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Political Cartoon: 'Finding The Right Fit'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Finding The Right Fit'" by Lisa Benson.

Here's today's health policy haiku:

THE OPIOID EPIDEMIC’S DEADLY TOLL

It’s overwhelming …
Not just for addicts, but for
First responders, too.

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Summaries Of The News:

Health Law Issues And Implementation

Administration Unveils Plans For Push To Enroll Young Adults In Health Plans

Social media and other digital strategies are at the center of the effort. Also in the news, the House passes a bill to exempt customers of failed insurance co-ops from the health law's coverage mandate, some people shopping for plans get help from brokers and more fallout from insurers leaving the marketplaces.

The Wall Street Journal: Health-Insurance Push Targets Young Adults
The Obama administration will use targeted, digital messages and online networks such as Twitter in a sweeping campaign to get young adults to sign up for health insurance during the Affordable Care Act’s fall open enrollment, appealing to a group seen as critical to the law’s success. The administration, which announced the new push on Tuesday, is betting the aggressive campaign will resonate with uninsured consumers age 35 and under. (Armour, 9/27)

The Hill: White House Makes New Push For Young ObamaCare Signups
The Obama administration is announcing new steps to increase ObamaCare outreach to young adults as it seeks to improve the stability of the healthcare law by bringing in more youthful, generally healthy participants. Amid concerns from insurers about financial losses due to a sicker-than-expected pool of enrollees, the administration is stepping up its efforts ahead of the signup period for next year, which begins Nov. 1. (Sullivan, 9/27)

The Hill: House Passes Bill Exempting Some From ObamaCare Mandate
The House on Tuesday passed a bill that would allow people enrolled in failed health insurance "co-ops" to skip this year's penalty for not having coverage. The Republican-backed bill passed on a mostly party-line vote of 258-165. Sixteen Democrats broke with their party to support the measure. ... Democrats opposed the bill, arguing it is unnecessary. They pointed out that enrollees in co-op plans that fail in the middle of the year are provided a special sign-up period in order to find a new plan. Rep. Sandy Levin (D-Mich.) said the bill is “yet another attempt to undermine the Affordable Care Act, plain and simple.” The White House threatened a veto on the bill, arguing that it would chip away at the individual mandate, a crucial component of the law that helps prevent people from waiting until they get sick to sign up for coverage. (Sullivan, 9/27)

The CT Mirror: With No Broker Fees, Will Obamacare Customers Get Enough Shopping Help?
Shopping for health insurance isn’t easy for most people, but for Branden Weaver, the stakes are especially high: His two young sons are on the autism spectrum, and he and his wife are determined to ensure they have a health plan that covers the practitioners who treat them. But the first time they tried signing up for coverage through the state’s health insurance exchange, Access Health CT, they ended up in Medicaid, which didn’t cover one of their older son’s providers. Weaver tried to sign his son up for a private insurance plan that did, but even with his information technology background, he found it difficult. So he turned to an insurance broker. (Levin Becker, 9/28)

The Tennessean: BCBST's Exit From 3 Obamacare Markets Sends Shock Waves
BlueCross BlueShield of Tennessee sent shock waves Monday across Tennessee with the company's decision to exit the Obamacare exchange in Nashville, Memphis and Knoxville, a move that highlights persistent volatility in the young health insurance marketplace. Three years into the Affordable Care Act exchange, the state’s largest insurer is grappling with hefty losses and ongoing uncertainty on the marketplace. BCBST is open to coming fully back into the market once uncertainties about policies and the membership wane. (Fletcher, 9/27)

The Des Moines Register: Wellmark Trims Broad-Network Health Insurance Options
Iowans looking to buy individual health insurance policies now have fewer options from the state’s largest carrier. Wellmark Blue Cross & Blue Shield leaders said Tuesday that they no longer will sell standard, broad-network health policies, known as PPO plans, on the individual market in Iowa. The company will continue to sell plans that steer participants to specific hospital-and-clinic systems, such as the Mercy Health System or the University of Iowa system. It also will sell an HMO plan that has some restrictions on out-of-network care. (Leys, 9/27)

Administration News

Expert Demoted After Raising Concerns About Efficacy Of CDC's Zika Test

Robert Lanciotti says the test the agency recommends misses nearly 40 percent of Zika infections. He has since been reinstated after filing a whistleblower retaliation claim.

The Washington Post: CDC Whistleblower Claims Agency Has Been Using Wrong Zika Test
In the midst of the fight to control Zika, the top public health agency in the United States has been engaged in an intense internal debate about the best way to test whether someone has been infected with the mosquito-borne virus. At the center of the debate at the Centers for Disease Control and Prevention is one of the leading experts on Zika virus. Robert Lanciotti is chief of the CDC lab responsible for developing tests to diagnose viral diseases such as Zika that are transmitted by mosquitoes, ticks and fleas. Lanciotti was demoted in May after he raised concerns inside and outside the agency about the CDC’s decision in the spring to recommend a new test for Zika. (Sun, 9/27)

In other Zika news —

Tampa Bay Times: Results From Gov. Scott's Emergency Zika Research Is Years Away
The results of an emergency research push for a Zika vaccine announced last week by Gov. Rick Scott likely won't come to fruition for years. Members of the state Biolmedical Research Advisory Council have been asked to get the grant program off the ground in the next four months with a three-year timeline for the projects that ultimately will be funded by the Department of Health. ... Last Thursday, Scott announced the grant program, a rare use of his power under a state of public health emergency declared in February as travel-related cases of Zika first arrived in Florida. He set aside $25 million primarily for research into a vaccine and more efficient Zika tests. (Auslen, 9/27)

Miami Herald: Zika Virus: Miami-Dade Mayor Will Release Zika Mosquito Trap Locations Unless State Prohibits It 
Miami-Dade County on Wednesday will release the locations of mosquito traps that captured Zika-positive insects in Miami Beach, the result of a public dispute between state and local officials after the Miami Herald filed a lawsuit seeking the information. The word came Tuesday evening, an hour after Gov. Rick Scott and Surgeon General Celeste Philip agreed that Miami-Dade can release the trap locations. (Flechas, 9/27)

Tampa Bay Times: Bay Area Zika Investigation Closed With No Further Cases Found
At least for now, Tampa Bay is considered officially Zika-free. Florida Department of Health officials announced Tuesday that they have closed the active investigation into the region's first locally transmitted case of the virus that has been linked to birth defects.The patient was a Tampa Fire Rescue firefighter who lived in Pinellas, triggering a scramble by health departments on both sides of the bay to contain a potential outbreak. (O'Donnell, 9/27)

Study Raises Concerns Over Revolving Door Between FDA, Pharma Companies It Regulates

More than half of the hematology-oncology assessors who reviewed drugs between 2001 and 2010 went on to work for the biopharmaceutical industry after leaving the agency.

Stat: From FDA Expert To Biotech Insider: The Drug Industry Thrives On The Revolving Door
Critics of the revolving door between government and industry cite the hundreds of lawmakers-turned-lobbyists as case studies in the art of cashing in on one’s years of public service. But less is known about the revolving door between the Food and Drug Administration and the biopharmaceutical industry. In a study published Tuesday in the journal BMJ, researchers who studied the careers of FDA medical reviewers found that more than half of the hematology-oncology assessors who reviewed drugs between 2001 and 2010 went on to work for the biopharmaceutical industry. (Kaplan, 9/27)

Kaiser Health News: When Drug Reviewers Leave The FDA, They Often Work For Pharma
More than a quarter of the Food and Drug Administration employees who approved cancer and hematology drugs from 2001 through 2010 left the agency and now work or consult for pharmaceutical companies, according to research published by a prominent medical journal Tuesday. Dr. Vinay Prasad, a hematologist-oncologist and assistant professor at Oregon Health and Science University, sought to understand the so-called “revolving door” between the FDA and the pharmaceutical industry, which he said is often discussed but hadn’t been quantified. (Lupkin, 9/27)

What's In A Word? FDA Seeks Input On Definition Of 'Healthy'

The Food and Drug Administraiton hasn't updated its recommendations on what is considered healthy since the '90s when low fat content was the main focus of health professionals and sugar wasn't even really on the radar. It will still be years before there's significant movement, but the agency is finally taking steps toward updating it.

The Wall Street Journal: FDA Takes Step Toward New ‘Healthy’ Labeling
The U.S. Food and Drug Administration on Tuesday took the first step toward redefining its decades-old definition of “healthy,” following pressure from food companies that say the current regulations are outdated. Regulators are now seeking opinions from consumers, companies and other members of the public on how the term “healthy” should be used on food packaging. It’s a process that will likely take years to complete. (Gasparro, 9/27)

In other news about healthful eating, nutrition and exercise —

Health News Florida: Chill Out: Stress Can Override Benefits Of Healthful Eating
Eating well has many known benefits. But a good diet may not be able to counteract all the ill effects of stress on our bodies. A new study, published in Molecular Psychiatry, suggests stress can override the benefits of making better food choices. To evaluate the interactions between diet and stress, researchers recruited 58 women who completed surveys to assess the kinds of stress they were experiencing. The women also participated in what researchers call a "meal challenge," where they were each given two different types of meals to eat, on different days. (Aubrey, 9/27)

The Washington Post: Craving Candy Or Soda? They Could Be Harder To Find In Md. Vending Machines.
It could get a bit harder for people in Prince George’s County to buy chips, cookies or soda in county facilities, if a bill to limit those choices and stock vending machines with healthier options is embraced by the County Council. Vice Chair Dannielle M. Glaros (D-Riverdale Park) introduced the bill Tuesday, saying she wanted to address the negative health impacts of sugary and fatty foods in a county with high rates of diabetes, obesity and other chronic diseases. (Hernandez, 9/27)

Minnesota Public Radio News: Conference Links Poor Native American Nutrition To Historical Trauma 
Stepping away from a breakout session at the First Annual Conference on Native American Nutrition, Ryan Bad Heart Bull — a tall, fit man in a dark-blue suit — said the event had been a monumental experience."It's been fascinating to learn the ways and the methods that other tribes have been using to provide better options for themselves as well as bring the community together," he said. He's part Oglala and Hunkpapa Lakota, an enrolled member of the Pine Ridge Reservation. He's also a new registered dietician, and said he's the first Native American to graduate from the University of Minnesota's Dietetic Internship program. Heart Bull said the gathering was historic because it's part of a food movement to reclaim Native American health. (Xaykaothao, 9/28)

Capitol Hill Watch

Breakthrough On Flint Could Pave Way To Spending Deal After Senate Blocks Bill

House leaders came to an agreement late Tuesday night on how to get funds to the water crisis in Flint.

The Washington Post: House Leaders Reach Deal On Flint Aid, Potentially Averting Shutdown
House Speaker Paul D. Ryan and Minority Leader Nancy Pelosi struck a deal late Tuesday to deliver federal aid to address the water crisis in Flint, Mich., potentially removing a major flashpoint in negotiations to keep the government fully operating past Friday. Under the deal, the House will vote Wednesday on an amendment to a pending water projects bill that would authorize up to $170 million in infrastructure funds for communities like Flint whose water systems are blighted by “chemical, physical, or biological” contaminants. (DeBonis, 9/27)

The Hill: Dems Demand Flint Funding Promise 'In Writing' From GOP
Senate Democrats say they plan to block a governing spending bill Tuesday because they don’t trust Republicans to keep their promise to separately approve funding for the Flint, Mich., drinking water crisis. Sen. Barbara Boxer (D-Calif.), who is on the Environment and Public Works Committee, said at a press conference about two hours before the vote that Democrats are demanding a commitment to Flint aid in writing. (Ferris, 9/7)

Health IT

Aetna Bets On Apple Watches Amid Growing Skepticism Of Wearables' Health Benefits

Starting next year, Aetna will give an Apple Watch to its employees for free as part of its wellness program and subsidize a “significant portion” of the Apple Watch cost for some large employers and groups.

Modern Healthcare: Aetna Makes Large Bet On Wellness With Apple Watches
Apple Watches are becoming near-ubiquitous in healthcare and the corporate world, and health insurer Aetna is now investing heavily in the wellness promises of the device. However, companies that have offered an Apple Watch with the hope of getting people to be more active and healthy have to prove wearable devices and wellness programs meaningfully change consumer behavior, which has often worked better in theory than in practice. “These types of technologies can really help to facilitate behavior change, but the devices themselves are not what drive behavior change,” said Dr. Mitesh Patel, an assistant professor of medicine at the University of Pennsylvania. (Herman, 9/27)

Bloomberg: Aetna Will Subsidize Apple Watch In First U.S. Insurer Deal
Aetna Inc. will give some customers and employees discounts on Apple Inc.’s smartwatch, offering the potential that incentives from the insurance industry could boost sales of the technology giant’s wearable device. The health insurer, which covers about 23 million people in the U.S., is developing apps for Apple devices that will help consumers remember to take their medicines, get a refill on prescriptions, or contact a doctor. The applications, which will be available next year, will also help members understand their insurance benefits and use Apple’s Wallet feature to pay bills, Aetna said Tuesday in a statement with Apple. (Tracer and Webb, 9/27)

Google Glass Expands Possibilities For High-Tech Doctor Visits, But Danger Lurks At Edges

Advocates envision a world in which technology allows office visits to be transcribed in real time or compares patient records to determine a diagnosis. But, in a situation where a glitch could have fatal consequences, moving away from human scribes could be a grave mistake.

The Washington Post: Coming To A Doctor’s Office Near You: Live-Streaming Your Exam With Google Glass
Jim Andrews is in a medical office wearing just a hospital gown, staring at his doctor of 11 years, who is staring back at him through the sleek, metallic lens of Google Glass. As the doctor examines Andrews, a new kind of medical scribe is watching the examination, transcribing everything he sees. The scribe, named Rahul, is thousands of miles away in India, and he is viewing the office visit live through the pint-size, WiFi-connected camera attached to the doctor’s glasses. (Dwoskin, 9/27)

In other health technology news —

Boston Globe: Uber Partners With Startup To Help Patients Get To The Doctor
A new startup is using Uber’s technology to help patients hail a ride to their doctors, hoping to cut down on the 3.6 million Americans who miss medical appointments each year because they don’t have transportation. The service is targeted at patients who don’t have cars and can’t afford or access public transit, and whose rides are covered by health plans such as Medicaid. The startup, Circulation, used Uber’s software to create an app that hospitals can use to request Uber vehicles for patients who need help getting to and from appointments. (McCluskey, 9/27)

Public Health And Education

First Baby Born Using New Wave Of 'Three-Parent' IVF Technique

The controversial procedure replaces the mother's faulty mitochondria with donor mitochondria to produce a healthy baby while preserving the vast majority of its mother's DNA.

The New York Times: Birth Of ‘3-Parent Baby’ A Success For Controversial Procedure
A few months ago, after a fertility procedure at a Mexican clinic, a healthy baby boy was born in New York to a couple from Jordan. It was the first live birth of a child who has been called — to the dismay of scientists who say the term is grossly misleading — a three-parent baby. ... The method used to help the couple is one that reproductive scientists have been itching to try, but it is enormously controversial because it uses genetic material from a donor in addition to that of the couple trying to conceive. (Kolata, 9/27)

Stat: World’s First Baby Born With Novel Three-Parent Embryo Technique
A boy born in April with three genetic parents is the first infant born using a new technique that incorporates DNA from two women and one man, New Scientist reported Tuesday. The technique offers promise to help children avoid often-fatal genetic diseases passed down by their mothers, but has raised thorny ethical questions and is not allowed in the United States. The boy was born in Mexico to Jordanian parents who tapped researchers from the New Hope Fertility Center in New York to help them conceive a healthy child, according to New Scientist. (Joseph, 9/7)

The Washington Post: First-Ever Baby Born Using ‘Three Parent’ Genetic Engineering Technique
So-called three parent babies actually have more like 2.001 parents, according to experts. And the baby boy born earlier this year isn't the first child to have a little more DNA than Mom and Dad could provide on their own: An IVF technique that relied on small transfers of donor DNA was pioneered in the United States during the 1990s but was banned after fewer than 100 babies were born. This Jordanian newborn represents the first successful birth in a new wave of "three parent" techniques — ones that are more sophisticated and that will likely stick around much longer. (Feltman, 9/27)

Los Angeles Times: Baby Boy With DNA From 3 People Offers Hope For Moms Who Would Pass On Deadly Genetic Diseases
Mitochondrial DNA consists of just 37 genes, a tiny fraction of the genetic material inside a cell. Unlike nuclear DNA — which is bundled into 23 pairs of chromosomes and influences traits such as eye color, height and cancer risk — mitochondrial DNA contains instructions for the energy-producing structures inside cells. It is passed down virtually unchanged from mother to child. That was a situation the infant’s mother wanted to avoid. Her mitochondrial DNA contains mutations that cause Leigh syndrome, a neurological disorder that is usually fatal during early childhood. (Kaplan, 9/27)

The $64,000 Question: Is The Flu Shot Worth All The Bother?

One expert weighs in on that and other questions about flu vaccine science.

Stat: A Guide To The Changing Science Of Flu Shots
While the flu is a common illness, that hardly means the science around it is static. Some recent studies have suggested that getting a yearly shot may actually diminish the benefit of successive vaccinations. Others have raised the possibility that statins — the commonly used cholesterol-lowering drugs — may actually interfere with your immune system’s response to influenza vaccine. Meanwhile, the Centers for Disease Control and Prevention recently recommended against the use of the nasal mist vaccine that many kids prefer over injected vaccine. (Branswell, 9/27)

Viral Images Of Parents' Overdoses Show Toll Opioid Epidemic Is Taking On Children

Police departments have started releasing photos and videos of parents who overdose in front of their children. Some say they're what's needed to finally get people outraged enough to act on the crisis, but others say it's demoralizing and only makes it harder for those who want to get help.

The New York Times: Addicted Parents Get Their Fix, Even With Children Watching
It was a horrific video — a young mother who had overdosed was lying unconscious on the floor of a Family Dollar store in Lawrence, Mass. Adding a gut-wrenching kick to the scene was that the woman’s 2-year-old daughter, wearing purple footie pajamas, was tugging at her mother’s limp arm, trying to wake her up. The girl was wailing. The mother looked lifeless. (Seelye, 9/27)

The Washington Post: Drug, Crime Experts Say Posting Shocking Photos Of Unconscious Drug Addicts Is Wrong
Police in small towns in Ohio and Massachusetts may have started a trend: releasing photos of unconscious drug addicts, to dramatically show the public what officers encounter on a daily basis as opioid abuse explodes across America. The photos of a man and woman passed out in the front seat of an SUV in East Liverpool, Ohio, and video of a woman lying on the floor of a discount store in Lawrence, Mass., being prodded by a terrified child, have gone viral and brought the hard reality of addiction home to millions who’ve never imagined its real life impact. (Jackman, 9/27)

In other news on the opioid crisis —

Politico: Drug Databases Are No Panacea For Opioid Crisis
In the fight against the opioid epidemic, authorities are increasingly relying on computers — state-run drug databases that can turn up evidence of abuse, like doctors who shovel prescriptions out the door indiscriminately or patients who doctor shop for pills. But while the prescription drug monitoring programs (PDMPs) help police and prosecutors, they haven’t necessarily helped address addiction as disease. (Allen, 9/27)

The Associated Press: Governor Signs Bill Targeting 'Doctor-Shopping' For Opioids
California doctors will be required to check a database of prescription narcotics before writing scripts for addictive drugs under legislation Gov. Jerry Brown signed Tuesday that aims to address the scourge of opioid abuse. The measure attempts to crack down on a practice known as "doctor-shopping," in which addicts visit multiple providers to obtain prescriptions for addictive drugs. (9/27)

The Philadelphia Inquirer: Report: More Pa. Babies Are Born Addicted To Opioids
Pennsylvania hospitals have seen soaring rates of babies born addicted to opioids over the last 15 years, a reflection of the national epidemic of pain pill and heroin abuse, according to a new state analysis. The Pennsylvania Health Care Cost Containment Council used hospital records from 2000 through 2015 to figure out how often mothers and newborns were hospitalized because of addiction issues. In 2015, 2,691 newborns were hospitalized in Pennsylvania for substance-related problems, or almost 2 percent of the 138,000 infant hospitalizations. (McCullough and Sapatkin, 9/27)

Kaiser Health News: Deadly Opioid Overwhelms First Responders And Crime Labs In Ohio
Jamie Landrum has been a police officer for two years in District 3 on the west side of Cincinnati. In late August, the city was hit by 174 overdoses in six days. Landrum says officers were scarce. “We were literally going from one heroin overdose, and then being on that one, and hearing someone come over [the radio] and say, ‘I have no more officers left,’ ” Landrum said. Three more people overdosed soon after that. (Harper, 9/28)

States Scramble To Act As Youth Suicide Rates Climb

Among the possible causes cited by suicide experts is a decline in the use of psychiatric medicines and the rise of cyberbullying. In other public health news, 92 percent of the world is breathing bad air, the Americas are declared free of endemic measles, C. diff is on the rise and a look at a mysterious lymphatic disease.

Stateline: Increase In Youth Suicide Prompts States to Act
Between 2006 and 2014, the suicide rate among Americans 19 and under rose from 2.18 to 2.72 per 100,000 people. At least 36 states have experienced an increase, but the problem is especially dire in Utah, where the suicide rate rose from 2.87 to 6.83 during that period. Among the possible causes cited by suicide experts is a decline in the use of psychiatric medicines and the rise of cyberbullying. Whatever the reasons, a number of states, over the last five years, have adopted measures to try to reverse the trend. (Ollove, 9/28)

The New York Times: More Than 9 In 10 People Breathe Bad Air, W.H.O. Study Says
The World Health Organization said Tuesday that 92 percent of people breathe what it classifies as unhealthy air, in another sign that atmospheric pollution is a significant threat to global public health. A new report, the W.H.O.’s most comprehensive analysis so far of outdoor air quality worldwide, also said about three million deaths a year — mostly from cardiovascular, pulmonary and other noncommunicable diseases — were linked to outdoor air pollution. (Ives, 9/27)

The New York Times: Americas Region Declared Free Of Endemic Measles
Global health authorities on Tuesday declared the Americas free of endemic measles, the first region to be so certified. The hemisphere’s last case of endemic measles — meaning one that did not spring from an imported strain — was in 2002. Normally, it takes three years without cases to declare a disease eradicated from a region, but in this instance it took 14 years. (McNeil, 9/27)

Consumer Reports: C. Diff: Deadly Infection On The Rise
In theory, clostridium difficile (aka C. diff) does not seem like a tough problem to solve. Yes, it’s a deadly bacterial infection that sickens almost a half-million people and contributes to some 29,000 deaths every year, the vast majority in hospitals and other healthcare settings. And yes, it has recently become both more common and more deadly. But the weapons needed to defeat this bug are inexpensive and straightforward: soap, gloves, disinfectants, and the proper use of antibiotics. (Interlandi, 9/27)

NPR: Lipedema Can Cause Disfiguring Fat Deposits In Women
Judy Maggiore remembers looking in the mirror in college, perplexed by her body's disproportion. "I was skinny. I was a stick. The upper part of my body was really, really thin. You could see my ribs!" exclaims Maggiore. "But from the waist down, it was like there were two of me or something." (McClurg, 9/27)

New Diagnostic Tool May Identify Living Patients That Have Disease Caused By Repeated Concussions

In other news related to head injuries, an analysis of regional insurance claims shows that concussion rates among young boys and girls are on the rise in many states.

Stat: Concussion Researchers Spark Hope With A New Tool To Diagnose Brain Damage
The diagnosis begins with the brain being pulled out of the skull. Then, to determine whether someone had a condition associated with repeated concussions, the pathologist preserves the tissue in formalin, slices it thin enough for light to shine through, washes it with chemicals, and peers at it through a microscope. If some areas remain blotched with reddish brown, then the pathologist can definitively diagnose the person with chronic traumatic encephalopathy, or CTE. (Boodman, 9/27)

The Philadelphia Inquirer: Concussion Rates Are Way Up, Especially In Pa. And N.J.
Concussion diagnoses have spiked in recent years as publicity about long-term brain damage has made head injuries more frightening, and Pennsylvania and New Jersey have among the highest rates in the nation, a new analysis of claims data by the Blue Cross Blue Shield Association has found. The report, released Tuesday morning, found that the increase was particularly pronounced among 10-to-19-year-olds. In that age group, concussion diagnoses increased by 71 percent from 2010 through 2015. The growth in concussion rates for girls and young women was 118 percent, while it was 48 percent for boys and young men. (Burling, 9/7)

Chicago Tribune: Concussion Diagnoses For Illinois Kids Up 83 Percent
The percentage of Illinois children diagnosed with concussions climbed by a whopping 83 percent between 2010 and 2015 as awareness of head injuries grew, according to new data released by Blue Cross and Blue Shield of Illinois. Concussions for Blue Cross members ages 10 through 19 jumped from a rate of 7.6 per 1,000 members in 2010 to 14 per 1,000 members in 2015. (Schencker, 9/27)

State Watch

Appeals Court Sides With FTC To Pause Proposed Penn State-Pinnacle Health Merger

In other state hospital news, Georgia's rural hospitals are hopeful about tax credit program, a Massachusetts watchdog agency raises a red flag about Boston Children's planned expansion and a surprise inspection of a Pennsylvania hospital finds shortcomings.

Modern Healthcare: FTC Wins Appeal To Halt Penn State Hershey/PinnacleHealth Merger
The U.S. Court of Appeals for the 3rd Circuit reversed the FTC's May loss in the Penn State-PinnacleHealth case, temporarily pausing the proposed merger while the agency takes on administrative review of the case. The 3rd Circuit judges said the lower court ignored the impact of the proposed merger on insurers when it ruled against the FTC, saying its analysis of the FTC's and Pennsylvania state regulators' proposed geographic market for the challenge was “economically unsound” and ignored commercial realities in the healthcare market. (Teichert, 9/27)

Georgia Health News: Rural Hospitals See Ray Of Hope In Tax Credit Program
Since the beginning of 2013, five rural hospitals in the state have closed, and many others are struggling financially, such as Phoebe Worth and Southwest Georgia Regional. Gilman’s remarks illustrated how small hospitals often feel caught between forces they can’t control. Each of her hospitals, she said, has had to sink more than $1 million into an electronic medical records system to comply with federal regulations. Meanwhile, “we are unable to improve our facility infrastructure.” (Miller, 9/27)

Boston Globe: State Watchdog Raises Concerns On Children’s Hospital Expansion
A state health care watchdog agency on Tuesday warned that medical costs in Massachusetts are likely to rise if Boston Children’s Hospital moves ahead with a controversial $1 billion expansion plan. The Health Policy Commission cannot block the project, but its views will be considered by the state Department of Public Health, which has the final say. The commission’s warning comes on top of opposition from competing hospitals and activist groups and may complicate the chances of swift approval for facilities that Children’s says are urgently needed. (Dayal McCluskey, 9/27)

The Philadelphia Inquirer/Philly.com: State: Philly Hospital Failed To Fully Investigate Children's Deaths
St. Christopher's Hospital for Children did not do enough to determine why nine of its patients died after heart surgery, according to a sweeping report by state investigators. The findings stem from a surprise three-day inspection of the North Philadelphia hospital one month after the Inquirer reported in February that the death rate among newborn heart-surgery patients there was nearly triple the national average. (Avril, Purcell and Fazlollah, 9/24)

And in New York, a man searches for answers on why his wife died —

The New York Times: A Woman Dies After Childbirth, And Her Husband Asks Why
After Amy Lam prematurely went into labor and gave birth to their baby at home, her husband, Gilbert Kwok, thought the worst was over. Once emergency responders had arrived and loaded Ms. Lam, 34, into an ambulance, the couple took photos with the newborn and called family members, smiling and elated that — despite the unexpected circumstances — their son had arrived. Less than 12 hours later, on Aug. 1, Ms. Lam was pronounced dead. She had bled to death after a series of surgical procedures at Harlem Hospital Center. (Schmidt, 9/28)

In Election, Trend-Setting States Could Determine National Conversation On Marijuana

Polls have shown the "yes" side leading in most states with a marijuana-related ballot measure.

The Associated Press: 9 States To Vote Soon On Expanding Legal Access To Marijuana
From California, with its counterculture heritage, to the fishing ports and mill towns of Maine, millions of Americans in nine states have a chance to vote Nov. 8 on expanding legal access to marijuana. Collectively, the ballot measures amount to the closest the U.S. has come to a national referendum on the drug. (Elias and Crary, 9/28)

Sacramento Bee: After Backing Gavin Newsom, California Nurses Group Gets Behind Pot Legalization 
The California Nurses Association, which last year offered an unusually early endorsement for Lt. Gov. Gavin Newsom’s 2018 gubernatorial bid, on Tuesday announced support for Newsom’s high-stakes fall initiative to legalize recreational marijuana. ... The formal endorsement puts the nurses on the side of the California Medical Association and at odds with the California Hospital Association, which opposes the Proposition 64 legalization proposal on the Nov. 8 ballot. Proposition 64 was proposed by Donald Lyman, a retired physician and former member of the California Medical Association who in 2011 wrote a white paper for the 40,000-member organization calling for the legalization of marijuana and declaring the federal ban on the drug “a failed public health policy.” (Cadelago, 9/27)

Kaiser Health News: Election Buzz: Critics Of Legal Pot Say Addiction Becomes ‘A Disease Of The Family’
If pot laws were colors, a map of the U.S. map would resemble a tie-dye T-shirt. In some states, marijuana is illegal. In others, it’s legal for medical purposes. And still in others, it is even legal for recreational use. Five more states could come into that last category this fall, as voters decide whether to legalize it in California, Nevada, Maine, Massachusetts and Arizona. (Foden-Vencil and Sieg, 9/28)

Idaho Legislative Panel To Hear Public Comments Today On Medicaid Expansion

The day-long session will explore whether the state should expand Medicaid to cover the estimated 78,000 residents who don't qualify for Medicaid or for subsidies to help buy insurance on the health marketplace. Also, Alaska officials and Xerox have settled a dispute over the complaints that the company, which set up a payment system for the state, was slow to reimburse doctors and other health providers.

Idaho Statesman: Public Gets Chance To Speak On Idaho Medicaid Expansion At Hearing Wednesday
The legislative committee reviewing health care options for Idaho’s working poor convenes a daylong session in the Capitol Wednesday, including a two-hour period of public testimony. Wednesday’s agenda features morning testimony from advocates on both sides of the debate over whether Idaho should expand Medicaid to cover the estimate 78,000 residents caught in a health coverage gap. Those residents earn too much to qualify for standard Medicaid health benefits, but not enough to qualify for subsidized coverage available on the state health insurance exchange. (Dentzer, 9/27)

Alaska Dispatch News: Alaska Health Department And Xerox Reach Settlement Over Botched Medicaid Payment System
The Alaska Department of Health and Social Services has settled its complaints with Xerox over management of Medicaid claims, resetting its health-care contract with the business giant for an agreed-upon series of performance standards. The state's claim against Xerox State Healthcare LLC followed the company's start of a multimillion-dollar Medicaid payment system about three years ago. The state said Xerox failed to issue timely and accurate payments to Alaska health care providers, among other problems. (Hanlon, 9/28)

State Highlights: New Calif. Law Requires All High Schoolers To Learn CPR; Still No Agreement Between Striking Minn. Nurses, Allina

Outlets report on health news from California, Minnesota, the District of Columbia, Florida, South Carolina, Wisconsin, New York, Massachusetts and Colorado.

Miami Herald: California High Schoolers Will Be Required To Take CPR Classes 
Now a new law in California will require high schoolers to learn those skills in hopes they might one day save a life. Gov. Jerry Brown signed a bill into law Saturday that now mandates a CPR component in high schools where health classes are required to graduate, starting with the 2018-2019 school year. The previous law had given schools the choice to substitute a first aid component in those classes instead. According to the American Heart Association, only 30 percent of Americans are trained to administer CPR in an emergency and about 32 percent of heart attack victims get CPR when a cardiac emergency occurs. (Koh, 9/27)

Pioneer Press: Allina Nurses, Management Break Talks For Night, Plan To Resume Wednesday
Allina Health and the Minnesota Nurses Association negotiated throughout the day Tuesday at the behest of a federal mediator without reaching an agreement. The two sides met from morning until 11 p.m. before agreeing to take a break, according to an Allina spokesman. They planned to pick up the discussions again in the morning. Union and Allina spokespeople both declined to provide details about the talks while they were ongoing. (Cooney, 9/27)

The Washington Post: D.C.’s Only Planned Parenthood Facility Is Open And Ready To See Patients
The only Planned Parenthood location in the nation’s capital marked its grand opening this week in a booming, semi-industrial area of Northeast Washington — an area in the center of the city that the health-care provider hopes will be accessible to people from all corners of the District. ... “There was a tremendous unmet need,” said Laura Meyers, president of Planned Parenthood of Metropolitan Washington. “With almost no advertising, patients are finding us.” (Stein, 9/27)

Health News Florida: Task Force Looking Into Further Regulations For Florida ’Sober Homes’
A new law could be in the works to regulate so-called “sober homes” in Florida. At a meeting attended by hundreds of residents in Lake Worth, Assistant State Attorney Al Johnson said that he is part of a task force created to crack down on  unscrupulous addiction recovery residences in Florida. The facilities are not currently required to be certified or licensed and the task force will propose legislation to change that. (9/27)

Modern Healthcare: Former Tuomey CEO To Personally Pay $1 Million To Settle False Claims Act Case
The former CEO of Tuomey Healthcare will personally pay $1 million to resolve his involvement in entering physician compensation arrangements that led to one of the largest-ever Stark law cases. Ralph "Jay" Cox III will also be excluded for four years from participating in any federal programs, the U.S. Department of Justice said on Tuesday. In October, Sumter, S.C.-based Tuomey agreed to pay $72.4 million to settle allegations of illegal compensation arrangements with doctors. As part of the settlement, Tuomey was sold to Palmetto Health. (Teichert, 9/27)

USA Today/Milwaukee Journal Sentinel: Johnson Pushes Right-To-Try Law
Tim Wendler doesn't give up easily. More than a year after his wife, Trickett Wendler, died from amyotrophic lateral sclerosis (ALS), he is giving voice to a congressional bill in her name. The Trickett Wendler Right to Try Act, authored by Republican U.S. Sen. Ron Johnson, would allow terminally ill patients to receive experimental drugs — which have not been approved by the Food and Drug Administration — and where no alternative exists. There is a companion bill in the House. (Glauber, 9/27)

The New York Times: City To Pay $5.75 Million Over Death Of Mentally Ill Inmate At Rikers Island
New York City has agreed to pay $5.75 million to settle a lawsuit stemming from the 2013 death of a mentally ill inmate who was found naked and covered in urine and feces after being locked in a cell at Rikers Island for six days. The settlement in Bradley Ballard’s death is apparently the largest the city has ever paid to settle a lawsuit over the death of an inmate in city custody. (Weiser, 9/27)

The Wall Street Journal: Boston Scientific To Acquire EndoChoice For $210 Million 
Medical-devices company Boston Scientific Corp. on Tuesday said it agreed to buy EndoChoice Holdings Inc. for roughly $210 million, expanding its endoscopy business as sales of some products have slowed. Boston Scientific said it would pay $8 a share in cash for EndoChoice, a 90% premium to its closing price of $4.22 a share on Monday. Boston Scientific, based in Marlborough, Mass., has diversified its product offerings in recent years to help pad softening sales in some bread-and-butter areas, such as pacemakers and implanted defibrillators. (Jamerson, 9/27)

Orlando Sentinel: Clinics To Start Hormone Therapy Services For Transgender People 
Starting next month, transgender individuals or those who want to start their transition process will be able to go to Planned Parenthood clinics in Central Florida to get hormone therapy services... This adds Florida to the list of 15 other states under the umbrella of the national Planned Parenthood to offer hormone therapy. LGBT advocates say the service brings another trusted source of care to the transgender community, which has been historically discriminated against and faced barriers to care. It is also a positive sign that the Central Florida community is embracing diversity, they say. (Miller. 9/27)

Sacramento Bee: Dying Californians Will Get To Seek Experimental Drugs 
One year after vetoing a similar measure, Gov. Jerry Brown signed a bill Tuesday that will allow pharmaceutical companies to offer experimental drugs to terminally ill Californians. A national “right to try” movement, which seeks to expand access to not-yet-approved treatments for people who fail to get into clinical trials, yielded bills in California last year but Brown deferred to federal regulators in vetoing a measure on his desk. The governor signed this year’s similar version, Assembly Bill 1668, after it won broad support in the Legislature. It would allow drug manufacturers to offer treatments not yet approved by the U.S. Food and Drug Administration if a patient has exhausted other FDA-sanctioned treatment options and has approval from two physicians. (White, 9/27)

The Denver Post: Report Details Abuse At Pueblo Center For Disabled, Staff Blames “Paranormal Activity”
Abuses at a Pueblo center for people with severe intellectual disabilities included a resident performing a sexual act in exchange for a soda and another burned with a blow dryer in an attempt to raise her body temperature, according to a federal report obtained by The Denver Post. A group of men, some who are nonverbal, had words scratched into their skin, including “die,” “kill,” and “I’m back,” federal investigators found. When questioned, three staffers said they believed the markings were the result of “paranormal activity.” Staffers had posted photos of the etchings on social media, the report said. (Osher and Brown, 9/27)

The Star Tribune: Three New Cases In Hopkins Legionnaires' Disease Outbreak 
State health officials have confirmed three new cases of Legionnaires’ disease linked to the ongoing Hopkins outbreak, bringing the total number to 20, including one death. In all the cases, including the three announced Tuesday, patients were exposed to the bacteria in the Hopkins area before Sep. 9. Since then, health officials have taken steps to eliminate possible infection sources; cooling towers on several local businesses were disinfected and a decorative fountain was shut down. (Howatt, 9/27)

Prescription Drug Watch

The Odd Silence From Patient Advocacy Groups On Drug Prices

News outlets report on stories related to pharmaceutical drug pricing.

The New York Times: Furor Over Drug Prices Puts Patient Advocacy Groups In Bind
Public anger over the cost of drugs has burned hot for a year, coursing through social media, popping up on the presidential campaign, and erupting in a series of congressional hearings, including one last week over the rising price of the allergy treatment EpiPen. But one set of voices has been oddly muted — the nation’s biggest patient advocacy groups. The groups wield multimillion-dollar budgets and influence on Capitol Hill, but they have been largely absent in the public debate over pricing. (Thomas, 9/27)

Stat: The Curious Case Of The $9,500 Skin Gel
Even in an age when prescription drugs are increasingly expensive, a $9,500 tube of gel to combat scaly skin can gain notice — especially when the price spikes 128 percent overnight. That’s what happened earlier this month when a little-known company called Novum Pharma suddenly hiked wholesale prices for all three of its dermatology products by whopping amounts. (Silverman, 9/23)

The Associated Press: Maryland Group Attacks High Cost Of Prescription Drugs
With EpiPens and other prescription drugs rising in cost, families who desperately need them but do not have health insurance are bearing a huge financial burden, according to community advocates. The Maryland Citizens’ Health Initiative, a coalition of more than 1,200 religious, labor, business and policy groups seeking quality and affordable health care, wants the state legislature to address that financial burden by overhauling some of the laws governing drug pricing. (Escobar, 9/27)

Mercury News: CA Prescription Drug Measure Has Big, Early Lead
The California Drug Price Relief Act would require the state to pay no more for prescription drugs than the Department of Veterans Affairs pays for the same medication. The federal agency negotiates drug prices with pharmaceutical companies, paying on average one-quarter less for drugs than other government agencies. The poll shows support for Proposition 61 is broad-based. Subgroups of likely voters most in favor include Democrats, liberals, voters in the nine-county Bay Area and Los Angeles County, college graduates, those under age 30 and Latinos. (Seipel, 9/24)

Consumer Reports: Mail-Order Medications Are Appealing, But They Have Some Drawbacks
Does having your medication mailed to your door sound appealing? The discounts are often significant, especially for drugs that people take regularly, such as those for diabetes and high blood pressure. You might be able to order a three-month supply for a co-payment of just a few dollars. In some cases, you might be eligible to get generic medications with no co-pay at all, and free shipping. In addition, of course, there’s no need for you to go to a drugstore. (9/23)

Morning Consult: Klobuchar: Drug Price Reforms Have Many Potential Vehicles
Sen. Amy Klobuchar (D-Minn.) on Monday laid out several paths forward for drug price legislation, though she said any movement could be dependent on a “trigger moment.” Possible vehicles, she said, include the prescription drug user fee agreement that must be passed next year, the 21st Century Cures Act, tax reform and reforms to the Affordable Care Act. Legislation could also pass as a package of pharmaceutical price reforms. (Owens, 9/26)

Perspectives: Mylan CEO's Hearing, Though Dreadful, Could Have Positive Results

Read recent commentaries about drug-cost issues.

Stat: Congress May Have Taken Key Step To Clarifying Drug Prices
Heather Bresch was beaten up by Congress last week — and rightfully so. The Mylan Pharmaceuticals chief executive testified before a House committee investigating EpiPen price hikes, and her performance was largely dreadful. Although soft-spoken and respectful, she often dodged questions, and too many of the answers she did give were vague or hard to follow. Nonetheless, the hearing may yet prove beneficial. (Ed Silverman, 9/27)

Fortune: Mylan’s EpiPen Pricing Crossed Ethical Boundaries
Here’s why the drugmaker should apologize to consumers. As the CEO of the drug maker that sells the EpiPen allergy-reaction injector defended the company’s six-fold price increases before Congress last week, it’s appalling to see that Heather Bresch took no fault. The company’s price hikes on a life-saving drug is clearly unethical if we take a closer look. EpiPen has gone from $100 for a two-pack in 2009 to $608 today. Usually, companies would be applauded for the ability to create revenue through such pricing power. But when it comes to life-saving drugs, consumers interpret these significant increases as the producer profiteering off a person’s life or death need. (Daniel Kozarich, 9/27)

CNBC: Mylan CEO's Testimony Was A Huge Blow To The Entire Pharma Industry
The disregard for children's health that Mylan CEO Heather Bresch demonstrated in her testimony to the House Oversight and Government Reform Committee directly harms consumers. Less directly, Mylan's exceptionally high price increases erode public confidence in all medical companies, including those investing billions in research to help people suffering from life-threatening diseases. (Bill George, 9/27)

The Sacramento Bee: Seeking Protection From Baseless Drug Price Hikes
I carry an EpiPen for my grandson’s peanut allergy whenever he is with me. This device can mean the difference between life and death. Millions of Americans have shouldered the skyrocketing price of the EpiPen, more than 400 percent since 2007, because the cost of going without this life-saving product would simply be too high. (Doris Matsui, 9/24)

Boston Globe: A Small Step Toward Understanding Drug Pricing 
One of the most unsatisfying aspects of the Mylan hearing — and a February verbal takedown of Turing Pharmaceuticals’ Martin Shkreli by the same committee — is that they were postmortems, not preemptive strikes. By the time fingers started pointing at the unrepentant CEOs, their companies already had made many millions of dollars from selling grossly overpriced products. A bipartisan bill just filed on Capitol Hill won’t stop such profiteering. It might, however, do away with some of the mystery surrounding pricing, and allow consumers and elected officials to weigh in before a hike takes effect. The proposal calls for requiring companies to provide the Department of Health and Human Services with a report explaining any price increase of 10 percent or more in an “understandable online format” – 30 days in advance of its implementation. (9/23)

Lexington Herald Leader: Drug Industry’s Quest For Profits Yields Superbugs
It has been three years since the Centers for Disease Control and Prevention effectively declared victory in the fight against Methicillin-resistant Staphylococcus aureus or MRSA and reported a decrease by over 50 percent in hospital-acquired MRSA infections. Now the United States is refocusing its efforts on antibiotic development and antibiotic stewardship, designed to both treat and prevent the emergence of infectious superbugs. (Devin Kavanagh, 9/23)

Editorials And Opinions

Viewpoints: Recognizing The Superbug Danger; Confronting Mental Health Stigma

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

The New York Times: The World Wakes Up To The Danger Of Superbugs
Tuberculosis. Malaria. Syphilis. Gonorrhea. The microbes that cause these diseases are increasingly resistant, and sometimes even impervious, to antibiotics that worked in the past. Last week, amid other pressing business, 193 nations at the United Nations General Assembly signed a declaration summoning each of them to a war against a powerful and resourceful enemy: superbugs that have learned to evade science’s last remaining defenses. (9/28)

The Huffington Post: Let’s Call Mental Health Stigma What It Really Is: Discrimination
It’s no secret that there’s a veil of shame surrounding mental illness. Nearly one in five American adults will experience a mental health disorder in a given year. Yet only 25 percent of people with a psychological condition feel that others are understanding or compassionate about their illness, according to the U.S. Centers of Disease Control and Prevention. (Lindsay Holmes, 9/27)

Louisville Courier-Journal: Mental Illness Affects Many
Mental illness does not target one demographic or group, nor does it avoid others. It is an equal opportunity disease. Whether it impacts the life of a school teacher, a business executive, a stay at home mom, or a young college student – mental illness and its unfortunate societal stigma can have a devastating impact on a person and their loved ones. When they realize they can no longer manage the emotional pain and other consequences of the illness, one of the first questions asked is, “Where do I turn for help?” (Ramona Johnson, 9/27)

Richmond Times Dispatch: Another Reason To Spike COPN 
Like 35 other states, Virginia requires health-care providers to get the state’s permission before they can spend their own money on capital investments such as new buildings and new equipment. Big players — hospital chains especially — routinely try to game the system to thwart competition from one another and from upstart entrepreneurs who bring new ideas and approaches to the delivery of medicine. Defenders of the system claim it helps hold down costs. But as the Department of Justice and the Federal Trade Commission have long pointed out, it doesn’t. (9/27)