessful efforts. But mental health professionals say it makes little sense and doesn’t reflect the reality of post-traumatic stress disorder, which is defined by how a person responds to trauma, rather than the type of traumatic event underlying it. (Levin Becker, 5/26)

Seniors Facing Hunger Problems While At The Same Time Parents Worry About Kids' Weight

Several news stories examine nutrition issues.

Kaiser Health News: In Sunlit Paradise, Seniors Go Hungry
While the U.S. economy adds jobs and the financial markets steadily improve, a growing number of seniors are having trouble keeping food on the table. In 2013, the most recent data available, 9.6 million Americans over the age of 60 —or one of every six older men and women—could not reliably buy or access food at least part of the year, according to an analysis from researchers at the University of Kentucky and the University of Illinois. (Varney, 5/26)

Minnesota Public Radio: At Some MN Clinics, The Doctor And Lawyer Will See You Now
When Eric Campbell's diabetes spiraled out of control last summer, he knew his nearly empty pantry was to blame. An unexpected $130 cut to his Hennepin County food support left him with only $2 a day to spend on food. His caregivers at Hennepin County Medical Center's Whittier Clinic were alarmed as Campbell's health deteriorated, but they couldn't do much to help. It was a legal problem killing him. (Benson, 5/26)

USA Today: How To Head Off Kids' Summer Weight Gain
In the real world, lots of kids will spend the summer watching more TV, playing more video games and, possibly, getting even less exercise than they do during the school year. Despite the dismal reputation of school food, many will eat junkier diets too. The result, studies suggest, is that summer is now prime time for excess weight gain — a serious health issue in a country where one third of children and teens are overweight or obese. (Painter, 5/24)

The New York Times: In Busy Silicon Valley, Protein Powder Is In Demand
Boom times in Silicon Valley call for hard work, and hard work — at least in technology land — means that coders, engineers and venture capitalists are turning to liquid meals with names like Schmoylent, Soylent, Schmilk and People Chow. The protein-packed products that come in powder form are inexpensive and quick and easy to make — just shake with water, or in the case of Schmilk, milk. While athletes and dieters have been drinking their dinner for years, Silicon Valley’s workers are now increasingly chugging their meals, too, so they can more quickly get back to their computer work. Demand for some of the powdered drinks, which typically mix nutrients like magnesium, zinc and vitamins, is so high that some engineers report being put on waiting lists of one to six months to receive their first orders. (Chen, 5/24)

State Watch

Health Law Offers Little Help For Georgians Who Can't Afford Dental Care

The Atlanta Journal-Constitution reports on the complexity of dental coverage under insurance policies. In North Carolina, nonprofit pediatric clinic provides dentistry for kids on Medicaid that the founders say could serve as a promising model in other regions.

The Charlotte Observer: NC Dentists: We've Built A Better Clinic For Kids On Medicaid
For the last 15 years, Lincoln Dental Services has taken pride in offering low-income children skilled dentistry, even if the setting was shabby. Now the nonprofit pediatric clinic has a new home, and the founders hope it will highlight what’s going on inside. In a small town 35 miles northwest of Charlotte, they say they’ve built a model for Medicaid dental care that feels like a private practice. (Helms, 5/25)

State Highlights: Texas Senate Advances Abortion Bill; Synthetic Drug Raises Concerns In Fla.

News outlets report on health issues from Arizona, Florida, Kansas, Minnesota, Mississippi, Ohio, Oregon, Pennsylvania, Rhode Island and Texas.

The Texas Tribune: Texas Senate Clears Bill Restricting Minors Seeking Abortions
After four hours of debate and more than a dozen failed amendments offered by Democrats, the Senate on Monday gave preliminary approval to far-reaching restrictions on minors seeking abortions in Texas without parental consent. ... After it reached the Senate, Perry did some rewriting on HB 3994 to address two of the bill's most controversial provisions on which both Democrats and some conservatives had raised concerns. As expected, he gutted a provision that would have required all doctors to presume a pregnant woman seeking an abortion was a minor unless she could present a “valid government record of identification" to prove she was 18 or older. (Ura, 5/25)

The Texas Tribune: Funding Program Shields Nursing Homes From Lawsuits
The nursing home industry has never accused Texas of being too generous with its Medicaid dollars — the state is among the worst in terms of the money it reimburses such facilities for providing care to needy Texans. So when a program began in March that allowed nursing homes to receive supplemental federal funding, hundreds of Texas facilities quickly signed up. There's a catch to the "Minimum Payment Amounts Program": To draw down those funds, nursing homes have to be government-owned. (Walters, 5/24)

The New York Times: Police In Florida Grapple With A Cheap And Dangerous New Drug
A hazardous new synthetic drug originating in China is being blamed for 18 recent deaths in a single South Florida county, as police grapple with an inexpensive narcotic that causes exaggerated strength and dangerous paranoid hallucinations. On Thursday, the Fort Lauderdale police killed a man, reportedly high on the man-made street drug, alpha-PVP, known more commonly as flakka, who had held a woman hostage with a knife to her throat. ... Law enforcement agencies have had difficulty tamping down a surge in synthetic drugs, which were banned after becoming popular in clubs five years ago only to re-emerge deadlier than ever under new formulations. (Robles, 5/24)

Jackson (Miss.) Clarion Ledger: South Jackson Hospital Could Lose Medicare Funds
Merit Health Central Hospital must prove it has made changes in handling emergency care patients, or it could lose Medicare funding, officials have warned the Jackson hospital. ... But administrators at the Merit Health hospital, formerly known as Central Mississippi Medical Center, say corrections were made after these allegations arose two years ago and their current health care meets or exceeds standards. ... In 2014, The Clarion-Ledger reported about the for-profit hospital in south Jackson repeatedly transferring emergency patients it was paid by the state to treat, possibly violating state hospital regulations and federal law. The hospital was then owned by HMA. (Mitchell, 5/23)

The Philadelphia Inquirer: At Home With Hope
Joseph Beinlich is being kept alive by an artificial heart. Temple University Hospital surgeons removed his own, badly diseased organ in August and replaced it with the 5.6-ounce plastic device. More than 1,000 other patients have gotten the implants since the Food and Drug Administration approved them in 2004. These days, some patients are able to leave the hospital, hooked to a portable, battery-powered "driver," instead of being tethered in the hospital to a clunky unit and cart that together can weigh well over 100 pounds. After a few months of recuperation, Beinlich in November became the first such recipient to go home from a Philadelphia hospital. (Avril, 5/24)

The Associated Press: Ohio Bill Would Allow Patients To Get STD Meds For Partners
A bill in Ohio seeks to expand access to treatment for certain sexually transmitted diseases by allowing doctors to prescribe medication to their patients' partners without examining them. Licensed health professionals in Ohio must first see patients before prescribing them antibiotics. But legislation before state lawmakers would create a limited exception for partners of patients who have been diagnosed with chlamydia, trichomoniasis or gonorrhea. The aim is to reduce infections. Ohio is one of four states that prohibit expedited partner therapy, according to the Centers for Disease Control and Prevention. Others are Florida, West Virginia and Kentucky. (Sanner, 5/25)

The Arizona Republic: Arizona Keeps Costs Low On Long-Term Care Spending, Moody's Says
Arizona faces steep potential budget pressures in providing care for people over 65, yet so far the state's government has met the challenge. That's the upshot of a new analysis by Moody's Investors Services that indicates Arizona has controlled Medicaid spending on long-term care for the 65-and-up population. Compared with national long-term care spending increases averaging 6.5 percent a year from 1999 to 2009, the period of the study, Arizona was one of six states that held its spending rate below 4 percent, Moody's said. (Wiles, 5/23)

Politico Pro: UPMC, Highmark Move On After Messy Breakup
In the aftermath of the messy breakup between this region’s largest health insurer and its largest health system, the two industry foes are facing perhaps their toughest challenge yet — proving that this health care cold war is the best possible outcome for patients. (Pradhan, 5/22)

The Register-Guard: U Of Oregon Considers Creating Student Health Plan
The University of Oregon is proposing to create its own health insurance plans — UOCare — and to sweep all new and returning students into one of the plans come fall. The plan would include the existing on-campus health care plus a yet-to-be-identified net­work of off-campus doctors, counselors, urgent care and hospital services. (Dietz, 5/24)

The Associated Press: In Rhode Island, Residents Gush About Paid Family Leave
As President Barack Obama pushes for a federal law to get paid leave to care for a new baby or an ailing relative, residents of one of the three states that already provide it sing its praises, hinting at the reception it could receive if rolled out nationally. Rhode Island last year began allowing workers to take up to four weeks of paid leave. Many workers say they love the program, and employers say it hasn't hurt business as some had feared. (McDermott, 5/25)

The Associated Press: Mississippi Hospital Whistleblower Gets $3.5M In Settlement
Former employee of a Mississippi hospital is getting almost $3.5 million as part of a string of settlements where 18 hospitals in seven states have agreed to pay $20.4 million over allegations they broke federal law by receiving Medicare reimbursements for psychiatric services that were not "medically reasonable or necessary." (Amy, 5/23)

Editorials And Opinions

Viewpoints: Exchanges May Not Be Sustainable; Gamble On Hospitals; Regulate Toxic Chemicals

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

The Wall Street Journal: In California’s Health Exchange Cuts, A Preview Of Other States’ Woes?
The Supreme Court is expected to rule soon on the legality of insurance subsidies in 37 states that use the federal site. Some states have discussed creating their own exchanges in the wake of the court’s decision, but those may not be fiscally sustainable. The Los Angeles Times reported last week that Covered California, the Golden State’s exchange, “is preparing to go on a diet,” cutting its budget 15% for the fiscal year beginning July 1 because of lower-than-expected enrollment. Earlier this month, Hawaii’s state exchange prepared plans to shut down this fall amid funding shortfalls. (Chris Jacobs, 5/22)

Bloomberg View: Sticker Shock For Some Obamacare Customers
So the proposed 2016 Obamacare rates have been filed in many states, and in many states, the numbers are eye-popping. Market leaders are requesting double-digit increases in a lot of places. Some of the biggest are really double-digit: 51 percent in New Mexico, 36 percent in Tennessee, 30 percent in Maryland, 25 percent in Oregon. The reason? They say that with a full year of claims data under their belt for the first time since Obamacare went into effect, they're finding the insurance pool was considerably older and sicker than expected. (Megan McArdle, 5/25)

The New York Times: Obamacare’s Big Gamble On Hospital Productivity
Historically, hospital productivity has grown much more slowly than the overall economy, if at all. That’s true of health care in general. ... But to finance coverage expansion, the Affordable Care Act made a big bet that hospitals could provide better care for less money from Medicare. Hospitals that cannot become more productive quickly enough will be forced to cut back. If the past is any guide, they may do so in ways that harm patients. (Austin Frakt, 5/25)

Modern Healthcare: Will Medicare And Medicaid Predict ACA's Future?
While politicians debate the future of Medicare and Medicaid, few question that those programs are here to stay. It's easy to forget how controversial the idea of government healthcare programs was for most of the 20th century, and how many decades it took to enact the programs. Supporters of the Affordable Care Act, which arrived in a more polarized era, hope it will eventually receive similar public acceptance. The history of Medicare and Medicaid offers some reasons to think the ACA will become a fixture of the healthcare landscape—and some to think it won't. (Harris Meyer, 5/23)

Chicago Tribune: Health Care, Faith And Conscience
Health care policy sometimes presents conflicts between the needs of patients and the conscience of those who care for them. The Affordable Care Act brought that issue into sharp relief by requiring religiously affiliated institutions like universities and hospitals to provide medical insurance covering contraception. ... A different issue has arisen in Illinois, which has one of the country's broadest laws protecting the right of medical professionals to decline to provide services that violate their beliefs. Under this statute, a physician may not be compelled to participate "in any form of medical practice or health care service that is contrary to his or her conscience." (5/25)

The New York Times: Stronger Regulation Of Toxic Chemicals
Both houses of Congress are moving to reform the notoriously weak Toxic Substances Control Act, which is supposed to ensure the safety of chemicals used in a wide range of consumer and industrial products. The measures under consideration have strong bipartisan support and are thus likely to provide the first significant reforms to the law since it was enacted nearly four decades ago. The measures are a substantial improvement over the current abysmal lack of enforcement, but neither would provide the public with what it needs most: speedy evaluations of the most worrisome chemicals among tens of thousands that have never been tested for safety. (5/25)

The Washington Post: The Front Lines Of Care For Our Veterans
Lawsuits filed in April against VA over disability claims, coupled with the Justice Department’s 2014 criminal investigation of VA facilities nationwide, highlight the chronic obstacles veterans face in obtaining treatment. Less obvious is the reality that, absent an effective VA system, it is families who are fulfilling the government’s responsibility to care for our vets. They face their own daunting challenges and desperately need support. (Meredith Ludlow, 5/24)

The New York Times: Lessons On End-Of-Life Care From A Sister’s Death
The health care professionals entering my sister’s hospital room, or answering my questions in the corridor, had perfected a polite method of ascertaining whether I was entitled to information about her condition. ... “I’m her sister and her health care proxy,” I would say. That was sufficient; we went on to discuss test results or her morphine dose. ... My sister Debra was the third family member I have accompanied, with as much dignity and comfort as we could arrange, through her last days. She was 62 when she died last month of a progressive neurological disease in a New Jersey hospital. I thought I would pass along some personal lessons. (Paula Span, 5/26)

The Wall Street Journal: The Assisted-Suicide Movement Goes On Life Support
In the past 20 years, more than 100 campaigns to legalize assisted suicide have been introduced in various states. All but three have failed. ... California is the latest place where the wheels appear to be coming off the assisted-suicide bandwagon. ... The bill was expected to fly through the California Senate, but now SB 128 is stalled. ... The bill’s opposition is a truly grass-roots effort that includes groups like the Disability Rights Education & Defense Fund, California Foundation for Independent Living Centers and the Autism Self Advocacy Network. Californians are realizing that assisted suicide represents the slipperiest of slopes. (Dr. Aaron Kheriaty, 5/22)

Alaska Dispatch News: Medicaid Expansion Is Bad For Alaska; Medicaid Reform Is Essential
The governor made Medicaid expansion and balancing the budget cornerstones of his election. Expansion is a red herring and discussing expansion deflects attention from the real issue: Medicaid in its current, nonexpansion form, is unsustainable and the state cannot balance its budget without reform. Once Medicaid reform has occurred, expansion can be explored. And when expansion is explored I believe it will be shown to be bad for Alaska. (Rep. Wes Keller, 5/22)

Fairbanks (Alaska) News Miner: Too Much Risk To Expand Medicaid Now
The [House] minority is committed to raising state employee pay, expanding the Medicaid system, and raising education funds. Some think those positions “sound good.” The positions sound good, but we have to analyze what they really mean, and what costs would be incurred. There are already expanding costs, hidden costs, and not-so-hidden costs that may create substantial financial risk for Alaska. (Chad Hutchison, 5/23)

The New York Times: The University Of Minnesota’s Medical Research Mess
If you want to see just how long an academic institution can tolerate a string of slow, festering research scandals, let me invite you to the University of Minnesota, where I teach medical ethics. Over the past 25 years, our department of psychiatry has been party to the following disgraces: a felony conviction and a Food and Drug Administration research disqualification for a psychiatrist guilty of fraud in a drug study; the F.D.A. disqualification of another psychiatrist, for enrolling illiterate Hmong refugees in a drug study without their consent; the suspended license of yet another psychiatrist, who was charged with “reckless, if not willful, disregard” for dozens of patients; and, in 2004, the discovery, in a halfway house bathroom, of the near-decapitated corpse of Dan Markingson, a seriously mentally ill young man under an involuntary commitment order who committed suicide after enrolling, over the objections of his mother, in an industry-funded antipsychotic study run by members of the department. (Carl Elliott, 5/26)

The Washington Post: A Prescription For Baltimore’s Health
Baltimore’s riots are last week’s news, but the underlying problems have not gone away. Violence, poverty and health disparities have many inputs. In Baltimore, the District and many other places across the country, these are closely tied to substance use and mental health problems, and to historical policies of mass arrest and incarceration. Consider these statistics. Among Baltimore’s population of 622,000, more than 73,000 arrests are made every year. The most common reason for arrest is a drug offense. Eight out of 10 people behind bars use illegal substances; four out of 10 have a diagnosed mental illness. (Baltimore Commissioner of Health Leana S. Wen, 5/22)

Des Moines Register: Contact Obama Administration To Stop Plan To Privatize Medicaid
Medicaid provides health insurance to about 500,000 Iowans. For decades, the government program has been operated by the state, which is not beholden to shareholders. Spending has been held down by reducing fraud, paying lower reimbursements to providers and giving seniors alternatives to expensive nursing homes. On average, the annual cost to insure an Iowan with Medicaid is significantly less than insuring an individual with private coverage. Yet Gov. Terry Branstad is seeking to hand over administration of the huge health insurance program to for-profit managed care companies. With $4.2 billion on the line, businesses are salivating at the idea of landing one of these contracts with the state. (5/23)

The Washington Post: Renew The U.S. Commitment To Sex Education
[T]he United States continues to have one of the highest teen birth rates and some of the highest rates of sexually transmitted disease in the industrialized world. Every hour in this country, 70 teenagers become pregnant, 1,100 youth acquire an STD and one young person contracts HIV. The newspapers are full of accounts of sexual assaults on college campuses, and violence and harassment continue to plague many of our gay and gender-nonconforming youth. Perhaps most distressing is that our national response continues to misunderstand the challenge. In fact, just last month Congress increased to $75 million a year funding for programs that promote sexual abstinence until marriage. (Richard Carmona, Joycelyn Elders and David Satcher, 5/22)

The New York Times: Smoking, Vaping And Nicotine
“We need a national debate on nicotine,” said Mitch Zeller. Zeller is the director of the Center for Tobacco Products, a division of the Food and Drug Administration created in 2009 when Congress passed legislation giving the F.D.A. regulatory authority — at long last! — over cigarettes. In addition, the center will soon have regulatory authority over other tobacco products, including electronic cigarettes, which have become enormously controversial even as they have gained in use. Through something called a “deeming rule,” the center is in the process of asserting that oversight over e-cigarettes. (Joe Nocera, 5/26)

JAMA: Ideological Anachronism Involving Needle And Syringe Exchange Programs
The federal ban on the funding of NSEPs [needle and syringe exchange programs], sponsored by the late Senator Jesse Helms (R-NC), dates back to the Health Omnibus Programs Extension of 1988. As written, the law precludes local authorities from using the Public Health Emergency Fund to provide “individuals with hypodermic needles or syringes so that such individuals may use illegal drugs.” ... serious consideration must be given at the national level to repealing the federal ban on the funding of NSEPs. What happened in rural Indiana can and will happen elsewhere. Failure to act would constitute a tragic and costly opportunity missed. (Josiah D. Rich and Eli Y. Adashi, 5/22)