KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Kaiser Health News Original Stories

Burwell Says Upcoming Enrollment Efforts Are Pivotal For Health Law

Health and Human Services Secretary Sylvia Burwell announces that federal officials expect the number of people picking plans will grow by 1 million this year to nearly 14 million people, but she acknowledges that rising prices and fewer insurers are challenging the marketplaces. (Mary Agnes Carey, 10/19)

West Virginia Grapples With High Drug Costs

Climbing drug prices are taking a toll on West Virginia's budget, some state legislators say. Expensive drugs fuel an increase in Medicaid spending, which leaves less money for schools and roads. (Kara Lofton, West Virginia Public Broadcasting, 10/20)

Political Cartoon: 'You're Not The Only One'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'You're Not The Only One'" by John Deering from "Strange Brew".

Here's today's health policy haiku:


Enrollment season
And the vote. Will premium
Prices factor in?

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

Summaries Of The News:

Campaign 2016

In Final Debate, Clinton Accuses Trump Of Using 'Scare Rhetoric' On Abortion

“If you go with what Hillary is saying, in the ninth month you can take the baby and rip the baby out of the womb of the mother just prior to the birth of the baby," Donald Trump said, after affirming that he would appoint anti-abortion justices to the Supreme Court. Hillary Clinton fired back, saying, "The government has no business in the decisions that women make with their families."

The New York Times: Donald Trump Won’t Say If He’ll Accept Result Of Election
The two candidates also tangled over abortion rights. After initially declining to flatly say whether he would support overturning Roe v. Wade, the 1973 Supreme Court decision that legalized abortion, Mr. Trump conceded that the justices he would appoint to the court would do just that. “If we put another two or perhaps three justices on, that’s really what will happen,” he said. “That’ll happen automatically in my opinion.” (Healy and Martin, 10/19)

The Wall Street Journal: Final Debate: Donald Trump Declines To Commit To Respecting Results If He Loses
Mr. Trump promised he would appoint justices who would overturn the Roe v. Wade abortion decision and protect gun rights. “They will have a conservative bent,” he said. “I will be appointing pro-life judges.” Mrs. Clinton said she would choose justices who would protect abortion rights, same-sex marriage and overturn Citizens United, which removed limits on corporate and union spending in elections. “The Supreme Court needs to stand on the side of the American people, not on the side of the powerful corporations and the wealthy,” she said. (Meckler, Bender and Nicholas, 10/20)

The Washington Post: At Third Debate, Trump Won’t Commit To Accepting Election Results If He Loses
Trump went on to describe late-term abortion procedures in graphic language, suggesting that many women end their pregnancies in the final one to four days. “You can take the baby and rip the baby out of the womb,” he said. Clinton used the moment to make a gender-based argument, telling Trump: “You should meet with some of the women I’ve met with, women I’ve known over the course of my life. This is one of the worst possible choices that any woman and her family could possibly make. . . . The government has no business in the decisions that women make with their families.” (Tumulty and Rucker, 10/19)

Meanwhile, the candidates also took questions on Medicare —

The Washington Post: Trump, Clinton Answers On Social Security Were Victories For The Left
Chris Wallace’s questions did assume that entitlements needed to be cut. He asked Trump if would “make a deal to save Medicare and Social Security that included both tax increases and benefit cuts, in effect, a grand bargain on entitlements,” and asked Clinton if she would back “a deal that includes both tax increases and benefit cuts.” But neither candidate accepted the premise. Trump insisted, tautologically, that his tax cuts would spur the economy “to grow at a record rate of growth,” solving any problem with entitlement spending. Clinton said she would raise taxes on the rich to expand benefits; “that will come from either raising the cap and/or finding other ways to get more money into it,” she said. “I will not cut benefits. I want to enhance benefits for low-income workers and for women who have been disadvantaged by the current Social Security system.” (Weigel, 10/20)

And media outlets fact check some of the debate's health care claims —

The Associated Press: Fact Check: Trump, Clinton And Their Debate Claims
Clinton is basically on target, but Medicare's funding problems are more complicated than she implies. The 2010 health care law was partly financed with cuts in future payments to hospitals, insurers and other Medicare service providers. According to projections at the time, that extended the solvency of the Medicare trust fund to 2029. (Otherwise Medicare would have been unable to fully pay its bills in 2017.) Republican budgets since then have kept Obama's Medicare cuts. But the health care law did not solve Medicare's financial problems. (10/20)

The Associated Press: Fact Check: Health Insurance Costs Up, But Not Doubling
Premiums are going up, and by double digits in many states, but to say it's over 100 percent is pure hyperbole. The full impact of next year's premium increases is going to take time to sort out and vary across the country. Full information will be available Nov. 1 when the market goes live. (10/20)

Modern Healthcare: ACA Troubles Make Fleeting Appearance In Final Clinton-Trump Debate 
Republican nominee Donald Trump's claim that premiums in the healthcare plans in the Affordable Care Act exchanges are increasing by as much as 100% is an exaggeration, but the candidates spent little time digging into the matter. In the waning moments of the final presidential debate Wednesday, the candidates used a question about entitlements to restate their positions on the ACA. Trump again vowed to “repeal and replace” the law and that he was glad premiums had gone up, presumably to make his point that President Barack Obama's signature healthcare reform law was “destroying our country.” (Muchmore, 10/19)

KHN offers clips from when the candidates talked about health care —

Kaiser Health News: Video Highlights: Health Care On The Debate Stage
In the third and final presidential debate Wednesday, candidates Donald Trump, the Republican, and Hillary Clinton, the Democrat, had their most extended exchanges on health care issues to date. Here are the video excerpts of those two discussions from the debate, which was held at the University of Nevada, Las Vegas. (10/20)

Health Law Issues And Implementation

Obama Administration Sets 13.8M Goal For Final Enrollment Period

If enrollment increases as the Obama administration predicts, it would suggest that the marketplace is steadier than its critics contend.

The Associated Press: Modest Gain Seen For Obama's Last Health Care Sign-Up Season
Some 13.8 million people are expected to sign up for 2017 coverage, Health and Human Services Secretary Sylvia Burwell said. That would be an increase of a bit less than 9 percent from the 12.7 million who picked plans during open enrollment for this year. This year is shaping up to be the most difficult sign-up season since launched in 2013 and the computer system froze up. But technology isn't the issue this time. Premiums are going up by double digits in many communities, and some major insurers have left the program, leaving consumers with fewer choices next year. (Alonson-Zaldivar, 10/19)

Modern Healthcare: HHS Predicts Uptick In Obamacare Enrollment For 2017 
HHS is predicting about 9% more people will sign up for coverage on the Affordable Care Act exchanges during the next open-enrollment period, but the estimate is still below the most recent projections from the Congressional Budget Office. The final open-enrollment period for the Barack Obama administration begins Nov. 1. That is just one week before voters head to the polls to elect the next president. The candidates have presented starkly different plans for the future of healthcare, with Democratic nominee Hillary Clinton saying she would build upon and strengthen the ACA and Republican nominee Donald Trump vowing to repeal it. (Muchmore, 10/19)

The Wall Street Journal: Obama Administration Expects Robust Open Enrollment Under ACA
The administration is under pressure to bolster enrollment to help stanch insurers’ financial losses, which have led some major carriers to pull out or scale back from the exchanges. To boost enrollment, the government will use television ads, direct mail and other targeted outreach efforts to potential enrollees, particularly young people. But the enrollment period, which starts Nov. 1 and runs through Jan. 31, 2017, also coincides with political turbulence brought about by the campaigns, the election and the transition to a new president and Congress in January. (Armour, 10/19)

The Washington Post: ACA Enrollment To Rise By 1 Million Next Year, Obama Administration Projects
Burwell used the annual enrollment prediction as a kind of paean to what she heralded as “the biggest step forward in a generation” — the administration’s work to usher in insurance that is better, more affordable and more broadly available. She acknowledged that future ACA proponents will need Congress as a partner to accomplish any “substantial changes” in the law, including a public insurance option to foster more market competition in places with few insurers. The secretary contended that the law’s marketplace “is sustainable in terms of its size.” In remarks at HHS headquarters, she said that it is “strong — and will continue to be strong — because it is offering a product that people want and need.” (Goldstein, 10/19)

Los Angeles Times: Obamacare Enrollment Is Expected To Grow By Just 1 Million Next Year
“Building a new market is never easy,” Health and Human Services Secretary Sylvia M. Burwell said Wednesday in remarks at the agency. “And as I’ve said before, we expect this to be a transition period for the marketplace. Issuers are adjusting their prices, bringing them in line with actual data on their costs. And at HHS, we’re enhancing the stability of the marketplace, and making it stronger for the future.” But Burwell renewed calls on Congress to help make adjustments to the law to make the marketplaces more sustainable. (Levey, 10/19)

Dallas Morning News: Top Health Official Touts Obamacare Successes As GOP Targets Rising Premiums, Less Coverage 
Burwell said challenges should be expected, given that "this is a complicated thing." She pointed to several proposals, such as creating a public option, that would stabilize the system. And she pinned some of these difficulties on the law's opponents, who've fought it "at every turn." "It's like you're in a boat, somebody is shooting in the boat and water is coming in," she told a group of reporters before a news conference. "And then they are like, 'Water is coming in!' ... That has made this challenge even harder." (Benning, 10/19)

Bloomberg: Obamacare Struggles To Sign Up The ‘Young And Invincible’
The forecast illustrates the administration’s confidence in enrolling more people and keeping those who are covered from dropping out in a challenging year. But the Obamacare exchanges are still not attracting enough young, healthy and higher-income individuals who could help spread the health-care costs of the sickest over a bigger group. “What we are still missing is the young and invincible,” said Deep Banerjee, an analyst at S&P Global Ratings. “The exchange market has to grow a lot more to become stable.” (Tracer and Doherty, 10/19)

Kaiser Health News: Burwell Says Upcoming Enrollment Efforts Are Pivotal For Health Law
Rate hikes are likely on the way for plans offered on the health law’s online exchanges, or marketplaces. Consumers’ out-of-pocket costs are expected to climb, and some major insurers are pulling out. Department of Health and Human Services Secretary Sylvia Burwell Wednesday acknowledged that the Affordable Care Act’s fourth enrollment season, scheduled to begin Nov. 1 and run until Jan. 31, is a pivotal time for President Barack Obama’s signature domestic policy achievement. (Carey, 10/19)

Meanwhile, the president heads to Florida to talk about the law —

Reuters: Obama To Give His Diagnosis For What Ails Obamacare
President Barack Obama on Thursday will head to the election battleground state Florida to give his prescription for fixing the Affordable Care Act, his signature healthcare law, but any remedies will be left up to his successor and the next Congress. (Humer, 10/20)

The Associated Press: Obama To Urge Young Adults To Sign Up For Health Care
President Barack Obama wants to encourage people to sign up for health care coverage under the Affordable Care Act during an upcoming enrollment period. It's the final sign-up season for Obama's prized health care overhaul and he wants it to be a success. But his signature domestic achievement is being buffeted by double-digit premium increases and fewer insurers offering coverage. (Superville, 10/20)

The Hill: Administration Starts Final ObamaCare Push 
The Obama administration is making a push to strengthen ObamaCare and make it more sustainable before leaving office. The enrollment period for 2017, which begins Nov. 1, comes at a challenging time for the healthcare law. Insurers have been dropping out of its marketplaces and hiking premiums due to financial losses from ObamaCare plans. Reversing that trend will require more people and healthier people to sign up. (Sullivan, 10/19)

And in news about expected rate increases —

The Fiscal Times: Obamacare Rate Hikes For 2017 Even Bigger Than Expected
Major insurers participating in Obamacare have won approval for substantial premium hikes next year in a dozen or more states. The increases range as high as 30 percent to 50 percent, according to new data. Shaken by the decisions of Aetna, UnitedHealthcare, Blue Cross Blue Shield and other giants to pull out of many states after incurring hundreds of millions in losses, state insurance regulators appear more than willing to go along with these rate increases to prop up insurers remaining in the program. Leading carriers that intend to continue selling individual policies on the government-subsidized and operated exchanges next year have been granted average premium increases of 30 percent or more in Alabama, Delaware, Hawaii, Kansas, Mississippi and Texas, according to The Wall Street Journal. (Pianin, 10/19)

Arizona Republic: 'Obamacare' In Arizona: 2 Remaining Insurers Hike Rates By 50-75 Percent
After months of health insurer exits from the Affordable Care Act marketplace in Arizona, state regulators have approved plans from two companies that will be the only marketplace insurance providers next year. Blue Cross Blue Shield of Arizona will sell marketplace plans in every county except Maricopa County in 2017. The Phoenix-based insurer's average rates will increase 51 percent, Arizona Department of Insurance filings show. (Alltucker, 10/19)

Capitol Hill Watch

21st Century Cures Bill Will Get Through Lame-Duck Congress, Pelosi Predicts

However, she said support from Democrats is not universal.

The Hill: Pelosi: Cures Bill ‘Will Pass’ 
House Minority Leader Nancy Pelosi (D-Calif.) is predicting that the latest version of the 21st Century Cures bill would have enough votes to pass this year. Pelosi said during a press conference on Wednesday that she would “build consensus” on a new version of the medical cures bill, which is expected to come up in a lame-duck session of Congress. The bill passed almost unanimously in the House last summer but has stalled in the Senate over concerns on how to pay for a half-decade’s worth of new research spending, totaling roughly $9 billion. (Ferris, 10/19)


Don't Expect A Price War Between J&J, Pfizer Over Arthritis Treatment

Pfizer's plans to sell a biosimilar version of Johnson & Johnson's blockbuster drug aren't going to move the price of it in the market.

Stat: Are Concerns About A Price War Between Johnson & Johnson And Pfizer 'Overblown'?
After Pfizer announced earlier this week that it will sell a biosimilar version of Remicade, the blockbuster rheumatoid arthritis treatment, Johnson & Johnson executives are scrambling to calm investors who worry the health care giant will quickly lose a big chunk of revenue. That’s because Pfizer plans to sell Inflectra at a 15 percent discount to Remicade, which generated roughly $1.2 billion in sales for Johnson & Johnson in this year’s first quarter. A biosimilar, you may recall, is a nearly identical variant of a biologic and is expected to provide the same result in patients, which means the Pfizer medicine is poised to eat into Remicade sales. The question, though, is by how much? (Silverman, 10/19)

NPR: Inflectra To Cost Only 15 Percent Less Than Remicade
Generic drugs generally cost 80 percent less than brand-name drugs, so hopes were high when a law enacted in 2010 paved the way for competition among the highest-priced drugs of all, known as biologics. But, as these competing drugs start to appear on the market, consumers aren't reaping a windfall. (Harris, 10/19)

Administration News

CDC: Children Under 14 Only Need Two Doses Of HPV Vaccine

Those aged 15 through 26 should continue to receive three doses, according to the Centers for Disease Control and Prevention.

The New York Times: Children 14 Or Under Need Fewer H.P.V. Vaccine Doses
Children 11 to 14 years old need only two doses of the H.P.V. vaccine, not the previously recommended three doses, to protect against cervical cancer and other cancers caused by the human papillomavirus, the Centers for Disease Control and Prevention said on Wednesday. But teenagers and young adults who start the vaccinations later, at ages 15 through 26, should stick with the three-dose regimen, the disease centers said. (Grady, 10/19)

The Washington Post: CDC Now Recommends Just Two HPV Vaccine Doses For Preteens
Children who start getting vaccinated against human papillomavirus before 15 need only two doses, the Centers for Disease Control and Prevention decided Wednesday. Its previous recommendation was for a three-shot regimen, but studies have shown that two doses work just as well. Experts predict that the simpler, more flexible timeline will result in higher rates of HPV vaccination, which has lagged among both girls and boys. (McGinley, 10/19)

The Philadelphia Inquirer: CDC Approves The Two-Dose HPV Vaccine, Instead Of Three
In a move that could boost HPV vaccination rates, the U.S. Centers for Disease Control and Prevention on Wednesday said younger adolescents need only two doses of the vaccine, rather than three as previously recommended. The human papillomavirus vaccine (HPV), introduced a decade ago, was hailed as a breakthrough in cancer prevention because it wards off infection with sexually-transmitted strains of the virus that cause cervical cancer and some rarer head, neck and genital cancers.  But doctors and parents of adolescents have been slow to embrace the immunization, put off by its novelty, link to sexual activity, and the complexity of the three-shot regimen, which is covered by insurance. (McCullough, 10/19)

Veterans' Health Care

Much Of Touted VA 'Shakeup' Post-Scandal Came From Within Agency

All but eight of the new Veterans Affairs' clinic directors worked for the agency already.

USA Today: VA Shuffles Managers, Declares ‘New Leadership’
Although Veterans Affairs Secretary Bob McDonald has asserted that more than “90%” of the VA’s medical centers have “new leadership” or “leadership teams” since he took over the troubled agency in 2014, a USA TODAY investigation found the VA has hired just eight medical center directors from outside the agency during that time. (Slack, 10/18)

In other VA news —

Denver Post: VA Investigators Looking At Claims Of Secret Waitlists In Colorado 
The top watchdog at the U.S. Department of Veterans Affairs confirmed Wednesday that his staff is investigating allegations of forgery and off-the-books recordkeeping at VA medical facilities in Colorado. In a letter to U.S. Sen. Cory Gardner — who requested the inquiry last month with Ron Johnson of Wisconsin — VA Inspector General Michael Missal acknowledged that his team is trying to determine whether agency personnel kept unofficial waitlists for patient care at VA offices in Denver, Golden and Colorado Springs. (Matthews, 10/19)

Public Health And Education

STD Rates Are Spiking And Experts Are Pointing Fingers At Budget Cuts, Dating Apps

Syphilis cases increased by 19 percent, gonorrhea by nearly 13 percent, and chlamydia by nearly 6 percent compared with 2014.

The New York Times: Reported Cases Of Sexually Transmitted Diseases Are On Rise
There were more cases of sexually transmitted diseases reported in the United States last year than ever before, according to new federal data. Rates of chlamydia, gonorrhea and syphilis — three of the most common S.T.D.s — grew for the second consecutive year, with sharper increases in the West than other regions. And while all three diseases are treatable with antibiotics, most cases continue to go undiagnosed, potentially causing infertility and other problems. (Goodnough, 10/19)

Stat: Syphilis And Gonorrhea Rates Have Risen Sharply In US
When it comes to the fight against sexually transmitted diseases, US health officials appear to be losing ground.Rates of gonorrhea, syphilis, and chlamydia infections — STDs that federal health officials actively track — all rose in 2015, according to a new report released Wednesday by the Centers for Disease Control and Prevention. In two of the three cases, the increases were in the double digits. Syphilis cases increased by 19 percent, gonorrhea by nearly 13 percent, and chlamydia by nearly 6 percent compared with 2014. (Branswell, 10/19)

St. Louis Post Dispatch: St. Louis Is Still The Sexually Transmitted Disease Capital Of The U.S. 
St. Louis again takes the title for the country’s highest rates of sexually transmitted diseases, in a year of record high numbers nationwide. Chlamydia, gonorrhea and syphilis reached about 2 million reported cases nationwide in 2015, according to an annual report released Wednesday by the Centers for Disease Control and Prevention. St. Louis city topped the list for chlamydia and gonorrhea cases per capita. The rankings are skewed partly because the city is mostly compared with counties in the data. If the entire metropolitan area is included, the St. Louis region ranks eighth for gonorrhea and 17th for chlamydia. (Bernhard, 10/20)

St. Louis Public Radio: Doctors 'Disheartened' By St. Louis Region’s High Ranking For STD Rates
Rates of three common sexually transmitted diseases have risen to a record high level nationwide, and St. Louis continues to rank high among cities, according to federal data released Wednesday. The St. Louis region recorded 14,961 cases of chlamydia in 2015, the 17th highest per-capita rate in the country. Rates of syphyllis stayed relatively steady at just over 400 cases in the metro area. The city of St. Louis, however, measured the highest rate of both chlamydia and gonorrhea among counties and independent cities. (Bouscaren, 10/19)

Millions Of Americans Not Getting Mental Health Treatment They Need, Report Finds

The rates are particularly bad among children and adolescents -- 80 percent of whom get either insufficient treatment or none at all.

The Washington Post: Report: More Than Half Of Mentally Ill U.S. Adults Get No Treatment
Mental Health America just released its annual assessment of Americans with mental illness, the treatment they receive and the resources available to them — and the conclusions are sobering: Twenty percent of adults (43.7 million people) have a mental health condition, and more than half of them do not receive treatment. Among youth, the rates of depression are rising, but 80 percent of children and adolescents get either insufficient treatment or none at all. (Nutt, 10/19)

In other news on mental health issues —

The Baltimore Sun: Effort In Howard County Toward Eliminating Stigma Of Mental Illness
Child and adolescent psychiatrist Dr. Meenakshi Suman says she recognizes the stigma of mental health fading away as she continues in her fourth year at Sheppard Pratt Health System in Howard and Baltimore counties. While some Howard County families are open to getting their children help for illnesses like depression, mood disorders, stress and anxiety, Suman believes furthering mental illness education through collaboration with the county and public schools can alleviate false beliefs that there are quick fixes to these rising, long-term struggles. (Michaels, 10/20)

The New York Times: In Quick Response, De Blasio Calls Fatal Shooting Of Mentally Ill Woman ‘Unacceptable’
Deborah Danner’s essay recounted her long, aching struggle with schizophrenia, a battle that had begun some 30 years earlier.Filed away last year by a lawyer who had been helping Ms. Danner, the neatly typed, six-page composition depicted a disturbing roll of memories, like the early morning spent roaming the streets of New York City with a knife, searching for a place to end her own life. (Rosenberg and Southall, 10/19)

Kansas City Star: Mental Health Patient Pleads Guilty In Beating Death Of Another Patient In Kansas
A Haviland, Kan., man who was undergoing treatment for mental illness has pleaded guilty to second-degree murder in the beating death of another patient last year. Brandon Brown entered the guilty plea Tuesday in Kiowa County District Court. He awaits sentencing.Brown was charged with second-degree murder after a May 2015 altercation with 61-year-old Jerry Martinez at the Haviland Care Center, a residential care facility west of Wichita. (Helling, 10/19)

Vt. Governor Wants To Limit Opioids Prescriptions Based On Expected Severity, Duration Of Pain

“We didn’t have a heroin crisis in America before OxyContin was approved and started being handed out like candy," Gov. Peter Shumlin, whose state has been particularly hard hit, said when talking about the proposed regulations. Media outlets also report on the epidemic out of New York, Delaware and North Carolina.

The Associated Press: NY Tells Health Insurers To Cover Addiction Treatment Drugs
New York state is requiring more health insurers to cover the cost of medications used to help those struggling with opioid addiction.The steps announced Wednesday by the Department of Financial Services apply to those covered under large-group insurance policies. State officials say they "mirror" the rules already covering small-group and individual policies. (10/20)

The Washington Post: Delaware Attorney General Eyes Heroin, Opioid Abuse Efforts
Attorney General Matt Denn says more work is needed to tackle heroin addiction and prescription painkiller abuse in Delaware. Denn on Wednesday said the state’s prescription drug monitoring program needs to be tightened to help officials identify prescribing patterns that should be referred to police or medical licensing authorities. (Chase, 10/19)

North Carolina Health News: To Reduce Addiction, Link Behavioral Health, Substance Abuse Care 
In April, when Hickory was ranked fifth in the nation in the rate of opioid abuse, the designation sent shock waves through this foothills city of about 40,000. At a recent conference there, citizens and professionals looked for solutions to Hickory’s headline-generating prescription drug abuse problems, offering lists of existing resources. But it was the lack of coordination among professionals treating people with both mental illness and substance abuse problems, known as “dual diagnosis” clients, that emerged as a possible key factor behind the problem during the daylong event. (Goldsmith, 10/20)

A Cure For The Common Cold? It May Not Be Impossible After All

Martin Moore, a virologist, has come up with a vaccine that has shown promising results in monkeys. And he's not the only one working on what was previously thought of as "just not possible." Meanwhile, in an age where editing genes will become the norm, scientists try to untangle basic questions about whether babies' DNA should be adjusted.

Stat: The Common Cold May Be Beatable, Scientists Say
Time and again, Martin Moore’s children get sick with a cold. He hauls them to their doctor, who then informs him that there’s nothing to be done aside from taking them home and waiting it out. The experience is maddening for Moore — especially because he’s a virologist. For everything that virologists have learned about rhinoviruses — the cause of the majority of colds — they have not invented a vaccine for them. In 2013, Moore wondered if he could make one. He consulted a rhinovirus expert for some advice. Instead, the expert told him, “Oh, there will never be a vaccine for rhinovirus — it’s just not possible.” (Zimmer, 10/20)

The Washington Post: Will Babies Be Better Off If We Know Their Genes?
Genome sequencing is supposed to be the future of medicine — a revolution that will bring about a new age of tailored treatments and unprecedented insight into people's individual biology. But perhaps nowhere are the “what if?” questions raised by genome sequencing more complex and ethically treacherous than at birth: Should we sequence the DNA of healthy newborn babies? (Johnson, 10/19)

In other public health news —

The Washington Post: There’s A Breast Microbiome, And It’s Different In Women With Breast Cancer
Among the most popular topics in biology in recent years is the human microbiome, the trillions of bacteria and other tiny organisms inside and outside our bodies that outnumber our own cells by as much as 3 to 1. Much of the news on this topic has been about the colony of bacteria deep in your gut; scientists believe that the mix may contribute to all sorts of medical conditions including from Crohn’s disease, an inflammatory bowel disorder, and anxiety. Now it looks as though the microbiomes in other parts of our bodies may also play an important role in disease. (Blakemore, 10/19)

Stat: 'Essentially Witchcraft:' A Former Naturopath Takes On The Field
Britt Hermes once considered herself a doctor. Now, she’s an apostate. Hermes spent three years practicing naturopathy, a broad-reaching form of alternative medicine that focuses on “natural” care, including herbal remedies, acupuncture, and the discredited practice of homeopathy. But unease about a colleague’s ethics led her to look more closely at her profession — and what she found alarmed her. So for the past two years, Hermes has been waging a scathing fight against naturopathy on social media, in science blogs, and on her own website, Naturopathic Diaries, which just won a “best blog of the year” award from a scientific skepticism magazine in the United Kingdom. She has not pulled punches. (Thielking, 10/20)

Stat: Is Pain Contagious? Study Suggests It Spreads Among Mice By Smell
The mice should not have been feeling pain. Their hind paws were being touched with filaments so thin that most mice would hardly notice the tickle. Yet these animals reacted as if their paws were on fire. Now, neuroscientists have an explanation: the mice caught their hypersensitivity to pain the way you catch a common cold. A paper published Wednesday in Science Advances shows that lab mice living in the same room as those who are primed to feel more pain end up taking on their roommates’ heightened susceptibility. How could such contagion happen? By smell, the researchers say. (Boodman, 10/19)

State Watch

Washington State Gets Approval From CMS To Overhaul Medicaid Program

State officials sought out the waiver as a way to help address Washington's ballooning Medicaid population.

Modern Healthcare: CMS Grants Preliminary OK To Washington State's Medicaid Waiver 
Under a nearly approved waiver, the state of Washington will focus on the social needs of its Medicaid population and leverage partnerships between providers and social support groups in an attempt to improve patients' quality of care. The CMS has granted Washington preliminary approval to overhaul its Medicaid program (PDF) and will give it $1.5 billion to create a five-year delivery system reform incentive payment program and expand options for long-term services and supports. The funding, which is half of what the state initially asked for in its waiver submission, will also pay for supportive housing and employment training opportunities. (Dickson, 10/19)

In other Medicaid news —

Kaiser Health News: Emergency Room Use Stayed High In Oregon Medicaid Study
Will Medicaid expansion save the country money as people stop using expensive emergency rooms for primary care? Not in the first years, said a study published Wednesday online in the New England Journal of Medicine. The study found ER use among Medicaid patients in Oregon stayed high even two years after people gained coverage, and even as more patients visited doctors’ offices, too. (Foden-Vencil, 10/19)

State Highlights: Calif. Takes Steps To Speed Approval Of Stem Cell Therapies; Following The Money In Mass. Marijuana Vote

Outlets report on health news from California, Massachusetts, Georgia, South Carolina, Texas, Illinois, Pennsylvania, New Hampshire, Louisiana and Washington.

Sacramento Bee: California Stem Cell Agency Approves $30 Million To Fast-Track Clinical Trials
The California stem cell agency on Wednesday completed creation of a $30 million effort to dramatically speed approval of stem cell therapies and establish the Golden State globally in the much-heralded regenerative medicine field. Dubbed the “pitching machine,” the two-part program is designed to pick up where basic stem cell research leaves off and to accelerate it through the all-important clinical trials involving humans. Such trials are required prior to widespread use of a therapy by the public and generally take years. (Jensen, 10/19)

WBUR: A Look At The Money For And Against Legalized Marijuana In Mass.
As Massachusetts voters get set to decide if recreational marijuana should be legalized, millions of dollars have been flowing into the state seeking to sway the result. And as Nov. 8 approaches, look for the commercial airwaves, and your social media feed, to contain more and more advertisements for and against Question 4. For the last two years, proponents of Question 4 have been amassing nearly $4 million advocating for legalization. Last month, more than 80 percent of expenditures went straight into television ads. (Brown, 10/20)

Georgia Health News: State Fares Poorly Again In Infant, Maternal Health
Georgia still ranks low among states in rates of premature births, low-birthweight babies, and infant mortality. The rankings in those categories are 43rd, 47th and 45th, respectively, based on the latest data, according to the Healthy Mothers, Healthy Babies Coalition of Georgia’s 2016 report on maternal and infant health. The recently released report also notes that the state suffers from an absence of key information. A federal publication of 2013 birth data identifies Georgia as having the highest rate of missing prenatal care data from its birth certificates, with about 16 percent not having that measure. (Miller, 10/19)

The Associated Press: Agency Says It Erred In Requiring Husband's OK For Abortion
A South Carolina agency said Wednesday it erred in suggesting married women get their husband's permission to get an abortion. That is among proposed changes to abortion clinic regulations that the state's health agency put out last month for public comment, following a unanimous vote by the agency's board. Abortion rights advocates called them extreme and politically driven. (10/19)

Dallas Morning News: A Cut Above: Austin's Luxury Surgical Hospital Features Gourmet Food,  'Unusually Spacious' Rooms 
An upscale surgical hospital touting robotic technology, unusually spacious patient rooms, high-end furnishings, and gourmet food choices opened Wednesday in North Austin. The St. David’s Surgical Hospital is a 146,381-square-foot “destination hospital” that will specialize in orthopedic, neurological, bariatric, gynecological and urological surgery. The hospital was purchased in May for $115 million by Austin-based St. David's HealthCare, which spent an additional $20 million to update the furniture and technology, reports the Austin Business Journal.  It had previously been owned by the Forest Park Medical Center, a Dallas-based chain that operated luxury hospitals in five Texas cities before going bankrupt. (Rice, 10/19)

Boston Globe: New Legislation Requires Evidence From Sexual Assault And Rape Cases Be Kept For At Least 15 Years
Governor Charlie Baker signed legislation Wednesday requiring forensic evidence from sexual assault and rape cases to be preserved for at least 15 years. The bill requires police to keep forensic evidence for a minimum of 15 years, which is the statute of limitations for crimes of sexual assault and rape, the governor’s office said. In the past, police only had to keep the forensic evidence for six months, unless a victim petitioned to have it preserved every six months, officials said. (Quintana, 10/19)

Chicago Sun Times: Nearly Half Of City 911 Call Takers On Leave, Sparking OT Problem 
Chicago’s 911 emergency center is still struggling to get a handle on runaway overtime because 49 percent of call takers are on “some type of” absence tied to the Family and Medical Leave Act, aldermen were told Wednesday. Testifying at City Council budget hearings, Alicia Tate-Nadeau, executive director of the city’s Office of Emergency Management and Communications, said the hiring of 48 additional call takers has reduced overtime by 28,000 hours over the same period last year. That should reduce overtime spending to $9.9 million, down $1 million from a year ago, she said. (Spielman, 10/19)

The Philadelphia Inquirer: Philly Heart Patient Claims Contaminated Device Caused Stroke
Surgeons at Penn Presbyterian Medical Center cut into Kenneth Piechowski's chest in December 2014 to replace a faulty aortic valve, and all seemed fine afterward.But a few months later, he began to feel weak and lethargic. Suddenly, in May, his right knee buckled, and he couldn't move the leg. Piechowski had suffered a stroke, which he says was caused by slow-growing bacteria that he had picked up from a device used during his surgery months earlier. He is now suing the hospital and the device-maker in Common Pleas Court in Philadelphia. (Avril, 10/19)

California Healthline: California’s RN Wages Now Highest In The Nation, Federal Data Show
Deborah Burger, co-president of the California Nurses Association, says that when she started her career as an intensive care unit nurse in the 1970s, a grocery clerk made more money than she did. Things have changed quite a bit since then, especially in California. Registered nurses in the Golden State earn $100,000 a year on average, more than their counterparts anywhere else in the country, according to recently-released data from the Bureau of Labor Statistics. The average hourly wage for registered nurses in California is $48.68 an hour, the 2015 data shows. (Ibarra, 10/20)

New Hampshire Times Union: State Board Reprimands Two Seacoast Doctors 
A Portsmouth Regional Hospital emergency room physician was reprimanded for professional misconduct after he misdiagnosed a life-threatening sepsis infection resulting in a patient having both feet partially amputated. Dr. William P. Carter III signed a settlement agreement Sept. 8 with the New Hampshire Board of Medicine "to avoid the delay and expense of further proceedings and to settle allegations of professional misconduct." Under it, he is required to take 16 hours of continuing medical education in diabetic patient management, sepsis recognition, emergency room standards of care and infectious disease recognition. He also was fined $1,000, and must furnish a copy of the settlement agreement to his employer. (Grossmith, 10/19)

New Orleans Times-Picayune: New Orleans Business Owner And Doctor Sentenced For Medicare Fraud 
The owner and director of the New Orleans medical service company Christian Home Health, Inc. were sentenced to prison on Wednesday (Oct. 19) for their roles in a $34 million Medicare fraud scheme. Chief U.S. District Judge Kurt Engelhardt sentenced owner Elaine Davis of New Orleans to 96 months in jail, and gave medical director Dr. Pramela Ganji of Harahan 72 months. In March 2016, a jury convicted both Davis, 60, and Ganji, 67, of one count of conspiracy to commit health care fraud and one count of health care fraud. Engelhardt has scheduled a hearing to determine what restitution the defendants owe on Dec. 7 of this year. (Lipinski, 10/19)

The Washington Post: App Helps Save Seattle Cardiac Patient
If your heart is going to stop, right outside a hospital is not a bad place for it. And if 41 people within a 330-yard radius have a cellphone app alerting them to your distress, so much the better. That’s what happened in Seattle last week when Stephen DeMont collapsed at a bus stop in front of University of Washington Medical Center. (Johnson, 10/20)

The Mercury News: Investigation Continues Into Pipe-Bomb Suicide At Clinic
A day after a wheelchair-bound man blew himself up with a pipe bomb in the lobby of an East Oakland health clinic, after waiting for everyone to leave, authorities were trying to find out what prompted the suicide. The man, whose name has not been released, was the only one injured in the blast at about 6:26 p.m. Tuesday at the San Antonio Neighborhood Health Center, 1030 International Blvd. Authorities said that in addition to the pipe bomb, some illegal fireworks were also found on the man after the explosion. (Harris, 10/19)

Macon Telegraph: Mom Sues After Autistic Son Is Arrested Over Bomb Threat At Upson County School
The mother of an autistic boy has filed a federal lawsuit alleging that he was illegally arrested after writing a bomb threat in an Upson County school restroom. She’s seeking more than $1 million in compensation and damages stemming from the incident, according to the suit, filed Monday in U.S. District Court for the Middle District of Georgia... The 9-year-old boy saw students being escorted out of school Dec. 3, 2014, after a bomb threat was found written on the wall of a bathroom stall, according to the complaint (Womack, 10/19)

Weekend Reading

Longer Looks: A Zika Experiment; Making Vaccines; The Big Soda Battle

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

FiveThirtyEight: Small Island, Big Experiment
The first thing Billy Ryan does after he arrives at work most mornings is drive to a yacht club or construction company lot, crawl into a mangrove, and stand for 60 seconds to count the mosquitoes that land on him. If there are five or more, he’ll request that a crew come spray the area the next day. (Anna Maria Barry-Jester, 10/18)

The Atlantic: To Make Vaccines Anywhere, Just Add Water
To get a vaccine from a factory to a child who needs it, you often need to cross countries, if not continents. Across that distance, vaccines are relayed through a “cold chain” of insulated boxes, freezers, vehicles, and depots. The chain is as fragile as it is necessary: If any link fails, the life-saving cargo would rapidly thaw and irreversibly degrade. (Ed Yong, 10/12)

Vox: Billionaires Vs. Big Soda: Inside The High-Stakes Soda Tax Fight
San Francisco, Oakland, and Albany, California, all have ballot measures that would levy a penny-per-ounce tax on distributors of sugary drinks. The people of Boulder, Colorado, will also vote on a two-cent-per-ounce excise tax on distributors. The stakes this year — for the beverage industry and for health-minded philanthrocapitalists who want to fight obesity — are high. Look no further than the dollars both sides are investing to try to win. (Julia Belluz, 10/18)

The Atlantic: The Delayed Gratification Of Obamacare
With the national rate of uninsured people at historic lows, why isn’t Obamacare more popular? Over the course of the last two years, which saw around 20 million Americans gain health insurance coverage, public opinion of the Affordable Care Act nevertheless remains negative. Its unfavorability rating in a Kaiser Family Foundation poll hovered at 47 percent in both September 2014 and 2016, and over the same time span favorability has increased from 35 percent to just 44 percent, though it was higher in 2015 than today. (Vann Newkirk, 10/17)

FiveThirtyEight: Prisoners With Hep C Get Cured In Some States But Not Others
Salvatore Chimenti already had advanced liver damage from the hepatitis C virus when he filed a lawsuit against the Pennsylvania Department of Corrections in the summer of 2015. He wanted access to new and expensive drugs that cure the virus in 90 percent or more of people who take them. Because he is an inmate, when the DOC denied him the medication, the only way Chimenti could potentially get it was to sue. (Anna Maria Barry-Jester, 10/17)

Editorials And Opinions

Viewpoints: Why Medicare Should Negotiate Drug Prices; What About That Cadillac Tax?

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

Stat: Medicare Shouldn't Pay More For Drugs When Others Pay Less
Hillary Clinton and Donald Trump don’t see eye-to-eye on much. But they do agree that drug costs are spiraling out of control at the public’s expense. Both the Democratic and the Republican candidates for president have said that Medicare should be able to negotiate drug prices, something that currently isn’t allowed by law. Letting Medicare do that — which the Department of Veterans Affairs and other countries have been doing for years — has the potential to transform health care. ... Giving Medicare the power to negotiate drug prices would immediately save billions of dollars. The implications would also reach far beyond the 37 million Americans covered by the Medicare drug benefit (Part D), because commercial insurers often follow Medicare’s lead. (Brian C. Callaghan and Lindsey De Lott, 10/18)

RealClear Health: Congress Shouldn’t Repeal The Cadillac Tax Without Replacing It
There are many provisions in the Affordable Care Act (ACA) that are ill advised and should be repealed immediately, but the “Cadillac” tax isn’t one of them. In fact, absent a better alternative, it shouldn’t be repealed at all. It’s likely to be the provision of the ACA that does the most to encourage higher-value and lower-cost health care, despite its flaws. (James C. Capretta, 10/19)

Boston Globe: One-Time Pay Increase For Nursing Home Workers Not Enough
The thousands of aides who prepare food, clean rooms, and do laundry at about 400 nursing homes across Massachusetts are grossly underpaid. Many earn as little as $11 an hour. So there was reason to cheer late last month when Governor Charlie Baker reversed his earlier decision to exclude those and other support-staff employees from a share of a $35.5 million “wage add-on” inserted into the state budget specifically to benefit nursing home workers at the low end of the salary scale... In all, nearly 60,000 workers are eligible to receive payments — including better-compensated staffers such as registered nurses and licensed practical nurses — but there’s no formula to dictate how the money should be distributed. (10/20)

Arizona Republic: Obamacare Is Imperfect But Worth Building On
It has become commonplace to play political football with the Affordable Care Act. While the system isn’t perfect, it’s important that we take stock of the advances spurred by the ACA, acknowledge its shortcomings, and work together to construct a system that provides high-quality care and healthier results for all. Our country spends more money on health care than any other developed nation, yet we are less healthy and live shorter lives than a majority of our international counterparts. The ACA was created to address this paradox — to lower the skyrocketing cost of care, advance health-care quality and improve health outcomes. (Marcus Johnson, 10/19)

The Wall Street Journal: A Better Way To Find Faulty Pacemakers
The U.S. government has spent a staggering 1.5 billion in taxpayer dollars to treat 375,000 Medicare patients who received faulty cardiac implants, an independent auditor reported this month. The review, conducted by the inspector general at the U.S. Department of Health and Human Services, took months to complete. It required painstaking detective work to tally the cost to patients and Medicare, even though it only involved seven models of cardiac implants out of the hundreds on the market. (Josh Rising, 10/19)

The New York Times: Marijuana Lights Up State Ballots
People in nine states, including California, Florida and Massachusetts, will vote Nov. 8 on ballot proposals permitting recreational or medical use of marijuana. These initiatives could give a big push to legalization, prompting the next president and Congress to overhaul the country’s failed drug laws. (10/19)

The Star Tribune: Six Actions Minnesota Can Take Now To Combat Health-Insurance Costs
About 6 percent of the population — mostly self-employed — composes a residual “pool” of people who must buy individual coverage, or pay a tax. This small “pool” is now comprised of higher-risk policyholders, as younger, healthier folks have continued without coverage rather than pay high premiums. The result? Rates have soared even higher for individuals in the pool who are mandated to buy health insurance. (Mike Hatch, 10/19)

WBUR: The Loneliest Patients: When They Can't Make Decisions, Who Will?
For decades, public guardians — court-appointed decision-making advocates for patients who need them — have been held up as the ideal for such cases, but funding and other support have been inadequate. And in some places, Massachusetts included, there is no public guardianship. Here, how such decisions are made varies from hospital to hospital. Some rely on private guardians; some have learned to avoid guardians. (Paul McLean, 10/19)