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Political Cartoon: 'Turn Turtle?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Turn Turtle?'" by Lee Judge, The Kansas City Star.

Here's today's health policy haiku:


At noon on this day
One presidency ends. And
The next takes the oath.

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Summaries Of The News:

Administration News

Trump Takes Office Amid Deep Uncertainty Surrounding Future Of Health Care

It's still unclear how Donald Trump's views on health care will mesh with congressional Republicans' ideas, but the eyes of a nation are watching as they navigate dismantling Barack Obama's signature legislation.

The Wall Street Journal: Donald Trump’s Presidency: A Look At His Proposed Policy Shifts
Mr. Trump takes office grasping a lightning rod of American domestic policy—health care. His party has already begun on the repeal, and potential replacement, of Barack Obama ’s signature health-care law, but the task of reworking a sweeping social program six years into its lifespan is proving messy. Republicans, including Mr. Trump, have put forward various ideas to serve as alternatives to the major provisions of the Affordable Care Act, which extended insurance to millions of Americans but also triggered criticism over rising premiums for some users and insurer withdrawals from the individual market. The party has yet to unify behind a single plan, and it remains unclear how much influence will be exerted by Mr. Trump and his administration and how much they will leave to four congressional committees and other groups of interested lawmakers to hash out in the House and Senate. (1/20)

Meanwhile, Stat offers a look at which medical companies are spending money on inauguration activities —

Stat: Biopharma Ponies Up For Inaugural Events
With President-elect Donald Trump’s inauguration mere hours away, celebrations in Washington, D.C., are getting underway, and the money — among other things — is flowing. Beginning Thursday and stretching through the weekend, most state societies and a number of players in the health care and pharmaceutical industries are hosting inaugural events. (Facher and Kaplan, 1/19)

Price's Health Record, Instead Of His Stocks, Under Fire From Democrats

Critics of the HHS nominee say that he has a long career of trying to take health care away from millions of Americans. Meanwhile, NPR offers a look at his stock portfolio. In other news, a pharma CEO and campaign donor wanted a study that questioned the safety of one of his drugs removed from a government website -- so he turned to Price for help.

Morning Consult: Senate Democrats Gather Witnesses To Critique Trump’s Health Pick
Senate Democrats on Thursday kept up the critiques of President-elect Donald Trump’s pick to lead the Department of Health and Human Services, hosting witnesses in a Senate office building to talk about how the Affordable Care Act, Medicare and Medicaid helped make their health care more affordable. Democrats focused their attacks on Rep. Tom Price’s (R-Ga.) health policy record rather than his stock trading, which was a big focus of his hearing before the Health, Education, Labor and Pensions Committee on Wednesday. (McIntire, 1/19)

NPR: Rep. Tom Price And His Health Care Portfolio
Georgia Republican Tom Price, who is President-elect Trump's choice to run the Department of Health and Human Services, is suddenly drowning in questions over the investments he has made while serving in the House of Representatives. The issue: Did Price use his position to influence the stock prices of companies he had invested in? Or, alternatively, did he buy shares in companies ahead of actions in Congress that might boost their value? (Kodjak, 1/19)

ProPublica: When A Study Cast Doubt On A Heart Pill, The Drug Company Turned To Tom Price 
The $3 pill known as BiDil was already a difficult sell when a Georgia-based pharmaceutical company bought the marketing rights a few years ago. A treatment for African Americans suffering from heart failure, BiDil had never really caught on, forcing the drug company that developed it to take a buyout offer. One strike against the drug was a 2009 study that raised questions about its safety and effectiveness. So last summer, the new owner of the drug, Arbor Pharmaceuticals LLC of Atlanta, sought to get the study taken down from a government website. For help, the company turned to the office of a congressman to whom the CEO had given the maximum $2,700 campaign donation — Rep. Tom Price, the Georgia Republican nominated by Donald Trump to become head of the Department of Health and Human Services. (Faturechi, 1/19)

CQ Roll Call: HHS Nominee Price, Staff Aided Donors In Battles With Agencies
President-elect Donald Trump’s choice to lead the Department of Health and Human Services has advocated over the years for companies with the federal agencies he may soon oversee. At least three of the companies aided by Rep. Tom Price and his staff contributed to his campaign funds. A CQ Roll Call review of more than 5,600 pages of congressional correspondence with HHS employees provide a picture of a lawmaker who has taken a deep interest in the workings of the Medicare entitlement program’s payments to the health industry. Price, a former surgeon, or his staff also pressured the Food and Drug Administration and the Agency for Healthcare Research and Quality to heed requests and complaints he received from donors and constituents. (Young and Siddons, 1/19)

Collins To Retain Spot As Head Of NIH -- For Now

It is not yet known whether Trump will permanently reappoint Dr. Francis Collins to be his NIH director for his full term.

Stat: NIH Director Francis Collins To Stay On, At Least For Now, Under Trump
Dr. Francis Collins is being held over as the director of the National Institutes of Health by the Trump administration, his office announced Thursday afternoon. Collins had been prepared to step down from the post on Friday, after Trump’s inauguration, and return to his lab at the NIH Bethesda campus. However, with Thursday’s news, he will remain as director for the time being. (Scott, 1/19)

The Washington Post: NIH Director Francis Collins To Stay In His Post For Now
Collins, who was appointed by President Obama in 2009, has said he would like to keep the job. He met with Trump last week in New York. Among the others said to be in the running to head the huge biomedical research agency are Rep. Andy Harris (R-Md.) and biotech entrepreneur Patrick Soon-Shiong. (Bernstein, 1/19)

CQ Roll Call: Collins To Stay At Helm Of NIH, Says Agency Official
Several GOP congressional leaders, including Senate Health, Education, Labor and Pensions Chairman Lamar Alexander of Tennessee, had urged Trump to keep Collins at the helm of the agency. Collins previously told CQ Roll Call he would stay in the role if asked but that he did not know if that would occur. (Williams, 1/19)

In other news about the incoming administration —

Kaiser Health News: Trump’s Nominee For Agriculture Has Key Health Role
Amid the cacophony of confirmation hearings for Cabinet nominees, President-elect Donald Trump reportedly has settled on former Georgia Gov. Sonny Perdue to fill the final Cabinet-department vacancy: secretary of Agriculture. Although consumers may simply think of the Department of Agriculture (USDA) as responsible for overseeing the farming industry, it also plays a key role in promoting health. The department is influential in maintaining the nation’s health in four key areas. (Heredia Rodriguez, 1/20)

Health Law

Governors Make Case For Federal Medicaid Funding But Want Money On Their Terms

Republican governors meet with members of the Senate Finance Committee to pitch "creative" ideas so that people who gained coverage through the health law's expansion of Medicaid don't lose it.

CNN: Why GOP Governors Like Medicaid Under Obamacare. Hint: $
Several GOP governors met with the Senate Finance Committee on Thursday to discuss the future of Medicaid and the Affordable Care Act. Also, House Majority Leader Kevin McCarthy has asked all governors to submit the changes they'd like made to Medicaid and Obamacare. ... [Ohio Gov. John] Kasich, one of the early GOP governors to embrace expansion, defended portions of the Affordable Care Act on Thursday. He noted that people, particularly those with pre-existing conditions, want to make sure they don't lose their coverage. (Luhby, 1/19)

The Hill: GOP Governors Defend Medicaid Expansion
Several Republican governors are defending ObamaCare's expansion of Medicaid in their states, highlighting a thorny issue for the party as lawmakers navigate repeal of the healthcare reform law. Full repeal would mean eliminating the law’s expansion of eligibility for Medicaid coverage, which has provided insurance for about 11 million new people in 31 states. Many of those states have Republican governors who are wary of their constituents losing coverage and of their state budgets losing the infusion of federal money that came with the expansion of the program, which affects low-income citizens. (Sullivan, 1/19)

Reuters: U.S. Governors Want Congress To Keep Funding Health Benefits For Poor
"There are some fundamental things that we can do that can settle people down, so they are not worried they are going to lose their coverage, but at the same time bring significant changes to the Obamacare package," [Ohio Gov. John] Kasich, a former Republican presidential candidate, told reporters after the meeting with other Republican governors and lawmakers hosted by the Senate finance committee. (Cornwell, 1/19)

Morning Consult: GOP Governors Pitch Medicaid Reforms As Cornyn Pledges No Coverage Losses
Republican governors told members of a key Senate panel on Thursday that they want more flexibility when it comes to Medicaid. That was the focus of a roughly two-hour, closed-door meeting among several GOP governors and Republicans on the Senate Finance Committee, which is set to play a key role in crafting legislation that would repeal and replace the Affordable Care Act. Officials inside the meeting described it as a listening session, during which Finance Committee members spoke little and governors made presentations about what they’d like to see. (McIntire, 1/19)

Bloomberg: Republican Governors Balk As Congress Races To End Obamacare 
“Nobody’s going to lose coverage,” Senator John Cornyn, a Texas Republican, said after the meeting. “If there’s one word that came up most, it’s flexibility. One-size-fits-all Washington doesn’t take into account the differences between a state like Texas with 28 million people and a state like South Dakota, for example.” (Tracer and Edney, 1/19)

Montgomery (Ala.) Advertiser: Bentley To Congress: Keep Funding For Medicaid, Hospitals
If Congress moves forward with health care changes, Gov. Robert Bentley wants the states to have more power to determine eligibility and benefits for Medicaid recipients, end federal marketplaces for health insurance and replacement of the individual mandate for health insurance with incentives for enrollment. But in a letter to House Majority Leader Kevin McCarthy, R-Calif., Bentley also asked Congress to maintain federal funding for the Alabama Medicaid and the Children’s Health Insurance Program (CHIP). The governor also asked for at least 18 months to put in place any changes approved by Congress. (Lyman, 1/19)

In other news —

The Tennessean: Medicaid Changes Loom Large For Health Care Industry
The future of how Medicaid unfolds, and possible block grants or additional states choosing to expand programs, will be important to the health care industry in the coming years as the next administration and Congress pen the next wave of health care reform, analysts said Thursday at panel in Nashville. Calls to repeal and replace the Affordable Care Act could evolve into a series of repairs and changes that come into place over the course of several years, according to health care equity analysts at a 'Wall Street's View on Prospects for the Health Care Industry' panel hosted by the Nashville Health Care Council. (Fletcher, 1/19)

Raleigh (N.C.) News & Observer: Cooper Calls On Public Health Workers To Help Expand Medicaid
Gov. Roy Cooper delivered a short but heartily received speech to a conference of public health officials on Thursday, asking them to help convince lawmakers to expand Medicaid coverage. “I need your help,” Cooper said. “I know a lot of you are in public employment, but your First Amendment rights aren’t taken away. I need you to speak out.” Cooper addressed more than 400 people during lunch at the Marriott Crabtree hotel in Raleigh. It was the annual state health directors conference of the N.C. Public Health Association. (Jarvis, 1/19)

And the Fiscal Times takes a closer look at block grants —

The Fiscal Times: How Block Grants Cap Federal Costs -- And Make States The Cost-Cutting Bad Guys
After briefly dangling a promise to deliver universal coverage to Americans, Trump has abruptly pulled it back and offered as a substitute an old GOP chestnut – a major overhaul of the nation’s Medicaid system, which was expanded to 133 percent of the poverty line under President Obama and included able-bodied people without dependent children. Contrary to the Republicans’ promises of improvements and broader coverage, some analysts have warned that block granting Medicaid could have an adverse impact on some of the country’s poorest people. (Pianin, 1/20)

Decoding The Charged Buzzwords Emerging In Health Law Debate

Stat offers a glossary of the terms and messaging both sides are using -- from "repair and rebuild" to "make America sick again." In other news, Republicans still don't appear to have a detailed replacement plan as Donald Trump is about to be sworn into office; nearly 50 percent of Americans say they favor the health law; a health care giant sees hope in "replacement"; and a transparency database may be on the chopping block.

Stat: Your Guide To The Weird World Of Obamacare Rhetoric
The Obamacare repeal effort is just getting underway and already the political wordplay is dizzying. On the GOP side, the rhetoric has gone from “repeal and replace” to “insurance for everybody” to “repair and rebuild.” Meanwhile, Democrats continually warn that the Republicans are trying to “rip apart our health care system.”To help you keep pace with the debate, we’ve assembled this handy glossary of buzzwords and talking points. (Ross, 1/19)

CQ Roll Call: Details Still Sparse On GOP Health Plan
Congressional Republicans appear no closer on Inauguration Day than in recent weeks to having a coherent strategy in place to achieve the incoming Trump administration’s goal to simultaneously repeal and replace the 2010 health care law. House and Senate Republicans hope to get more organized during a policy retreat next week in Philadelphia where health care is expected to be a significant topic. Several major questions—including what the GOP will do about the $9 billion or so that would be needed to fund cost-sharing subsidies for people covered by Obamacare plans, and whether to repeal the law’s Medicaid expansion—remain unanswered. Even basic questions are still up in the air, including timelines for the four committee markups of reconciliation instructions that will carry repeal. (Williams, 1/20)

The Hill: GOP Senator: Let's Work With Dems To 'Fix' ObamaCare
Sen. Ron Johnson (R-Wis.) said Thursday that he thinks Republicans should work with Democrats to “fix” ObamaCare. The remarks strike a more pragmatic and cautious tone on ObamaCare than the usual Republican rhetoric of “repeal and replace.” “Let’s start working with Democrats. Let’s transition to a system that will actually work, that, you know, Democrats are talking about. They want to fix it. Well, let’s fix it for the benefit of the American public,” Johnson said on CNBC. (Sullivan, 1/19)

The Hill: Poll: Nearly 50 Percent Of Americans Favor ObamaCare
Americans are largely split over ObamaCare, according to a new poll.A CNN/ORC poll finds that 49 percent of Americans favor ObamaCare. But 47 percent of respondents oppose President Obama's signature healthcare legislation. The poll marks the first time more people have said they favor the healthcare law than oppose it since it passed in 2010, CNN noted. (Savaranksy, 1/19)

Bloomberg: Obamacare Replacement May Improve Patient Access, Novartis Says 
Repealing and replacing Obamacare could benefit the pharmaceutical industry if it allows drugmakers to get cutting-edge new medicines to more U.S. patients, said Joe Jimenez, chief executive officer of Swiss health-care giant Novartis AG. Parts of the Affordable Care Act, President Barack Obama’s signature health-care law, have made it hard for patients to get access to some new drugs because they have high co-pays or aren’t covered, Jimenez said in an interview on Thursday at the World Economic Forum in Davos, Switzerland. (Simmons, Zelenko and Paton, 1/19)

Modern Healthcare: Will Open Payments Be A Casualty Of The ACA Repeal?
Right now, when doctors accept money or gifts from drug companies and devicemakers, that information is published on Open Payments, an online database created under the Affordable Care Act. The program has increased transparency in an era of murky conflicts of interest and has helped link physicians' prescribing habits to their industry connections. But as Republican lawmakers rush toward repealing the Affordable Care Act, some observers fear the section of the law that created the Open Payments program will face the chopping block. (Whitman, 1/19)

Meanwhile, in the states —

New Orleans Times-Picayune: Mayor Landrieu, New Orleans Council Want Obamacare Preserved
Mayor Mitch Landrieu and the New Orleans City Council lent their voices to a chorus of local and state officials urging Republicans in Congress to reconsider the push to repeal the Affordable Care Act, also known as Obamacare. With a letter to House Speaker Paul Ryan, R-Wisconsin, and Senate Majority Leader Mitch McConnell, R-Kentucky, Wednesday (Jan. 18) Landrieu said a repeal would jeopardize health insurance coverage for one out of every five Louisiana residents. It also shakes the financial confidence of health care providers, he said. (Rainey, 1/19)

The Philadelphia Inquirer: Report Projects ACA Repeal Would Cost 137,000 PA Jobs And Double State Budget Deficit
Repealing the Affordable Care Act would cause significant financial pain to businesses, patients, and taxpayers in Pennsylvania, according to a report released Thursday. The state's projected budget deficit would nearly double, and an estimated 3,425 additional residents would die prematurely each year. The nonpartisan Congressional Budget Office had projected two days earlier that partial repeal would increase the ranks of the uninsured nationwide by 18 million the first year and 32 million within a decade. (Sapatkin, 1/19)

The Baltimore Sun: Maryland Could Lose Billions In Federal Funding If ACA Is Repealed
The repeal of Obamacare could cost the State of Maryland nearly $2 billion in Medicaid funding for more than 260,000 people, state legislative analysts told lawmakers Thursday. Hospitals could lose an additional $2.3 billion, the analysts told the House Health and Government Operations Committee. That's federal money they receive for working to keep health care costs down. (Cohn, 1/19)

California Healthline: California Withdraws Bid To Allow Undocumented Immigrants To Buy Unsubsidized Obamacare Plans
Lawmakers in Sacramento have halted a first-in-the-nation effort by California to expand access to health coverage for immigrants living in the state without legal documents. At the behest of the state Legislature, Covered California, the state’s insurance exchange, withdrew its request to sell unsubsidized health plans to people who are here illegally. (Ibarra and Terhune, 1/20)

And Minnesota continues to try to ease the pain of high premium increases —

Pioneer Press: MN Health Insurance Relief Moves Ahead, Compromise Near?
Minnesota’s top leaders seem on the brink of a deal to bring health insurance premium relief to as many as 120,000 Minnesotans. This doesn’t mean a deal will actually get done. More than once in recent months, Democratic-Farmer-Labor Gov. Mark Dayton and legislative leaders have been close to a compromise only for everything to fall apart. And despite signs of compromise, several major divisive issues remain. (Montgomery, 1/19)

Pioneer Press: Minnesota Lawmakers Hope ‘Reinsurance’ Will Help Fix Health Insurance Market. Here’s How It Would Work 
Reinsurance, at its most basic, is insurance for insurance companies. Just like normal insurance distributes risk from individuals to a broader pool of people, reinsurance distributes risk away from a given insurance company.  More specifically, the kind of plan Minnesota is considering would shift the costs of some expensive patients away from the individual market.“It’s a mechanism to stabilize the market, (and) ultimately keep premiums down for consumers,” said Mike Rothman, Minnesota’s commerce commissioner. (Montgomery, 1/19)


EpiPen Competitor Swoops Back In After Price-Gouging Controversy

Kaleo will make the product free for those without insurance or families with low-income, but it's setting a high price for insurance companies. Meanwhile, Mylan has not reached a settlement with the Department of Justice over how it classified the EpiPen under Medicaid.

USA Today: EpiPen Competitor Will Be Out In February, Free To 200M People
Five months after the CEO of Mylan faced an irate House panel over price increases for its EpiPen auto injectors, a former competitor will be back next month — at a far higher list price, the company announced Thursday. Kaleo, the maker of the Auvi-Q, says the price paid by consumers with commercial insurance will still be far lower for its reintroduced epinephrine auto injector than any of its brand name or generic competitors. (O'Donnell, 1/19)


9 States, D.C. Made Up Lion's Share Of Medicare Waste In 2015

This is the second consecutive year that the District of Columbia has topped all states in Medicare waste per beneficiary. In other news, Medicare officials warn Pennsylvania health plans that they could face fines if they don't fix their directories.

The Fiscal Times: The 10 States With The Worst Medicare Waste 
Despite stepped up efforts to crack down on Medicare fraud and wasteful spending, the federal government lost at least $43 billion in fiscal 2015 to health care providers who filed improper or bogus claims to the program, according to a new study. Nine states and the District of Columbia were responsible for the lion’s share of the total improper payments, according to a new study by the Council for Medicare Integrity, a non-profit government watchdog. The states include Texas with $50.2 million in improper payments, California with $47.8 million, New Jersey with $22.6 million and Pennsylvania $22.1 with million. (Pianin, 1/19)

Pittsburgh Post-Gazette: Medicare Officials Warn Three Pa. Health Plans To Fix Physician Network Directories
Medicare has warned three Pennsylvania health plans that sell coverage for seniors to fix their physician network directories by Feb. 6 or face fines or enrollment bans. Highmark Health and its affiliate, Gateway Health Plan, both located Downtown, and Philadelphia-based Health Partners Plans Inc. were among 21 Medicare Advantage insurers warned by federal officials about high error rates in their online physician network directories. The Centers for Medicare & Medicaid Services, which oversees Medicare, conducted the audit, which was the government’s first in-depth look at the accuracy of provider directories. (Mamula, 1/19)


Federal Officials Criticize Kansas Medicaid Program, Deny Request For Extension

The federal office that oversees Medicaid says the managed care program in Kansas does not meet federal standards and puts the health and safety of enrollees at risk.

Kansas City Star: Criticizing Kansas, Feds Deny Extension Of KanCare Privatized Medicaid Program
Federal officials have rejected Kansas’ request to extend its privatized Medicaid program, KanCare, saying it has failed to meet federal standards and risked the health and safety of enrollees. Kansas is “substantively out of compliance with Federal statutes and regulations, as well as its Medicaid State Plan” based on a review by federal investigators in October, according to a letter sent to the state Jan. 13 from the Centers for Medicare and Medicaid Services. The state’s failure to ensure effective oversight of the program put the lives of enrollees at risk and made it difficult for them to navigate their benefits, the investigators found. They cited concerns about the program’s transparency and effectiveness. (Lowry and Woodall, 1/19)

Topeka (Kan.) Capital Journal: Lawmakers Furious, Feel ‘Blindsided’ By Brownback Administration Over Harsh KanCare Report
The disclosure of a highly critical federal review of Kansas’ Medicaid program provoked bipartisan fury among lawmakers on Thursday, who said they were blindsided and not informed of the troubling findings. ... Republicans and Democrats voiced anger with Brownback’s administration over two letters from the Centers for Medicare and Medicaid Services sent to the state this month that detail significant problems with KanCare, the privatized system that covers more than 400,000 individuals, substantiated during an October review. Lawmakers said they hadn’t been informed of either communication. (Shorman, 1/19)

KCUR: Lawmakers Seek Answers After KanCare Extension Denial 
Kansas legislators are seeking answers from the Brownback administration after federal officials denied a one-year extension of the state’s Medicaid program known as KanCare. The denial letter, dated Jan. 17, outlines a series of concerns about the state’s privatization of Medicaid under three insurance companies. Federal officials cited poor coordination between the Kansas Department of Health and Environment and the Kansas Department for Aging and Disability Services and said neither state agency was doing enough to hold the three insurance companies known as managed care organizations, or MCOs, accountable to Medicaid rules. (Marso, 1/19)

Women’s Health

Even Before Trump, Anti-Abortion Movement Has Been Making Huge Gains

The 334 restrictions passed by states in the past five years account for a third of all restrictions enacted since 1973. Now as Donald Trump is sworn into office, advocates are afraid the women who depend on Planned Parenthood are going to suffer. In other news, a study looks at clinic closures in Texas.

Thomson Reuters Foundation: Anti-Abortion Effort Gathers Steam Ahead Of Trump Presidency, Research Finds
While abortion rights advocates look ahead to the U.S. presidency of Donald Trump with trepidation, obstacles to women seeking to end unwanted pregnancies already are gathering intensity, research showed on Thursday. Fifty new abortion restrictions were passed last year in 18 of the 50 U.S. states, where legislators introduced more than 400 measures aimed at limiting abortion access, according to The Century Foundation, a U.S.-based public policy research group. The study found that 32 states tried to ban all or some abortions. (Wulfhorst, 1/19)

New Orleans Times-Picayune: Fewer Women Are Getting Abortions In Louisiana, New Study Finds
Mirroring a trend observed in most states around the country, the abortion rate in Louisiana declined by around 18 percent between 2011 and 2014, a new survey finds. The report, released this week by the Guttmacher Institute, a research group that supports abortion rights, counted 12,210 abortions in the state in 2011. By 2014, the total had dropped to 10,150, a slight increase from the 9,890 reported in 2013. (Lipinski, 1/19)

NPR: At Planned Parenthood Clinic In Virginia, Practitioners Worry For Their Patients
From her desk in Roanoke, Va., Patrice Campbell books appointments for the 15 Planned Parenthood clinics across the region. Right after the election, she noticed a huge increase in calls, many of them asking for the same thing. "We've seen where a lot of patients — I would say maybe 50 to 70 percent of patients — [are] eager to get in for long-term contraceptives," Campbell says. "So their focus is, I need to get an IUD before Jan. 20 because an IUD can last for five, even 10 years." Jan. 20, of course, is Inauguration Day. (Shapiro, 1/19)

Texas Tribune: Study: Longer Distances To Texas Clinics Linked To Decline In Abortions
A wave of abortion clinic closures in Texas since 2013 has led to a drop in the number of abortions performed, and the steepest declines are associated with communities that were the farthest from the remaining clinics, according to a study published Thursday in the Journal of the American Medical Association. The U.S. Supreme Court last year struck down the state's most stringent abortion restrictions proposed by House Bill 2, which then-Gov. Rick Perry signed into law in 2013 and required all Texas facilities performing abortions to meet hospital-like ambulatory surgical center standards and forced doctors to have admitting privileges at hospitals within 30 miles of the clinics. (Alfaro, 1/19)

Meanwhile, a judge temporarily blocks Texas' decision to cut off funding for Planned Parenthood —

Veterans' Health Care

Suit Accuses VA Of Obstructing Investigation Into Agent Orange

ProPublica and the Virginia-Pilot have been reporting on the herbicide and its effects on veterans for the past year and half, but they say they have been met with one delay after another on their FOIA requests.

ProPublica: ProPublica Files Lawsuit Seeking VA Correspondence Related To Agent Orange
ProPublica and the Virginian-Pilot filed a lawsuit [Thursday] in federal court against the U.S. Department of Veterans Affairs, accusing the agency of stonewalling requests for documents under the Freedom of Information Act. The lawsuit, ProPublica’s second against the VA in two months, seeks a preliminary injunction compelling the government to immediately release correspondence about Agent Orange, an herbicide used to kill vegetation during the Vietnam War, including documents sent to and received by Dr. David Shulkin, the VA’s undersecretary for health. Shulkin has been nominated to be VA secretary by President-elect Donald Trump. (Fields, 1/19)

Public Health And Education

OxyContin Maker Turned Blind Eye To Reap 'Obscene Profits,' City Claims In Suit

Everett, a city north of Seattle, has been hit hard by the painkiller epidemic. In other news, Anthem is changing its policy on pre-authorizations for drugs to treat opioid abuse.

USA Today: Anthem To Change Opioid Treatment Policy Under Deal With NY Regulators
Anthem, the nation's second-largest insurance company, has ended its policy of pre-authorizations for drugs to treat opioid use disorder following an agreement with New York Attorney General Eric Schneiderman, his office said Thursday. The agreement, which affects Anthem plans across the United States and Empire Blue Cross Blue Shield customers in New York, followed an investigation into Empire's practices in New York. (O'Donnell and DeMio, 1/19)

In other news —

The Philadelphia Inquirer: Christie Set To Impose Pain Pill Limits Despite N.J. Doctors' Objections
Gov. Christie wants to tackle opioid addiction by limiting the number of pills physicians can initially prescribe - an idea experts say could reduce excess supply but may cause some pain patients to go days without medication. Christie, a Republican serving the last year of his second term, last week ordered new rules that would limit doctors to writing initial prescriptions for five days' worth of opioid-based medications, down from 30. (Seidman, 1/19)

Chicago Tribune: Despite Progress, Lake County's Fight Against Opioid Epidemic Sees Early Setbacks In 2017
Last year, the sheriff's office was responsible for saving 14 lives using Naloxone, and if the start of 2017 is any indication, the opioid epidemic might be increasing. In 2016, deputies saved two people in January and didn't have another save until March...According to the latest statistics from the Lake County coroner's office, opioid or heroin-related deaths went up from 39 in 2014 to 42 in 2015. Lake County Coroner Dr. Howard Cooper said that for the first three quarters of 2016, there were 31 opioid- or heroin-related deaths, which was down from the same period in 2015. (Abderholden, 1/19)

Seattle Times: Safe Heroin Injection Sites Get OK From King County Health Board 
King County is moving closer to opening at least two public sites where drug users can inject heroin under supervision. The county’s Board of Health voted unanimously Thursday to endorse the sites, which would be the first of their kind in the nation.A task force, made up of experts on heroin and opioid abuse, recommended the supervised injection sites in September, as a way to reduce the wave of overdose deaths that has wracked Seattle and King County in recent years. (Gutman, 1/19)

Health Experts Want Private Donors To Fill Public Funding Gap On Gun Violence Research

A group of public health experts has set out an "agenda for action" to help deal with one of the major causes of death in America. In other news, non-medical exemptions are rising in states that were not thought to be hotbeds to anti-vaccination sentiment, the FDA has advice for pregnant women, and experts weigh in on breakfast.

Stat: Public Health Experts Call For More Funding Of Research Into Gun Violence
Despite being one of the leading causes of death in the US, gun violence has received very little federal research funding for decades. So a group of public health researchers are taking matters into their own hands, calling for their field to take the lead in securing private funding for studies of gun violence, and to push forward pragmatic gun safety rules at the local and state level. The group of 80 people, consisting of deans and professors from 42 schools of public health as well as gun safety activists and politicians, first met in Boston in November 2016. The “agenda for action” that resulted from that meeting was published Thursday in the American Journal of Public Health. (Sheridan, 1/19)

Stat: Vaccine Exemptions Are On The Rise In A Number Of US States
On the whole, fewer US families have opted out of school-required immunizations in recent years, thanks in part to stricter state laws. But data from the Centers for Disease Control and Prevention indicate that, while nonmedical exemptions (which includes religious and philosophical opposition) are on the decline nationally, they’re rising in certain states, including states that haven’t previously been considered hotbeds of anti-vaccination sentiment — which may put those areas at risk of a disease outbreak. (Samuel, 1/20)

NPR: FDA Issues New Seafood Advice For Moms-To-Be. Not Everyone Is Thrilled
For many pregnant women, understanding what seafood is safe and healthy, and what should be avoided because of mercury concerns comes with a lot of hand-wringing. In part, that's because the federal government's advice on the matter, first issued in 2004, has long been criticized as unclear. That guidance has included advice on how much seafood to eat, and which species pregnant and nursing women should avoid over concerns about mercury contamination. (Leschin-Hoar, 1/19)

The Associated Press: Can Breakfast Help Keep Us Thin? Nutrition Science Is Tricky
Cereal makers have happily encouraged the belief that eating breakfast can help keep us thin and bring other benefits, partly by paying for studies that seem to support the idea. So, does that mean breakfast is bad for you? Not that either. What it does show is how difficult it can be to sort the hype from reliable dietary advice when studies are funded by the makers of Froot Loops, nutrition science is often inconclusive, and gray areas can be spun for marketing. (Choi, 1/19)

Cities With Higher Lead Levels Than Flint Launch Groundswell Of Activity To Address Problem

A Reuters report shines a light on the communities that have been affected. Officials there say it was a wake-up call they needed. "This has just laid out that it's not just a Detroit issue, it's not just a Baltimore issue," said Ruth Ann Norton, president of Green & Healthy Homes Initiative, a Baltimore-based nonprofit.

Meanwhile, some lawmakers want to reopen the investigation on Flint —

Roll Call: Oversight Panel Democrats Want Flint Investigation Reopened
Democrats on the House Oversight and Government Reform Committee want to reopen its investigation into the Flint, Mich., water crisis, according to a letter written by ranking member Elijah E. Cummings of Maryland and released Wednesday. The investigation, which led to a high profile oversight hearing that turned into partisan finger-pointing last March, was quietly closed before the Christmas holiday by Chairman Jason Chaffetz, R-Utah. Democrats say they were not consulted on the decision, and that questions about how the crisis occurred, who bears responsibility and the progress of recovery remain unanswered. (Dillon, 1/19)

State Watch

NYPD's Mental Health Training Falls Apart At Seams When Put Into Practice, Report Finds

The department's dispatch team is unable to tell who has received training, so it's "random chance" on whether an officer who arrives at the scene has been trained in how to handle a mental health crisis, according to the report.

In other news on the New York Police Department —

State Highlights: Va. House Eyes Direct Primary Care Legislation Again; States Begin Funding 'Food Hubs'

Outlets report on news from Virginia, Maryland, Florida and California.

The Associated Press: House GOP Plans To Push Direct Primary Care Plan
Republicans in the Virginia House of Delegates will be pushing legislation again this session to promote direct primary care agreements, in which patients pay a fee for unlimited primary care. Del. Steven Landes outlined Republicans’ health care priorities in a speech on the House floor Thursday. (1/19)

Stateline: States See Value In Backing ‘Food Hubs’ For Farmers, Consumers
In New York City, where shoppers and diners can find delicacies from all over the world, there is hefty demand for food grown closer to home. The taste for products from farms in the Northeast has led South Bronx-based Greenmarket Co., a nonprofit regional food distributor that serves as the middleman between farmers and buyers, to constantly expand the size and scope of its operation over the last half-decade. The state of New York has taken notice of its role in the regional food supply chain and in August allocated $15 million of the $20 million needed to build Greenmarket’s new 20,000-square-foot distribution center .... Like New York, other states such as Michigan, Minnesota, Ohio and Vermont, and the federal government are investing in food hubs as a way to connect small and midsize farmers, who may not have the volume or do not have the capacity to work with large food wholesalers, with businesses and consumers to increase sales. (Breitenbach, 1/19)

The Baltimore Sun: WellDoc Receives FDA Clearance For Non-Prescription Version Of Diabetes Management App 
WellDoc, a Columbia health care technology company, has received clearance from the U.S. Food and Drug Administration to sell a version of its diabetes management mobile application that does not require a prescription. The new offering, which should be available by the end of March, significantly expands WellDoc's potential client base and opens up new options for developing the business, said Kevin McRaith, its president and CEO. (Gantz, 1/19)

Miami Herald: Miami Cardiologist Acquitted Of Taking Thousands In Kickbacks To Fleece Medicare 
A Miami-Dade cardiologist has been acquitted of receiving thousands of dollars in kickbacks as part of a $57 million Medicare fraud scheme. Dr. Michael Bahrami, 61, who practices in the Aventura area, was found not guilty Wednesday by a Miami federal jury on a single conspiracy charge of defrauding the government. He had faced up to five years in prison in a case that threatened to end his medical career. (Weaver, 1/19)

Miami Herald: Obama Commutes Prison Sentence Of California Healthcare Collective Operator
President Barack Obama on Thursday commuted the 20-year prison sentenced imposed on Richard Ruiz Montes, convicted in 2008 for his role in the Modesto’s pot-dealing California Healthcare Collective. In one of his final presidential acts, Obama used his executive authority to cut Montes’ sentence by more than half. Now held at a federal facility in Atwater, according to the Bureau of Prisons’ inmate locator, the 36-year-old Montes will be released May 19. (Doyle, 1/19)

Health Policy Research

Research Roundup: After-Hospital Care; Drug Exclusivity; Abortions In Texas

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

Health Affairs: Less Intense Postacute Care, Better Outcomes For Enrollees In Medicare Advantage Than Those In Fee-For-Service
Traditional fee-for-service (FFS) Medicare’s prospective payment systems for postacute care provide little incentive to coordinate care or control costs. In contrast, Medicare Advantage plans pay for postacute care out of monthly capitated payments and thus have stronger incentives to use it efficiently. We compared the use of postacute care in skilled nursing and inpatient rehabilitation facilities by enrollees in Medicare Advantage and FFS Medicare after hospital discharge for three high-volume conditions .... we found lower intensity of postacute care for Medicare Advantage patients compared to FFS Medicare patients discharged from the same hospital, across all three conditions. Medicare Advantage patients also exhibited better outcomes than their FFS Medicare counterparts. (Huckfeldt et al., 1/9)

Health Affairs: Six-Month Market Exclusivity Extensions To Promote Research Offer Substantial Returns For Many Drug Makers
[A] recent proposal would encourage rare disease research by providing six months of extended exclusivity for any existing drug that is granted subsequent FDA approval for a new rare disease indication. ... We found that for the thirteen FDA-approved drugs that gained supplemental approval for a rare disease indication from 2005 through 2010, the median projected cost of clinical trials leading to approval was $29.8 million. If the exclusivity extension had been in place, the median discounted financial gain to manufacturers would have been $94.6 million. Median net returns would have been $82.4 million, with higher returns for drugs with higher annual sales. Extending market exclusivity would provide substantial compensation to many manufacturers, particularly for top-selling products, far in excess of the cost of conducting these trials. (Kesselheim et al., 1/18)

JAMA: Change In Distance To Nearest Facility And Abortion In Texas, 2012 To 2014
Texas House Bill 2, enacted in 2013, was one of the most restrictive abortion laws in the country before the US Supreme Court ruled in June 2016 that 2 provisions were unconstitutional. Following introduction and passage of the bill, the number of Texas facilities providing abortions declined, from 41 in 2012 to 17 in June 2016. ... When the change in distance was 100 miles or more, the number of abortions decreased 50.3% .... abortions also declined among women in counties with an open facility in 2014, indicating that there were other factors related to the decrease, such as limited capacity to meet demand for services. (Grossman et al., 1/19)

The New England Journal of Medicine: Mechanisms, Pathophysiology, And Management Of Obesity
Seven of the top 10 leading causes of death and disability in the United States today are chronic diseases (e.g., cancer and diabetes). Prevention and treatment of most of these conditions must address the close link with obesity. People who are overweight or obese account for more than two thirds of the U.S. population and are overrepresented in primary care practices. Some professional organizations now classify obesity, defined as a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 30 or higher, as a disease. Management of overweight (BMI, ≥25) or obesity in the clinical setting, alone or in combination with a chronic disease, is the focus of this review. (Heymsfield and Wadden, 1/19)

Urban Institute: Instead Of ACA Repeal And Replace, Fix It
[P]olicymakers should consider fixing the major problems they have with the ACA rather than repealing it; this would not disrupt the parts that are working effectively. To that end, we propose a range of policies that would address critics’ concerns and also strengthen the law, expand coverage, improve affordability, increase market stability, and lower the high premiums that exist in some markets. (Holahan and Blumberg, 1/16)

The Kaiser Family Foundation: Comparison Of Medicare Provisions In Recent Bills And Proposals To Repeal And Replace The Affordable Care Act
This brief provides a side-by-side comparison of the Medicare-related provisions in six bills and proposals that would repeal the ACA, excluding proposals that would not directly affect Medicare. Two of these proposals would repeal the ACA in its entirety, including all Medicare provisions, two would repeal some Medicare provisions in the ACA, one would retain all Medicare provisions in the ACA, and one does not specify. The first part of the side-by-side describes the Medicare provisions in the ACA that would be retained or repealed in each bill or proposal. The second part of the side-by-side describes the additional ways in which the bills and proposals would change Medicare, such as structural modifications to the Medicare program. (Jacobson et al., 1/18)

Here is a selection of news coverage of other recent research:

CNN: Controversial New Blood Pressure Guidelines Aren't One-Size-Fits-All
New guidelines tackle a question many older adults on blood pressure medication face: How low should you go? But finding the right blood pressure might not be so straightforward. The latest guidelines, released yesterday by two physicians' groups, have already drawn criticism for how high they set targets for adults 60 and older, even in light of recent data that some patients, especially those at higher risk for stroke and heart attack, may benefit from lower blood pressures. (Nedelman, 1/17)

Editorials And Opinions

Viewpoints: Trump's Difficult Insurance Pledge; Keeping Part Of Obamacare

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

Los Angeles Times: Cheaper, Better 'Insurance For Everybody'? Good Luck With That
Let’s give Donald Trump, who will be sworn in Friday as the 45th president of the United States, the benefit of the doubt. Let’s take him at his word that he has a plan to provide “insurance for everybody” that is “much less expensive and much better,” as he said in an interview with the Washington Post. How will he do it? Trump didn’t reveal any details .... So I turned to several prominent healthcare experts — people who, unlike Trump, have spent many years studying this stuff — and asked how you’d cover everyone and do it better than current insurance plans and for less money. The experts were unanimous. It can’t be done. (David Lazarus, 1/20)

Morning Consult: Bipartisan ACA Provisions Worth Keeping
Whenever I think of our current health insurance system, I’m reminded of Jenga, the old wooden block-stacking game. Shifting just one piece of the shaky tower can result in collapse. As Congress proceeds toward repeal and replacement of the Affordable Care Act, it would do well to keep Jenga in mind and carefully consider which pieces should stay while moving to keep the tower standing. (B. Douglas Hoey, 1/20)

Bloomberg: The Guessing Games Republicans Play On Health Care
Tea-leaf readers, stop straining those prophetic eyeballs: The future of Republican health-care policy will be just as clear if you stare into a random pile of vegetable matter. Trump is a cipher, having clearly never given the matter much thought himself; congressional Republicans want to repeal Obamacare to please their base, but somehow do it without upsetting the people who will thereby lose coverage. In between them is the nominee for secretary of Health and Human Services, Tom Price, a man of firm convictions, but unclear mandate to enact his ideas. (Megan McArdle, 1/19)

Forbes: Beyond ACA, Suggestions For Senate Confirmation Process For Tom Price
As confirmation hearings began for President Trump's nominee for Secretary of Health and Human Services, Congressman Tom Price, questions remained on healthcare reform and his vision for Trumpcare. Those issues merit top billing, but there are other important policy questions for Price outside the Affordable Care Act (ACA). And history says that these issues are likely to be as important, time consuming, political capital using and complex as the ACA agenda they arrive with. (Bob Kocher and David Beier, 1/19)

Forbes: The Health Reform Vulnerable Americans Really Need
As Congress and the Trump-administration-to-be scope out possibilities for replacing The Affordable Care Act, here’s one area that needs attention stat: getting vulnerable Americans better health information about their options and costs and treating them with more respect. Findings from a new study on the subject could make your blood boil. “We’re not suffering from a lack of health care information,” says Chris Duke, research director of Right Place, Right Time: Improving Access to Health Care Information for Vulnerable Patients. “There’s a lack of targeted health care information. We need to move toward a system that pushes relevant, salient information to people at the right place and the right time.” (Richard Eisenberg, 1/19)

Health Affairs: CBO Scoring: The Issue Is Not How It’s Done, But How It’s Used
At a House Budget Committee hearing last fall on the Center for Medicare and Medicaid Innovation (CMMI), members of the majority expressed strong criticism of how the Congressional Budget Office (CBO) scores Medicare demonstration projects, continuing a long-running debate over CBO’s methods. Committee Chair Tom Price (R-GA), President-elect Trump’s pick to be Secretary of Health and Human Services, criticized CBO’s admitted inability to predict “which, if any, of the current demonstration projects CMMI has embarked upon will result in savings.” CBO plays an important role in the policy process. ... CBO certainly should (and, in fact, does) work to constantly improve its ability to develop reliable estimates. But all too often, criticisms of CBO’s methods are motivated by a misunderstanding of what CBO can and cannot be expected to do. (Stuart Guterman, 1/19)