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Political Cartoon: 'Cold Comfort?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Cold Comfort?'" by Dave Coverly, Speed Bump.

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The health law’s support
Is now on the rise. Don’t it
Always seem to go

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Summaries Of The News:

Capitol Hill Watch

Dismissing Concerns Voiced At Town Hall Meetings, Conservatives Push GOP Lawmakers To Quickly Repeal The Health Law

But others point out the dangers of proceeding without clear cut methods to ensure the process doesn't harm people who gained coverage. Meanwhile, a key House committee is hoping to begin the mark up for repeal and replace legislation next month.

Roll Call: Conservatives Want Obamacare Repeal, And They Want It Now
Conservatives rallying here are calling for their congressional brethren to keep the faith and quickly gut the 2010 health care law, dismissing concerns about lost health coverage and motivated voters at town halls. Reported remarks by former Speaker John A. Boehner, R-Ohio, far away from the conservatives gathered at the convention hotel provided the latest cause for alarm. Boehner had said that repeal and replace was “not going to happen,” according to Politico. “The last I checked, Boehner doesn’t have a vote anymore,” Sen. Ted Cruz of Texas told Roll Call. (Lesniewski and McPherson, 2/23)

Morning Consult: Experts Question GOP Approach To Pre-Existing Health Conditions
A key plank of the House GOP’s blueprint to replace the Affordable Care Act would fail to provide adequate health insurance to people with existing medical conditions without substantial state or federal funding, according to veteran health care officials and experts. ... But prior experience with [high-risk] pools, which were operated in 35 states before the ACA, shows they had inconsistent results and were rarely sufficient to cover everyone in need. Studies estimate the pools covered about 200,000 people nationwide by the time the ACA was passed. That’s a tiny fraction of the 52 million Americans with pre-existing conditions that could become uninsurable if Obamacare is repealed. (Reid, 2/23)

The Hill: House Markup Of ObamaCare Repeal Bill Up In The Air 
The timing of a House committee session to work on ObamaCare repeal and replace legislation is in flux as Republicans seek to flesh out the details. Though no date was ever formally scheduled, the House Energy and Commerce Committee had been eyeing March 1 for a markup of repeal and replace legislation. Lobbyists and aides now say a markup is not likely to happen until at least the week of March 6. Several lobbyists said Republicans on the committee sent some elements of a healthcare bill to the Congressional Budget Office (CBO), but did not receive the cost estimates that they had expected.  (Sullivan, 2/23)

All The Outrage At Town Halls Over Repeal Not Backed By Cold-Hard Cash

Health groups and advocacy organizations that once supported the health law haven't returned with large financial efforts to save the legislation. So although supporters are making their voices heard at town halls, without money to back it up, they might be left fighting formidable foes without much punch.

Politico: The Left Rallies To Save Obamacare With Passion But Little Cash
Obamacare is blowing up congressional town hall meetings from California to Virginia. But high-rollers aren't stepping up to write checks to defend the law and possibly turn voter outrage over losing coverage into a sustainable movement. Though many Republicans charge the town hall sessions are stoked by moneyed interests and professional protesters, health care groups and foundations that have been crucial to the ACA cause have remained on the sidelines. Without cash, the smaller progressive organizations left could be hard-pressed to fight a long battle as conservatives spend heavily to pressure lawmakers to finish off the law and, possibly, revamp Medicaid. (Pradhan, 2/24)

The Washington Post: Republicans Distance Themselves From Trump’s Agenda At Rowdy Town Halls
When a voter here asked whether Sen. Charles E. Grassley supports a probe of President Trump’s tax returns, the Republican gave a qualified “yes.” In Virginia, asked about Russian interference in the presidential election, Rep. David Brat said an investigator should “follow the rule of law wherever it leads.” And in Arkansas, Sen. Tom Cotton told 1,400 people sardined into a high school auditorium that the Affordable Care Act “has helped Arkansans.” This week’s congressional town halls have repeatedly found Republicans hedging their support for the new president’s agenda — and in many cases contradicting their past statements. (Weigel, 2/23)

The Washington Post: Republican Lawmaker Who Won’t Hold A Town Hall Invokes Gabby Giffords Shooting. She Responds: ‘Have Some Courage.’
As Republican lawmakers across the country have faced raucous, chaotic town halls in recent days, a number have refused to have these events. ... Rep. Louie Gohmert (R-Tex.), in a statement released this week, blamed his decision not to hold these events in person on “the threat of violence at town hall meetings.” He also pointed to a specific violent event to bolster his case, invoking the 2011 shooting that severely injured Rep. Gabrielle Giffords (D-Ariz.) and killed six others. ... “To the politicians who have abandoned their civic obligations, I say this: Have some courage,” Giffords said in a statement. “Face your constituents. Hold town halls.” (Berman, 2/23)

Roll Call: Giffords to GOP: ’Have Some Courage,’ Don’t Dodge Town Halls
Former Arizona Rep. Gabrielle Giffords on Thursday urged congressional Republicans to “have some courage” and hold town halls, after Texas Republican Rep. Louie Gohmert referenced her shooting in his explanation for not holding one. In a letter to his constituents who had requested a town hall meeting with him, Gohmert referred to “groups from the more violent strains of the leftist ideology, some even being paid, who are preying on public town halls to wreak havoc and threaten public safety.” (McPherson, 2/23)

Denver Post: Buck: Affordable Care Act Replacement Will “Take A While To Formulate” 
Town hall meetings across the country that have showcased national strife over a repeal of the Affordable Care Act have also revealed something else this month: a lack of consensus among Republicans over the timing of replacing the law. In a meeting with constituents in Douglas County on Tuesday, Colorado Congressman Ken Buck said he believes that fully implementing a replacement could take years after the vote to repeal the law. His fellow Colorado U.S. Rep. Mike Coffman, though, told constituents in a video message last week that he would not vote to repeal the law without “a concurrent replacement.” (Ingold, 2/23)

The Fiscal Times: Americans Sour On Trump And Congress As Replacing Obamacare Flounders 
Barely a month into the new Trump era, Americans are beginning to sour on President Donald Trump and the Republican-controlled Congress as the wheels begin to come off the GOP drive to repeal and replace the Affordable Care Act. Voter displeasure with some GOP policies, particularly the effort to dismantle Obamacare instead of finding ways to improve it, have been welling up during town hall meetings held by Republican House and Senate members during a week-long congressional recess. And there are indications that the White House may renege on Trump’s repeated pledge to unveil a comprehensive new health insurance plan sometime in the next few weeks. (Pianin, 2/23)

Boehner: Repeal Won't Happen Because 'Republicans Never Ever Agree On Health Care'

The former House speaker says he should never have called it "repeal and replace" because most of the framework of the Affordable Care Act will probably remain.

The Associated Press: Former House Speaker Predicts 'Obamacare' Won't Be Repealed
Former House Speaker John Boehner predicted on Thursday that a full repeal and replacement of "Obamacare" is "not going to happen." The Ohio Republican, who was forced out by conservatives in 2015, said he started laughing when he heard President Donald Trump and Republicans promise swift action on undoing and replacing the health law. "Republicans never ever agree on health care," Boehner said. (2/23)

Politico: Boehner: Republicans Won't Repeal And Replace Obamacare
“They’ll fix Obamacare, and I shouldn’t have called it repeal and replace because that’s not what’s going to happen. They’re basically going to fix the flaws and put a more conservative box around it,” Boehner said. The former speaker’s frank comments capture the conundrum that many Republicans find themselves in as they try to deliver on pledges to axe Obamacare but struggle to coalesce around an alternative. (Tahir, 2/23)

CNN: Boehner: Obamacare Repeal And Replace 'Not What's Going To Happen'
He said lawmakers were too confident in how easy they thought the process would go. "All this happy talk that went on in November and December and January about repeal, repeal, repeal -- yeah we'll do replace, replace -- I started laughing because if you pass repeal without replace, first, anything that happens is your fault. You broke it." Boehner said he warned GOP leaders about repealing Obamacare without a replacement ready because the members "will never ever agree what the bill should be." "Perfect always becomes the enemy of the good," he added. (Burlij, 2/24)

Health Law

Governors, Who Hold Key Role In GOP's Hopes To Revamp Medicaid, Bring Concerns To D.C.

The National Governors Association's annual meeting begins in Washington this weekend, and the governors are expecting to raise their concerns about efforts to change Medicaid in discussions with members of Congress and President Donald Trump. Some states are already requesting waivers to make key alterations in that program, but many of the governors are nervous about how Republican efforts could shift financial responsibilities to the states.

The Wall Street Journal: Republican-Led States Push To Reshape Their Medicaid Programs
A growing number of Republican state leaders, not content to wait as Congress struggles to repeal the Affordable Care Act and overhaul Medicaid, are mobilizing in an effort to reshape how health care is delivered in their states. Encouraged by a Trump administration that appears receptive to such moves, more than a half-dozen states are seeking federal permission to impose coverage restrictions on many Medicaid beneficiaries, including drug testing and lifetime enrollment caps, some of which would be unprecedented. (Armour, Levitz and Hackman, 2/23)

CNN: Hill GOP Asks Governors To Help Save Obamacare Repeal
Congressional Republicans struggling over how to repeal Obamacare are stuck on a key problem: what to do with the millions of people in 31 states covered under the dramatic expansion of Medicaid the law enabled. So they have privately turned to a handful of governors to help resolve the issue -- including Wisconsin's Scott Walker and Ohio's John Kasich, according to several sources involved in the talks. The hope, according to congressional sources, is to let the governors cut a deal on an issue that directly impacts their states and let the White House and Republican leaders endorse the plan that eventually emerges. (Raju, 2/23)

McClatchy: Governors Head For Washington, Will Press Trump On Obamacare Repeal
The governors are especially worried about what will happen to Medicaid, the health care program primarily for low income Americans. Even conservative Kansas Gov. Sam Brownback, whose state did not agree to the federal Medicaid expansion, said people who already received coverage should not lose it. Brownback said “Obamacare repeal and replace is going to be the top discussion” at the governors meetings. “The governors are going to be at the tip of the spear on that. You’ve got to do it in such a way that you are repealing but you’re not kicking people off,” he said. (Cockerham, Wise and Hotakainen, 2/24)

Columbus Dispatch: Kasich Summoned To Help Craft Medicaid Solution Amid Obamacare Repeal
Ohio Gov. John Kasich is among a small group of governors being called upon by congressional Republicans to help craft a solution to the Medicaid expansion conundrum amid the repeal and replacement of Obamacare. ... Kasich arrived in Washington D.C. today following a trip to Germany and the United Kingdom and is expected to meet with the other governors, the source said. Kasich worked the phones while overseas, talking to other governors and their staffs on crafting a health-care replacement plan. The governor is scheduled to meet with Trump on Friday. (Ludlow, 2/24)

The Hill: GOP Governors Confront Medicaid Divide
Governors are descending on Washington this weekend as Republicans wrestle with the future of ObamaCare's expansion of Medicaid. GOP lawmakers say they are looking to governors for advice on what to do about the program, which is one of the toughest issues Republicans face as they look to repeal and replace the healthcare law. Many of the lawmakers representing states that accepted the Medicaid expansion are looking to keep it. But they are at odds with conservatives and Republicans from states that rejected the expansion; they are pushing full repeal. (Sullivan, 2/24)

Modern Healthcare: Trump Will Meet With Governors Worried About Medicaid Funding
Most governors realize that the GOP's Medicaid restructuring plan, recently outlined by House Republican leaders, would mean significantly less federal funding over time, even though states would get more flexibility in how to spend those dollars. It “will result in the single largest transfer of risk ever from the federal government to the states,” Arizona's Republican Gov. Doug Ducey recently wrote to House leaders. (Meyer, 2/23)

CQ Roll Call: GOP Faces Pressure From Mayors On Obamacare Repeal Efforts
A bipartisan association of mayors from across the United States outlined on Thursday its demands for a Republican alternative to the 2010 health care law. Mayors of several major cities also cautioned that repealing the law without an adequate replacement could have significant consequences for local economies. Among the main areas of the law the U.S. Conference of Mayors wants to see maintained are provisions that GOP lawmakers in Congress also support, such as the ban on insurers denying coverage based on pre-existing health conditions and allowing young adults to stay on their parents' plans until the age of 26. But one key area where the group differs from some congressional Republicans is what to do regarding the law’s Medicaid expansion. (Williams, 2/23)

The Fiscal Times: Federal Block Grants Have Been A Big Financial Loser For The States 
A key element of the Republicans’ plan for replacing Obamacare is transforming the costly Medicaid program into a series of block grants to the states. The idea is to save the federal government billions of dollars in the coming years while giving state officials more flexibility to set eligibility requirements and spending levels to provide health care services to the nation’s poor and disabled. But there is one serious catch: While the extensive use of block grants has proven over the years to be a great financial boon for Congress and the federal government in attempting to rein in spending, it has been a bad deal for the states and hundreds of millions of Americans dependent on federal assistance. (Pianin, 2/23)

8 Out Of 10 Americans Support Health Law's Medicaid Expansion, Poll Finds

Both Republicans and Democrats wanted to preserve the funding that's helped 11 million low-income people get health care coverage.

Kaiser Health News: Support For Health Law Grows, Leaving Republicans In A Bind
The monthly tracking poll from the Kaiser Family Foundation finds overall support for the health law ticked up to 48 percent in February, the highest point since shortly after it passed in 2010. That was a 5-point increase since the last poll in December. In addition, 6 in 10 people said they did not favor current GOP proposals for turning control of Medicaid, the federal-state program for low-income residents, over to the states or changing the federal funding method. More than half said Medicaid is important to them or family members. (Rovner, 2/24)

Kansas House Passes Medicaid Expansion Bill But Senate Action Is Uncertain

Gov. Sam Brownback opposes Medicaid expansion, and the margin in the House vote was three votes shy of a veto-proof majority.

Kansas City Star: Kansas House Passes Medicaid Expansion
The Kansas House gave final approval to a bill that would expand Medicaid in the state, just days after the expansion effort looked like it never would make it to the House floor. Lawmakers voted 81-44 Thursday to pass the bill, three votes shy of the margin needed for a veto proof majority. It will now head to the Senate where its chances to pass are unclear. The effort to expand Medicaid in Kansas almost never made it out of a House committee. (Woodall, 2/23)

Topeka Capital Journal: Health-Related Bills Sail Through Kansas House
Medicaid expansion passed its second and final House vote on Thursday, but even if it passes the Senate, it remains vulnerable to potential veto by Gov. Sam Brownback. Medicaid expansion lost a few supporters compared to the initial vote a day earlier, bringing the final tally to 81 in favor and 44 against. The threshold for a veto-proof majority is 84 votes. (Llopis-Jepsen, 2/23)

Wichita (Kan.) Eagle: Kansas House Sends Medicaid Expansion Bill To Senate Panel
Brownback has opposed expanding Medicaid throughout his tenure, pointing mainly to the cost. “Kansas should not tie itself to this failed program of the past just before its inevitable demise,” he said in a statement earlier this month. House Minority Leader Rep. Jim Ward, the Wichita Democrat who pushed earlier in the week for the House to debate Medicaid expansion, said it was an “incredible opportunity” to boost economic development in Kansas. He suggested a potential Brownback veto could “alienate” the Legislature further and draw more lawmakers toward the side of expansion. (Salazar, 2/23)

And in other Medicaid news —

NPR: NPR Fact Checks Indiana's Claims About Its Medicaid Program
Indiana expanded Medicaid under the Affordable Care Act in 2015, with a few extra conditions that were designed to appeal to the conservative leadership in the state. The Federal government approved the experiment, called the Healthy Indiana Plan, or HIP 2.0, and it is now is up for another three-year renewal. But a close reading of the state's renewal application shows misleading and inaccurate information is being used to justify extending HIP 2.0. (Harper, 2/24)

The Philadelphia Inquirer: Protest Builds Over Pa. Medicaid Contracts
Winning a contract to manage part of Pennsylvania's $12 billion in Medicaid benefits is a big prize. That's why losing bidders with a long-term presence in the market of 2.3 million participants are not taking lightly the Pennsylvania Department of Human Services' decision last month to cut them out of all or part of Medicaid management in Pennsylvania. Insurance giants UnitedHealthcare and Aetna came out empty-handed in January. AmeriHealth Caritas, a subsidiary of Philadelphia's Independence Blue Cross, was bumped out of a region that stretches from the Lehigh Valley to Fulton County and where it had the largest market share in December. (Brubaker, 2/23)

'Obamacare Must Go': Pence Draws Hard Line On Replacement At CPAC

The vice president promised those at the Conservative Political Action Conference that “America's Obamacare nightmare is about to end."

The Washington Post: VP Pence: ‘America’s Obamacare Nightmare Is About To End’
Vice President Pence forcefully defended on Thursday night the Trump administration's plans to repeal and replace the Affordable Care Act, saying the law known as Obamacare is a “nightmare” and that the administration is committed to “an orderly transition” to a new health-care system. Addressing a gathering of conservative activists in the Washington area, Pence sought to minimize the voices of the hundreds of people who have demonstrated against changes to the law at congressional town hall meetings across the country. (Rucker, 2/23)

Politico: Pence: GOP Full Tilt On Obamacare Repeal
Pence said the administration would soon advance plans that preserve some of the current healthcare law’s most popular features — such as protections for patients with preexisting conditions — but that added more free market solutions, like the ability to purchase plans across state lines. And the vice president dismissed recent protests at Republican town halls as manufactured outcry, arguing that the GOP had the right principles behind their policies. (Jackson, 2/23)

Uncertainty Over Health Law Repeal Throws Taxpayers For A Loop This Season

As Americans are filing their taxes, many are confused about what they have to divulge about their health insurance status.

Politico: Obamacare’s Limbo Befuddles Taxpayers
Republicans’ stalled campaign to repeal the Affordable Care Act is sowing confusion among those now trying to do their taxes. Many taxpayers believe Republicans have already repealed the law, tax preparers say, and they’re surprised and upset to learn they are still subject to Obamacare’s penalty for failing to have health insurance — a charge that climbed this year to more than $2,000 per family. (Faler, 2/23)

California Healthline: To Pay Or Not To Pay – That Is The Question
K.A. Curtis gave up her career in the nonprofit world in 2008 to care for her ailing parents in Fresno, which also meant giving up her income. She wasn’t able to afford health insurance as a result, and for each tax year since 2014, Curtis has applied for — and received — an exemption from the Affordable Care Act’s coverage requirement and the related tax penalty, she says. This year, given President Donald Trump’s promise to repeal the ACA, along with his executive order urging federal officials to weaken parts of the law, Curtis began to wonder whether she’d even have to apply for an exemption for her 2016 taxes. (Bazar, 2/24)

Meanwhile, the threat of repeal hangs heavy over those who rely on the health law —

The Washington Post: Cancer Patients, Survivors Fear GOP Efforts To Dismantle The Affordable Care Act
Ashley Walton was 25 when a mole on her back turned out to be melanoma. She had it removed, but three years later she discovered a lump in her abdomen. She was then unemployed and uninsured, and so she put off going to a doctor. She tried to buy health insurance. Every company rejected her. By the time Walton finally sought medical help, the melanoma had spread to her brain, lungs and elsewhere. And she eventually became eligible for California’s Medicaid program, which had been expanded under the Affordable Care Act. Two major surgeries, radiation and immunotherapy did not cure the cancer — but did beat it back. (McGinley, 2/23)

Kaiser Health News: Threat Of Obamacare Repeal Leaves Community Health Centers In Limbo
Treating people for free or for very little money has been the role of community health centers across the U.S. for decades. In 2015, 1 in 12 Americans sought care at one of these clinics; nearly 6 in 10 were women, and hundreds of thousands were veterans. The community clinics — now roughly 1,300-strong — have also expanded in recent years to serve people who gained insurance under the Affordable Care Act. (2/24)

Extension On Non-ACA Compliant Plans Could Undermine Efforts To Stabilize Markets

The Centers for Medicare & Medicaid Services issued the ruling Thursday to allow "grandmothered" plans to operate until Dec. 31, 2018. Meanwhile AHIP President Marilyn Tavenner and American Hospital Association President Rick Pollack talk about fixing the marketplace for individuals.

Modern Healthcare: Will CMS' Decision To Extend Non-ACA Compliant Plans Help Or Hurt The Market? 
The Trump administration will allow insurers and consumers to extend for an additional year individual and small-group health plans that do not comply with the Affordable Care Act's coverage rules. The insurance industry lobbied for the grandmothering extension. But some experts say it will hurt efforts to stabilize the individual market and moderate rate hikes by letting healthier people stay in plans outside the ACA-regulated insurance pool...It's estimated that fewer than one million people currently remain in grandmothered individual-market plans in the three dozen or so states that still allow them. The rest of the states, including California and New York, already halted the sale of non-ACA compliant plans to strengthen their ACA-regulated markets. (Meyer, 2/23)

Modern Healthcare: Tavenner, Pollack Ask That ACA Replacement Plan Tackle Individual Markets First, Medicaid Later
If the Trump Administration and Congress repeal the Affordable Care Act, they ought to first fix the marketplace for individuals and put off the contentious debate of Medicaid reform for many months, two leading health association presidents said Thursday. Speaking at a Nashville Health Care Council luncheon, American Hospital Association President Rick Pollack and Marilyn Tavenner, president of the America's Health Insurance Plans, agreed that the individual insurance market was unstable before the ACA and it remains so. Of the millions of newly insured on the exchanges, 70% are receiving subsidies to be able to afford coverage, Tavenner said. (Barkholz, 2/23)

Women’s Health

Sen. Murkowski Will Not Vote For Health Law Repeal That Also Defunds Planned Parenthood

In other news on women's reproductive health, St. Louis takes steps to preempt an anti-abortion measure that is moving through the Missouri legislature. And a group of doctors call on the Food and Drug Administration to loosen regulations surrounding the "abortion pill."

The Hill: GOP Senator Won't Vote To Defund Planned Parenthood 
Sen. Lisa Murkowski (R-Alaska) says she will not vote for an ObamaCare repeal bill that defunds Planned Parenthood. In her address to Alaska's state legislature Wednesday, the moderate Republican offered her firmest commitment yet that she will not support defunding Planned Parenthood. "I, for one, do not believe that Planned Parenthood has any place in our deliberations on the Affordable Care Act," she said. (Hellmann, 2/23)

The Philadelphia Inquirer: Doctors Urge FDA To Loosen Restrictions On Abortion Pill
A group of reproductive health experts has called on the U.S. Food and Drug Administration to loosen regulation of the "abortion pill" so women can get it by prescription in pharmacies without necessarily seeing a doctor. The commentary, in Thursday's New England Journal of Medicine, comes as the Trump administration, which has been hostile to abortion rights, prepares to appoint a new FDA commissioner. The FDA last year updated the prescribing information for the abortion pill, mifepristone, marketed as Mifeprex, to let women use it later in pregnancy, with two visits to the doctor rather than three. But special restrictions still prohibit the sale of the drug in pharmacies; it can only be dispensed in clinics, hospitals, and medical offices by health-care providers  who undergo a certification process. (McCullough, 2/23)

Supreme Court

Supreme Court Appears To Take Critical View In Nursing Home Arbitration Case

In the case, Kindred Healthcare is fighting the daughters of two former residents of one of their nursing facilities. Although the daughters signed admission paperwork for their parents, Kentucky's Supreme Court said the arbitration agreements in those contracts violated the residents' “God-given” right to litigate any disputes. Meanwhile, although the high court's justices ruled in favor of arbitration in two earlier cases, their questions this time around seemed to take a different tone.

Public Health And Education

'Unique Threat Of Fentanyl' Has Lawmakers Seeking Answers From Nation's Drug Czar

The powerful opioid is responsible for nearly 20 percent of fatal overdoses, and lawmakers want assurance that the federal government recognizes the lethal threat. In other news on the crisis, researchers try to understand why there are so many relapses when it comes to opioid addiction, Virginia's governor takes steps to address the problem, lawmakers ask for an investigation into a rash of overdoses at Connecticut "sober homes" and hundreds rally to support preserving substance abuse treatment.

The Wall Street Journal: U.S. House Committee Presses Drug Czar On Fentanyl
U.S. House lawmakers are pressing the nation’s drug czar for more data on the dangerous synthetic opioid fentanyl, including how it is trafficked and how many people it has killed, in the latest effort to thwart a spiraling drug crisis. The four-page letter from the U.S. House Energy and Commerce Committee, signed by bipartisan committee leaders and reviewed by The Wall Street Journal, calls the fentanyl crisis a top oversight priority. Addressed to Kemp Chester, acting director of the White House Office of National Drug Control Policy and sent Thursday, the letter includes 15 questions such as how much fentanyl comes into the U.S. through the mail and how many counterfeit fentanyl pills authorities have seized. (Kamp and Campo-Flores, 2/23)

Stat: Fatal Drug Overdoses In US On The Rise, CDC Says
Fatal drug overdoses continued their depressing climb in 2015, while the opioid crisis shifts from taking lives with painkillers like oxycodone to more lethal compounds like heroin and fentanyl, new data released Friday show. Overall, the rate of fatal overdoses from all drugs has increased more than 2.5 times since 1999, rising from 6.1 deaths per 100,000 people then to 16.3 deaths in 2015, according to the new report from the Centers for Disease Control and Prevention. (Joseph, 2/24)

Stat: Backers Of White House Drug Policy Office Scramble To Protect It
With the US opioid crisis the subject of increased political focus, advocates in the recovery community had been quietly hoping President Trump might elevate the White House “drug czar” to his Cabinet. Now they are mobilizing to ensure the drug czar’s office won’t be eliminated entirely. A recent report that the White House may propose axing the White House Office of National Drug Control Policy has sparked a scramble among leaders in the recovery community and among law enforcement. The National Fraternal Order of Police has already prepared a letter to Trump urging him to reject any proposal to eliminate the office. Advocates in the recovery community have drafted their own letter expressing support for the office. (Scott, 2/23)

The Washington Post: Many People Keep Taking Prescription Opioids During Addiction Treatment
The grip of opioid addiction is so strong that many people who undergo treatment relapse repeatedly. Now a study by Johns Hopkins University researchers offers new clues about why treatment is so difficult. The researchers discovered that 43 percent of people receiving buprenorphine, a widely used anti-addiction medication, filled at least one prescription for opioids — which they presumably consumed or diverted to others. (Bernstein, 2/23)

The Associated Press: Governor Signs Bills Aimed At Stemming Opioid Epidemic
Gov. Terry McAuliffe has signed a set of bills that aim to stem Virginia’s growing opioid epidemic. McAuliffe’s office said in a statement Thursday that among the measures he signed into law is one allowing community organizations to possess and dispense naloxone, an overdose-reversal drug. Another measure mandates that all opioid prescriptions be transmitted to pharmacies electronically by 2020. (2/23)

Richmond Times Dispatch: McAuliffe Signs Four Bills To Address Virginia's Opioid Crisis 
Noting that opioid overdose deaths are likely to have topped 1,000 in 2016, Gov. Terry McAuliffe signed four bills into law Thursday that are meant to address the state’s ongoing epidemic. The bills put into action syringe-services programs; initiatives to increase access to the overdose-reversal drug naloxone; changes to opioid prescription policies; and processes for providing services to infants exposed to opioids in utero. (Demeria, 2/23)

CT Mirror: Murphy Presses For Federal Probe Of ‘Sober Homes’ After Overdose Deaths 
A rash of overdoses in “sober homes” in Connecticut and other states has prompted Sen. Chris Murphy and a bipartisan group of his colleagues to ask federal investigators to determine if additional oversight is needed of these residences for people recovering from substance abuse. Murphy is leading an effort that has been joined by Sens. Elizabeth Warren, D-Mass.; Orrin Hatch R-Utah; and Marco Rubio, R-Fla. The senators this week wrote the U.S. Government Accountability Office, asking it to investigate state and federal oversight of these homes. (Radelat, 2/23)

The Baltimore Sun: Hundreds Rally For Mental Health And Drug Treatment 
Hundreds of people packed Lawyers Mall in Annapolis Thursday to urge lawmakers to "keep the door open" for mental health and substance abuse treatment. Sen. Guy Guzzone, a sponsor of the Keep the Door Open Act, said that too often mental health and substance abuse treatment are considered the "stepchild" of the healthcare system...Guzzone's bill would increase the rate that the state pays to state-funded community clinics and organizations that offer behavioral health treatment and would guarantee future increases. It would cost the state about $16.75 million to raise the rates as required by the bill, according to a nonpartisan analysis. (Wood, 2/23)

New Hampshire Union Leader: NH Substance Abuse Advocate To Be Hassan's Special Guest For Trump Speech 
A substance abuse advocate from Dover will be the guest of honor of Sen. Maggie Hassan, D-N.H., when President Donald Trump gives a speech to the Joint Session of Congress next Tuesday. Ashley Hurteau lived with addiction for nearly a decade, but was helped when the state’s expansion of Medicaid gave her health insurance coverage for substance abuse, Hassan said. The new senator and former governor met Hurteau at the Farnum Center in Manchester last month where they both served on a panel to discuss changes to the Affordable Care Act. (2/23)

Sorry, Kids: FluMist May Not Be Coming Back Any Time Soon

The efficacy of the nasal mist was called into question last year, and it might be a long road back for this vaccine method. In other public health news, a mumps outbreaks, transgender teenagers, air pollution, smokers, gun wounds and heart disease.

Stat: Nasal Vaccine FluMist May Not Be Recommended For Use For Years
Once a darling of pediatricians and parents, the nasal mist vaccine was not recommended for use in the United States this winter because studies showed it offered limited protection in recent years. On Wednesday, officials from MedImmune, the division of AstraZeneca that makes the vaccine, reported on their efforts to fix the vaccine during a meeting here of the Advisory Committee on Immunization Practices, the expert panel that counsels the Centers for Disease Control and Prevention on vaccine use. (Branswell, 2/23)

The Washington Post: Rise In Mumps Outbreaks Prompts U.S. Officials To Weigh Third Vaccine Dose
Federal health officials are evaluating the benefit of an additional dose of the mumps vaccine because of the increasing number of mumps outbreaks since 2006. More than 5,000 cases of the contagious viral illness were reported last year in the United States, the most in a decade. Among the outbreaks in recent years, 19 occurred last year on college campuses. Arkansas has been battling an outbreak that began in one community last summer and has since infected 2,815 people, the largest recorded in that state. (Sun, 2/23)

The New York Times: One In Every 137 Teenagers Would Identify As Transgender, Report Says
Nearly 150,000 American teenagers from 13 to 17 years old — or one out of every 137 — would identify as transgender if survey takers asked, according to an analysis of state and federal data that offers an answer to a question that has long eluded researchers. The figure stands to inform the fierce debate over the rights of transgender youth, reignited on Wednesday by President Trump’s decision to rescind an Obama administration policy that protected the rights of students to use bathrooms corresponding to their gender identity. (Chokshi, 2/23)

The Washington Post: Air Pollution Affects Preterm Birthrates Globally, Study Finds
A pregnant woman's exposure to air pollution has adverse effects on her fetus, according to a new international study, with prolonged exposure associated with nearly 1 in 5 premature births globally. The study, published recently in the journal Environment International, is the first global estimate of preterm births associated with pollution caused by fine particulate matter. This matter, known as PM2.5, is identified by the size of the microscopic particles and droplets it contains (2.5 micrometers in diameter or less), and it can reach deep into the respiratory tract. It is emitted by man-made sources such as diesel engines, industrial plants and the cooking fuels used mostly in parts of Asia, as well as by natural sources such as chemical reactions occurring in the atmosphere. (Naqvi, 2/23)

Miami Herald: Kids Are Developing Heart Disease At An Early Age Due To Their Weight 
Obesity, coupled with a sedentary lifestyle and poor eating habits, has given rise to children developing at least three of the most dangerous risk factors for type 2 diabetes and cardiovascular disease: high blood pressure, high cholesterol, large waistlines or high blood sugar levels. Dr. Anthony Rossi, a pediatric cardiologist specializing in critical care at Nicklaus Children’s Hospital, didn’t worry about kids contracting type 2 diabetes when he started his career. It didn’t exist in children. (Medina, 2/23)

State Watch

State Highlights: Minn. Plans Online Resource To Help Consumers Compare Assisted-Living Facilities' Quality; Calif. Proposal Would Require Problem Docs To Be Transparent

Outlets report on news from Minnesota, California, Georgia, Massachusetts, Kansas, Alabama and Michigan.

The Star Tribune: State Plans Online 'Report Card' For You To Gauge Assisted-Living Facilities 
For decades, Minnesota families seeking senior living arrangements for their elderly loved ones have found themselves casting about in an informational void. But a proposal by the Minnesota Department of Human Services would create the state’s first standardized system for measuring the quality of assisted-living homes — a fast-growing but lightly regulated industry that now serves more than 50,000 Minnesotans in nearly 1,200 facilities. (Serres, 2/23)

The Star Tribune: Rochester Set To Remove 180-Plus Students Over Failure To Follow Vaccination Law
More than 180 public school students in Rochester will be removed from school March 1 if they are not vaccinated or officially exempted from the state law that requires them to be immunized. School officials said this week that they have worked “diligently” since January to inform families that students must be vaccinated to attend school or provide documentation for an exemption. (Smith, 2/23)

The Star Tribune: HCMC Cutting 131 Jobs Through Layoffs Amid Budget Pinch 
Hennepin County Medical Center leaders announced the layoff of more than 131 workers this week, saying they believe it will resolve a projected financial crisis at the hospital caused by worsening reimbursements for patient care. The announcement drew angry responses from affected employees, including a protest by cleaners and clerical workers Thursday afternoon and criticism by a bioelectronics technician, who predicted that the hospital will end up spending more by outsourcing critical tasks. (Olson, 2/23)

Los Angeles Times: Political Spending Of AIDS Nonprofit Comes Under Fire
The AIDS Healthcare Foundation oversees a global philanthropic empire that extends from its Hollywood headquarters to 15 states and 38 countries. The 30-year-old nonprofit organization treats hundreds of thousands of patients. It hands out tens of millions of condoms annually. And it puts up provocative billboards urging people to get tested for sexually transmitted diseases. But in recent months, it has become known for the kind of activism usually associated with homeowner groups, spurring criticism that it has strayed too far from its mission. (Reyes and Zahniser, 2/24)

Boston Globe: City Seeks Private Partner To Rebuild Former Bromley-Heath Complex
The roofs leak, the elevators malfunction, and the heating system is old. Tenants of the Mildred C. Hailey Apartments complain about people sleeping in the hallways or doing drugs, and sometimes they find used needles scattered about. But there is no federal money to repair or rebuild the Jamaica Plain housing development’s 804 units of federally subsidized public housing, Boston Housing Authority officials say. So on Wednesday, the authority announced it is seeking proposals from private developers to tear down and rebuild a portion of the complex: six dilapidated buildings on Centre Street, Parker Street, and Lamartine Street. (Allen and Gans, 2/23)

Sacramento Bee: Muslims Seek Mental Health Aid After Mosque Attacks, Travel Ban 
Coming at the same time as other anti-Muslim attacks and a presidential order banning entry by people from seven predominantly Muslim countries, many Muslim Americans are asking themselves whether they still are welcome in this country while they worry about their own safety and the safety of their loved ones. In response, mosques, student groups and mental health agencies around the Sacramento region are stepping up and offering Muslims a safe place to share their anxieties and receive professional help. (Caiola, 2/23)

KCUR: Osteopathic Med Schools Like Kansas City University Answer The Call For More Doctors 
With the United States facing a shortage of physicians over the next decade, health care groups and lawmakers are scrambling to increase the number of doctors – primary care providers in particular – to serve an aging population. Kansas meets only about 65 percent of its physician needs, according to the Health Resources & Services Administration. Missouri is even worse off, meeting only about 30 percent of its physician needs. Many Missouri counties are designated Health Professional Shortage Areas, meaning they have only one provider in the area to serve at least 3,500 people. (Worth, 2/23)

The Wall Street Journal: Alabama Doctors Convicted In Health-Care Fraud Case
Two Alabama doctors were convicted Thursday of health-care fraud, taking kickbacks from Insys Therapeutics Inc. and prescribing opioid painkillers for no medical purpose, among other crimes. John Couch and Xiulu Ruan were each convicted on more than 10 criminal counts brought by the U.S. attorney’s office in Mobile, Ala. (Walker, 2/23)

KCUR: Osawatomie Contract Bidder Has History Of Safety Issues At Its Florida Psychiatric Facilities 
Correct Care Solutions, a Tennessee-based company that is the sole bidder for a contract to operate Osawatomie State Hospital, has a history of safety problems at the state psychiatric facilities it runs in Florida. Officials with the Kansas Department for Aging and Disability Services declined to provide details this week on Correct Care’s bid to operate Osawatomie State Hospital, one of two state facilities for people deemed a danger to themselves or others. The department is evaluating the proposal and hasn’t given a timeline for whether or when it would bring it before the Legislature. Under a law they approved last year, lawmakers must approve the contract before KDADS can move forward. (Wingerter, 2/23)

Detroit Free Press: Tick-Borne Lyme Disease Exploding Into Michigan; Human Cases Up 5-Fold
All it took was an unusual February warm spell this past week for the tiny insects causing an increasingly big problem in Michigan to become active once again, beginning their hunt for blood...The ticks are of interest because of what they often carry with them: the bacterium Borrelia burgdorferi. When the ticks bite an animal, seeking a blood meal, that bacteria can transfer. And that bacteria, in dogs, horses and humans, can cause Lyme disease, a serious affliction that can be permanently debilitating for people when it's not treated early and well. (Matheny, 2/23)

Health Policy Research

Research Roundup: Beverage Tax In Mexico; Health Care Access Survey; State Marketplaces

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

Health Affairs: In Mexico, Evidence Of Sustained Consumer Response Two Years After Implementing A Sugar-Sweetened Beverage Tax
Mexico implemented a 1 peso per liter excise tax on sugar-sweetened beverages on January 1, 2014, and a previous study found a 6 percent reduction in purchases of taxed beverages in 2014. In this study we estimated changes in beverage purchases for 2014 and 2015. We used store purchase data for 6,645 households from January 2012 to December 2015. ... Purchases of taxed beverages decreased 5.5 percent in 2014 and 9.7 percent in 2015, yielding an average reduction of 7.6 percent over the study period. Households at the lowest socioeconomic level had the largest decreases in purchases of taxed beverages in both years. ... Findings from Mexico may encourage other countries to use fiscal policies to reduce consumption of unhealthy beverages. (Cochero et al., 2/22)

Morbidity and Mortality Weekly Report/CDC: Surveillance for Health Care Access and Health Services Use, Adults Aged 18–64 Years — Behavioral Risk Factor Surveillance System, United States, 2014
This report summarizes 2014 BRFSS [Behavioral Risk Factor Surveillance System] data from all 50 states and the District of Columbia on health care access and use of selected [clinical preventive services]. ... The findings ... indicate substantial variations in health insurance coverage; other health care access measures; and use of CPS .... In 2014, health insurance coverage, having a usual source of care, having a routine checkup, and not experiencing unmet health care need because of cost were higher among adults living below the poverty level (i.e., household income <100% of FPL) in states that expanded Medicaid than in states that did not. Similarly, estimates of breast and cervical cancer screening and influenza vaccination were higher among adults living below the poverty level in states that expanded Medicaid than in states that did not. (Okoro et al., 2/23)

Pediatrics: Pediatric Resident Burnout And Attitudes Toward Patients
Burnout occurs in up to 75% of resident physicians. Our study objectives were to: (1) determine the prevalence of burnout, and (2) examine the association between burnout and self-reported patient care attitudes and behaviors among pediatric residents. ... A total of 39% of respondents ... endorsed burnout. Residents with burnout had significantly greater odds ... of reporting suboptimal patient care attitudes and behaviors, including: discharging patients to make the service more manageable ... not fully discussing treatment options or answering questions ..., making treatment or medication errors ..., ignoring the social or personal impact of an illness ..., and feeling guilty about how a patient was treated. (Baer et al., 2/23)

The Kaiser Family Foundation: Pre-ACA Market Practices Provide Lessons For ACA Replacement Approaches
One of the biggest changes that the ACA made to the non-group insurance market was to eliminate consideration by insurers of a person’s health or health history in enrollment and rating decisions. ... Proposals for replacing the ACA such as Rep. Tom Price’s Empowering Patients First Act and Speaker Paul Ryan’s “A Better Way” policy paper would repeal these insurance market rules, moving back towards pre-ACA standards where insurers generally had more leeway to use individual health in enrollment and rating for non-group coverage. ... [This discussion] focuses on some of the issues faced by people with health issues in the pre-ACA non-group insurance market. These pre-ACA insurance practices highlight some of the challenges in providing access and stable coverage for people and some of the issues that any ACA replacement plan will need to address. (Claxton, Levitt and Pollitz, 2/16)

Brookings: How Has Obamacare Impacted State Health Care Marketplaces?
[O]ur five states had four years of experience in the open enrollment periods from 2014 through 2017. The states array themselves in a continuum of apparent success in enhancing and maintaining competition among insurers. California and Michigan appear to have had success in nurturing insurer competition, in at least the urban areas of their states. Florida, North Carolina, and Texas were less successful. This divergence is recent, however. As recently as the 2015 and 2016 open enrollment periods, all of the states had what appeared to be promising, if not always robust, insurance competition. Large changes occurred in the run-up to the 2017 open enrollment period. (Morrisey et al., 2/9)

In news coverage of other recent research:

CNN: Chronic Knee Pain Eased With The Help Of Skype
Exercise, an online pain-coping skills program and Skype sessions with a physiotherapist helped relieve patients' chronic knee pain, according to a study published Monday in the journal Annals of Internal Medicine. ... The new study was designed to investigate "the efficacy of a combined internet delivered treatment package including education, Skype-delivered exercise physiotherapy and an Internet-based interactive pain-coping skills training program," said Kim Bennell, lead author of the study and a research physiotherapist and professor at the University of Melbourne. (Scutti, 2/20)

Editorials And Opinions

Viewpoints: Executive Orders, Obamacare Replacements And Cold, Hard Facts; Medicare's Challenges In Health Law Debate

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

The Wall Street Journal: The ObamaCare Holdouts
Republicans are getting battered at town halls on ObamaCare, with constituents — or least protestors — yelling about the benefits they’ll lose if the entitlement is repealed. But maybe the better measure of public sentiment is the choices that the people who are subject to ObamaCare have made in practice. (2/23)

The New England Journal Of Medicine: Trump’s Executive Order On Health Care — Can It Undermine The ACA If Congress Fails To Act?
Within hours after taking the oath of office, President Donald Trump executed his first official act: an executive order redeeming his campaign pledge to, on “day one,” begin repeal of the Affordable Care Act (ACA). The New York Times characterized his action as itself “scaling back Obamacare,” and the Washington Post said the order “could effectively gut [the ACA’s] individual mandate” to obtain health insurance coverage. But consumer advocate Ron Pollack dismissed Trump’s action as “much ado about very little.” To put these divergent assessments into perspective, it’s important to examine the actual executive order, recognize the departures from the Obama administration that it contemplates, and assess the scope and significance of changes the administration can lawfully make by executive order or other administrative actions. (Timothy Stoltzfus Jost and Simon Lazarus, 2/22)

Vox: John Boehner Told Republicans Some Inconvenient Truths On Obamacare
Didn’t Boehner hold repeal vote after repeal vote? Didn’t he win back the House in 2010, and hold it thereafter, promising to repeal Obamacare? Didn’t he participate in the government shutdown over Obamacare in 2013? He did. But to interpret Boehner generously, Obamacare is in a very different place now than it was in 2010, 2012, or even 2013. It’s delivering benefits to about 30 million people. Dozens of states have built budgets around Medicaid dollars flowing in from the federal government. Health systems nationwide have reorganized themselves around its provisions. (Ezra Klein, 2/23)

RealClear Health: Repeal & Replace: Missing The Medicare Forest For The Obamacare Trees
The Trump Administration has promised to deliver to the American people a healthcare plan that is, in President Trump’s own words, “much less expensive and far better” than Obamacare. But While Obamacare is expected to spend over $900 billion from 2018 to 2027, focusing solely on the Obama administration’s signature achievement ignores bigger fiscal challenges; Namely, the Medicare program. (Yevgeniy Feyman, 2/24)

Tribune News Service/Lincoln (Neb.) Journal-Star: A Simple Solution On Health Care
But the largest contributing factor to the voter anger directed at Republican senators and representatives didn’t require sly scheming — because it is very real, and even frightening to many voters. They are frightened about what they are NOT hearing from Trump and most Republicans in Congress about what will happen when they succeed in repealing President Obama’s Affordable Care Act. Republicans haven’t shown voters how they will replace it or sufficiently addressed what its elimination might mean to middle class folks who voted for Trump as an act of blind trust. (Martin Schram, 2/24)

Topeka Capital Journal: Medicaid Expansion Lives In Kansas
Considering how much disagreement there is on the economic and practical dimensions of Medicaid expansion – as well as the massive impact it has on the people of Kansas – didn’t it deserve a full debate in the Legislature? To Ward, Rep. Susan Concannon (a Beloit Republican who introduced the Medicaid amendment to HB 2044) and the legislators who voted in favor of expansion: Thank you for representing the interests of your fellow Kansans. While we’re not saying legislators should vote for a bill simply because it’s popular, they do have a responsibility to take their constituents’ concerns seriously and give critical issues their full attention. The lawmakers who tried to kill the Medicaid expansion bill in committee did the opposite. (2/23)

The New England Journal Of Medicine: Protecting The Tired, The Poor, The Huddled Masses
During Donald Trump’s presidential campaign and transition period, I worried that the climate of xenophobia and the widespread misunderstanding of the immigrants and refugees already in our country would dissuade others from seeking asylum here. ... as a person who believes that health is a human right and that ensuring basic human rights promotes health, I remain terrified for the world’s well-being. The suspension of the U.S. Refugee Admissions Program for 120 days was poorly planned and discriminatory, and it has only intensified the fear and anxiety of people who are fleeing terror, bombings, domestic abuse, and other types of persecution because of their religion, sexual orientation, or ethnic background. ... Moreover, many U.S. clinicians have noted that their patients who are already here are refraining from seeking the medical care they need or using other vital public services for fear of being incarcerated and deported. (Katherine Peeler, 2/22)

The Washington Post: Sean Spicer Seemed To Tie Marijuana Use To Opioids. The Evidence Isn’t On His Side.
The epidemic of opioid addiction in the United States has been well documented. A staggering 33,000 people died in 2015 from overdosing on prescription painkillers, heroin or similar drugs, on par with the number killed by firearms and in car accidents. The epidemic is growing, but its general causes are not in dispute. Nearly all research on the issue shows that excessive and improper prescriptions are what’s causing more people to become addicted. But White House press secretary Sean Spicer on Thursday appeared to link the surge in opioid abuse to another factor: recreational marijuana use. (Derek Hawkins, 2/24)

Milwaukee Journal Sentinel: Try Something New To Deal With Drug Crisis
In 2016, Milwaukee County saw a record high in deaths from drug overdoses, when at least 340 people died. Many of the drugs involved in this crisis such as oxytocin, vicodin and oxycodone are at first prescribed legally to treat physical pain. When users become addicted and lose avenues to these prescribed drugs, they often turn to illegal drugs. Bravo to Gov. Scott Walker, who has called for a special session of the Legislature to address this crisis. (Jerry Schultz, 2/23)

Stat: The Power — And The Fear — Of Knowing Your Cancer Genome
When it comes to cancer, all knowledge is power — even when that knowledge is scary. Knowing as much as you can about cancer lets you and your health care team act decisively in devising your treatment strategy. Even more important, it lets you act specifically in selecting treatments or clinical trials that might be best in treating your disease. ... For me, learning everything about my disease has been essential to discovering how to attack and treat my cancer and, I believe, why I went into a surprising but welcome long-lasting remission. (Kathy Giusti, 2/23)

The New England Journal Of Medicine: The Perils Of Trumping Science In Global Health — The Mexico City Policy And Beyond
During his first week in office, President Donald Trump reinstated an executive order banning U.S. aid to any international organization that supports abortion-related activities, including counseling or referrals. The so-called Mexico City Policy — colloquially referred to as the “global gag rule” on women’s reproductive health — is allegedly intended to reduce the number of abortions around the world, in accordance with an antiabortion agenda. Scientific evidence suggests, however, that the policy achieves the opposite: it significantly increases abortion rates. The policy defunds — and in so doing, incapacitates — organizations that would otherwise provide education and contraceptive services to reduce the frequency of unintended pregnancies and the need for abortions. (Nathan C. Lo and Michele Barry, 2/22)

Seattle Times: Ethics And Trust Paramount In Physician, Patient Relationship
dramatic and complex changes in the health-care environment have placed a strain on medical professionalism and on physicians’ ability to exercise independent clinical judgment. We must ensure that doctors’ professionalism and independent judgment remain protected, even in our quest to have a healthy bottom line. (Jennifer Lawrence Hanscom, 2/22)

The New England Journal Of Medicine: Recreational Cannabis — Minimizing The Health Risks From Legalization
The cannabis-policy landscape is undergoing dramatic change. Although many jurisdictions have removed criminal penalties for possessing small amounts of cannabis and more than half of U.S. states allow physicians to recommend it to patients, legalizing the supply and possession of cannabis for nonmedical purposes is a very different public policy. Since the November 2016 election, 20% of the U.S. population lives in states that have passed ballot initiatives to allow companies to sell cannabis for any reason and adults 21 or older to purchase it. Although other states may move toward legalization, uncertainty abounds because of the federal prohibition on cannabis. The Obama administration tolerated these state laws; it’s unclear what the Trump administration will do. (Beau Kilmer, 2/22)