KHN Morning Briefing

Summaries of health policy coverage from major news organizations

In This Edition:

From Kaiser Health News - Latest Stories:

Kaiser Health News Original Stories

Political Cartoon: 'How'd You Guess?'

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

Here's today's health policy haiku:


Aid-in-dying bill
Washington leads the nation.
(That's DC! For real!)

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

Beyond Bluster Of Campaign, Candidates Have Deep Differences On Health Care Issues

The Associated Press offers a series looking at where the candidates stand on health care issues and why it matters.

The Associated Press: Why It Matters: Beneath The Fury, Issues That Matter
This is a presidential campaign about trust, temperament, honesty, judgment, character, personality and, some are convinced, a personality disorder or two. It's pocked with Donald Trump's ballistic-missile tweets in the middle of the night. It's enlivened by the spectacle of Hillary Clinton's campaign innards spilling day after day into public view, quite a WikiMess. Got a minute for the issues? Beyond all of the bluster in this campaign, a clash of ideas is also at work, with consequences for nearly all Americans and plenty of people around the world. (10/23)

The Associated Press: Why It Matters: Health Care
About 9 in 10 Americans now have health insurance, more than at any time in history. But progress is incomplete, and the future far from certain. Millions remain uninsured. Quality is still uneven. Costs are high and trending up again. Medicare's insolvency is two years closer, now projected in 2028. Every family has a stake. (Alonso-Zaldivar, 10/23)

The Associated Press: Why It Matters: Abortion
Persistent Republican-led efforts to restrict access to abortion and to curb government funding for Planned Parenthood have been hotly debated in Washington and in states, and will be shaped in some way by the next president. (Crary, 10/22)

The Associated Press: Why It Matters: Opioid Epidemic
More Americans are dying from opioids than at any time in recent history, with overdose deaths hitting a peak of 28,000 in 2014. That amounts to 78 Americans dying from an opioid overdose every day, according to the Centers for Disease Control and Prevention. The CDC uses opioid as an umbrella term for synthetic painkillers and for drugs derived naturally from opium (known more specifically as opiates), such a heroin. (Ronayne, 10/22)

The Associated Press: Why It Matters: Veterans
There are an estimated 21.6 million veterans in the United States. Among them, nearly 9 million are enrolled in health care provided by the Department of Veterans Affairs. About 4.3 million veterans get disability compensation from the VA and nearly 900,000 have been diagnosed with post-traumatic stress disorder. A 2014 law signed by President Barack Obama aimed to alleviate delays many veterans faced in getting treatment at VA hospitals and clinics and end the widespread practice of fake wait lists that covered up long waits for veterans seeking health care. Two years later, many of the problems remain. (Daly, 10/22)

'Politically, We’re On Defense': Anti-Abortion Groups Fear Ramifications Of Election

With Donald Trump's chances of taking the White House fading, many on the anti-abortion side of the fight fear he's doing more harm than good.

The Washington Post: Antiabortion Activists Face Headwinds With Clinton Leading And Trump Stumbling On Women’s Issues
Antiabortion activists, already experiencing a difficult year, say their movement faces a pivotal moment as another Democrat who staunchly supports abortion rights appears likely to occupy the White House. First came the death of Antonin Scalia, an ardent ally on the Supreme Court. Then came a stinging defeat before the justices over a sweeping Texas law regulating abortion providers. Now, activists are afraid that Hillary Clinton is headed to victory — and angry that Donald Trump has done his share, they say, to set back a movement that has strived to show sensitivity toward women. (Somashekhar and Zezima, 10/21)

In other 2016 election news —

Modern Healthcare: Colorado Set To Vote On Single-Payer Healthcare System 
Years before Sen. Bernie Sanders touted single-payer healthcare as a core issue in his insurgent presidential campaign, a Democratic state lawmaker in Colorado was perennially introducing legislation for a single-payer system in the state. That legislation, backed by state Sen. Irene Aguilar, a physician, never gained much traction. But last year, its supporters collected more than 150,000 signatures to bring the plan before voters directly on the Nov. 8 ballot. (Livingston, 10/22)

Pioneer Press: Minnesota Candidates Focus On Health Care As 2016 Elections Near
Health care is dominating political campaigns in Minnesota as the election draws nearer. Lawmakers in both parties say they’re hearing from lots of voters about health care costs and access as they knock on doors around the state. “We were hearing from too many Minnesotans that this is just too big a burden for them,” said Senate Majority Leader Tom Bakk, DFL-Cook, while his Republican counterpart Sen. David Hann of Eden Prairie said the issue of health care is “blowing up all over the state.” That means lawmakers are scrambling to convince voters that they’re taking the problem seriously — and that the other side isn’t. (Stassen-Berger, 10/23)

Presidential Election Could Weigh Heavily On Future Of Medicaid Expansion

Democrat Hillary Clinton wants to convince remaining states to accept the health law's provision to expand Medicaid to more lower-income residents, while Republican nominee Donald Trump seeks to reverse the expansion. Also, NPR looks at the difficulties getting dental care for patients with disabilities, who often have Medicaid insurance.

NPR: For People With Disabilities, Getting Dental Care Can Be Difficult
At the Marshfield Clinic dental center in Chippewa Falls, Wis., hygienist Karen Aslinger is getting her room ready. It's all quite routine — covering the chair's headrest with plastic, opening instruments, wiping down trays. But then she starts getting creative. "My next patient is pretty tiny and frail, so I like to go to oral surgery and get a heated blanket. I wrap her up, and I think it soothes her," Aslinger says. (Kodjak, 10/24)

Health Law Issues And Implementation

Both GOP And Democrats Seek Changes To Health Law, But Can They Find Common Ground?

Pressure from insurers who may leave the health law's marketplaces could spur lawmakers to consider updates to the law. Also in the news, a study examines costs off and on the marketplaces, Minnesota's governor wants changes to bring down insurance costs on the individual market, people buying insurance through their workplace are seeing more high-deductible plans and a look at how many insurance shoppers are hampered by confusion and terminology.

The Wall Street Journal: Rising Insurance Premiums Boost Talk Of Changes To Affordable Care Act
Insurer defections and rising premiums in the individual insurance market are spurring Democrats and Republicans alike to talk about changes to the 2010 Affordable Care Act. For now, the conversations are largely aimed at their party’s base. President Barack Obama led his party’s cry on Thursday with suggestions that would further entrench the law, including the addition of a government-run health plan in parts of the country with limited competition. GOP lawmakers have continued to call for gutting the law, including proposals to waive its penalties for people who forgo coverage in areas with limited insurance options. In each of these proposals, both sides have been largely talking past one another. Come January, they will have to talk to each other instead. (Radnofsky, 10/21)

Modern Healthcare: New Data Expose Mysterious World Of Off-Exchange Health Plans
Average premiums and deductibles for individual and small-group health plans on the Affordable Care Act exchanges in 2016 were nearly 13% cheaper than for plans sold off the exchanges, according to new data from the Robert Wood Johnson Foundation. The data set, compiled from information purchased from Vericred, a New York City-based data company serving the health insurance industry, provides the most detailed look yet at how the ACA marketplace compares with the off-exchange market, about which much less is known. (Meyer, 10/24)

Pioneer Press: Mark Dayton Demands Quick Action On ‘Unaffordable’ Affordable Care Act 
Gov. Mark Dayton on Friday guaranteed that the cost of health care will echo in Minnesotans’ decisions as they vote for the next Legislature in November. A week after bluntly critiquing the Affordable Care Act for making health care unaffordable for many, Dayton called on Republican and Democratic state lawmakers to reach quick agreement on fixes. He wants legislators to have their joint plan ready by Nov. 1 — a week before Election Day. “Time is running short, so legislators must begin their work immediately,” Dayton said. The governor’s comments on the cost increases have played a starring role in Republican ads against Democrats, and Dayton said Friday he heard from a deputy assistant to President Obama about them. (Stassen-Berger, 10/22)

The Mercury News: While Premiums Hold Steady, High-Deductible Health Plans Shifting Costs To Employees
Double-digit premium hikes are jolting millions of Americans who get their coverage through the Affordable Care Act, but just the opposite is happening to Ryan Lemburg. Like most Americans who get their health insurance through their employers, the Tracy school teacher has seen his annual premiums creep up at a historically low pace since the country’s controversial health care law, Obamacare, was passed six years ago. ... Behind that stability in premiums for many of the country’s 150 million workers is a trade-off: they’re being shifted to high-deductible health plans, which companies are increasingly championing as a way to hold down their own health care costs. (Seipel, 10/23)

Richmond Times Dispatch: Most Uninformed Before Open Enrollment
Since the passage of the Affordable Care Act, those signing up for health insurance are, for the first time ever, able to easily compare plans and decide which is best for them. But that doesn’t do much good if they don’t understand what frequently used insurance terms mean. A poll conducted in late September by the country’s largest insurer, Minnesota-based UnitedHealthcare, found that only 7 percent of Americans fully understand the meanings of four basic insurance terms: premium, deductible, coinsurance and out-of-pocket maximum. (Demeria, 10/23)

The Baltimore Sun: Maryland Health Exchange Faces New Challenges In Its Fourth Year
As thousands of Marylanders begin enrolling in health insurance on the state exchange starting next week, they'll face significantly higher premiums that nationwide have turned the Affordable Care Act into even more of a political issue that it already was. Rates for insurance plans purchased through the online marketplace will increase no less than 20 percent, making it even more important for the state health officials and advocates to conduct outreach and explain the subsidies available to many buyers. (Cohn, 10/23)

Administration News

DEA Officials Stonewalled Efforts To Battle Opioid Epidemic, Investigation Finds

The Washington Post looks into the slowdown of Drug Enforcement Administration's actions during the crisis.

The Washington Post: Investigation: The DEA Slowed Enforcement While The Opioid Epidemic Grew Out Of Control
A decade ago, the Drug ­Enforcement Administration launched an aggressive campaign to curb a rising opioid epidemic that was claiming thousands of American lives each year. The DEA began to target wholesale companies that distributed hundreds of millions of highly addictive pills to the corrupt pharmacies and pill mills that illegally sold the drugs for street use. Leading the campaign was the agency’s Office of Diversion Control, whose investigators around the country began filing civil cases against the distributors, issuing orders to immediately suspend the flow of drugs and generating large fines. But the industry fought back. (Bernstein and Higham, 10/22)

The Washington Post: How Drugs Intended For Patients Ended Up In The Hands Of Illegal Users: ‘No One Was Doing Their Job’
For 10 years, the government waged a behind-the-scenes war against pharmaceutical companies that hardly anyone knows: wholesale distributors of prescription narcotics that ship drugs from manufacturers to consumers. The Drug Enforcement Administration targeted these middlemen for a simple reason. If the agency could force the companies to police their own drug shipments, it could keep millions of pills out of the hands of abusers and dealers. That would be much more effective than fighting “diversion” of legal painkillers at each drugstore and pain clinic. (Bernstein, Fallis and Higham, 10/22)

In other news from the opioid crisis —

The Associated Press: Insurer Cigna Eases Rules For Opioid Addiction Medication
The health insurer Cigna has agreed to end a policy that required physicians to fill out extra paperwork before they could give patients a drug used to treat opioid addiction. The move announced Friday comes after New York Attorney General Eric Schneiderman raised questions about whether Cigna’s requirement created unnecessary treatment delays. (10/21)

WABE: GBI Expands Morgue To Handle Drug Overdose Death Increase
More than 1,200 people in Georgia died of a drug overdose in 2014, according to the Atlanta-based Centers for Disease Control and Prevention. To keep up with the increase in these cases, the Georgia Bureau of Investigation's Medical Examiner's office in south DeKalb County is spending $4.5 million to expand its morgue and office space. (Shamma, 10/20)


Administration's Tough Campaign Against Medicare Fraud Busts Some Major Scams

The Justice Department reports that since 2010 the administration's task force has arrested and prosecuted 1,200 people for defrauding Medicare and Medicaid.

The Fiscal Times: Crackdown On Medicare Fraud Is Producing Some Impressive Results
After years of losing tens of billions of dollars through Medicare fraud, Justice Department and Health and Human Services officials, the FBI, government agency inspectors general, auditors and others have made important headway in slamming the door on fraudulent activities by doctors, hospitals, nursing home facilities, recruiters and conspiring patients. At the beginning of his second term, President Obama made combatting Medicare and Medicaid fraud a top priority – a decision that has led to a series of high-profile arrests and prosecutions by federal and state law enforcement agencies. (Pianin, 10/23)

The Hill: Nursing Homes Challenge New Rule Giving Residents Right To Sue
The nursing home industry is fighting back against new rules from the Obama administration that would give patients at federally funded facilities the right to settle disputes in court. Starting Nov. 28, nursing homes that accept Medicare and/or Medicaid funds will be banned from using pre-dispute arbitration clauses in resident contracts. The policy is being enacted under new rules from the Centers for Medicaid and Medicare services (CMS). The arbitration language — often slipped into the fine print — forces residents to settle disputes privately with an arbitrator rather than through the courts. (Wheeler, 10/23)

Veterans' Health Care

VA Refuses To Disclose Internal Rankings For Its Medical Centers

The Department of Veterans Affairs says that patient satisfaction surveys should be used as a true measure of improving care. But it's unclear if such surveys exist or how those satisfaction scores would compare to non-VA facilities.

Arizona Republic: VA Touts Patient Satisfaction, But Its Findings Are Questionable
Leaders at the Department of Veterans Affairs have asserted for more than two years that medical care and service for America’s ex-warriors should be measured not by how long patients wait for appointments, but how they respond to surveys. Indeed, Secretary Bob McDonald and his team tout industry-recognized satisfaction surveys as evidence that VA hospitals are more customer friendly than other medical centers. Despite months of requests, however, department administrators have failed to produce clear proof of those claims. (Wagner, 10/21)

Public Health And Education

Examination Of 130 Shootings Offers Panoramic View Of Key Problems With Guns In America

The New York Times investigates the circumstances of 130 cases in which four or more people were shot, at least one fatally, and investigators identified at least one attacker. The results offer a look at fundamental cracks in the system, including how mental health issues play a role.

The New York Times: What 130 Of The Worst Shootings Say About Guns In America
After nearly two decades of expanding legal access to firearms, a succession of horrific shootings like Mr. Houser’s have refocused attention on gun control. Since the 2012 massacre of 26 elementary school children and teachers in Newtown, Conn., gun control advocates have scored some significant victories in state legislatures. Nationwide, several polls suggest that public opinion has shifted markedly in favor of stricter gun laws. And for the first time since Al Gore called for tighter firearm restrictions in his losing 2000 campaign, gun control is a top-level issue in the presidential contest, as well as in two close Senate races and four state ballot initiatives. (LaFraniere and Palmer, 10/21)

In other news —

Kansas Health Institute: Handling Kansans With Mental Illness A Matter Of Training For Law Enforcement 
In particular, police approaches to mental illness exist along an urban-rural divide within the state. Large and midsize cities in Kansas have access to greater resources, while law enforcement in small towns and rural areas must grapple with limited resources and simple geography: Vast expanses of land often separate police from mental health professionals. But police, especially in the eastern part of the state, also face acute challenges stemming from ongoing problems at the state’s psychiatric hospitals. With some individuals waiting days to be admitted to Osawatomie State Hospital, officers have grown increasingly frustrated. (Shorman, 10/24)

Kansas Health Institute: Washington State Takes Lead On Police Mental Health Training 
Legislators in Washington state broke new ground in 2015 when they passed a bill requiring all law enforcement officers to be trained for encounters with people in mental health crises. ... Law enforcement experts nationwide hail the mental health training as useful, given how frequently officers deal with people in crisis since states began moving away from institutionalizations in the 1960s. But nearly every state, including Kansas, leaves the decision of whether to require the training up to local jurisdictions.Local law enforcement agencies were reluctant to give up that authority in Washington, too, but the Ostlings and their partners showed how to make the mandate palatable. (Marso, 10/24)

Houston Chronicle: Team Uses Low-Key Uniforms And Patience When Interacting With County's Mentally Ill 
One of eight deputies with the sheriff's office Crisis Intervention Team, Gary] Kidder responds to calls about "consumers," as police say, with symptoms of mental illness. Sometimes, this means a person is threatening suicide, or freaking out on some illicit drugs, or trying to escape a psychiatric facility. Kidder and his peers are specially trained to de-escalate these situations as best they can. They take the time needed to proceed without force and estimate that they transport consumers to a hospital in roughly every other case. (Foxhall, 10/22)

Extremely Early Intervention: Scientists Try To Prevent Mental Illness Prenatally

Researchers gave the B vitamin choline to pregnant women, and found it successful in reducing pre-markers for schizophrenia after the child was born. In other news on children's health, a mother hunts down the mysterious cause of her son's paralysis, doctors turn away unvaccinated patients, the American Academy of Pediatrics updates its recommendations on SIDS and a doctor's drug warning.

NPR: Can Mental Illness Be Prevented In The Womb?
Every day in the United States, millions of expectant mothers take a prenatal vitamin on the advice of their doctor. The counsel typically comes with physical health in mind: folic acid to help avoid fetal spinal cord problems; iodine to spur healthy brain development; calcium to be bound like molecular Legos into diminutive baby bones. But what about a child's future mental health? (Stetka, 10/22)

Chicago Tribune: Should Doctors Turn Away Unvaccinated Children To Protect Other Patients?
Childhood immunizations remain a deeply divisive issue. And though studies purporting to link vaccines to autism have been widely discredited, pockets of parental resistance persist: According to surveys by Elk Grove Village-based American Academy of Pediatrics of its member physicians, more doctors in 2013 than in 2006 reported encountering vaccine-hesitant families. In a report released in September, the academy also revealed that as parents decline to have their children vaccinated, more pediatricians are turning such families away in the name of safeguarding the health of other patients. (Thayer, 10/24)

The Washington Post: Updated Guidelines On Infant Sleep Highlight Danger Of Parents’ Tiredness
The American Academy of Pediatrics updated its advice on how to prevent sudden infant death syndrome (SIDS) and other sleep-related deaths in a policy statement released Monday. The guidelines reaffirm many of the recommendations from the AAP’s previous policy, published in 2011. Parents should place babies to sleep on their backs and on a firm surface without any soft or loose bedding. It’s safest for babies to sleep in the same room as their parents but not in the same bed. (Callahan, 10/24)

WBUR: Leading Psychosis Expert To His Students: To Avoid Risk, Hold Off On Pot Til 30
Virtually all American schoolchildren are told that starting alcohol or drugs early could be bad for their brains. But Öngür's warning to his medical students stems specifically from a body of research that has been accumulating since the 1980s, suggesting that heavy marijuana use early on -- mainly in the teen years, but also into the 20s — is linked to a higher risk of psychosis. A review paper in the peer-reviewed journal Biological Psychiatry this April summed up 10 long-term studies to date, most with sample sizes in the thousands, and concluded: "Overall, evidence from epidemiologic studies provides strong enough evidence to warrant a public health message that cannabis use can increase the risk of psychotic disorders." (Goldberg, 10/21)

And some common myths are busted —

The Washington Post: Sugar Doesn’t Hype Kids Up, Vaccines Don’t Cause The Flu, And Other Myths, Busted.
As you think about decorating for the holidays, don’t worry about having poinsettias around. “Those beautiful flowers you’ve been so wary of keeping in your home during the holidays (lest they poison pets or children) are not toxic,” Live Science reports in “25 Medical Myths that Just Won’t Go Away,” citing a study that looked at nearly 23,000 cases of poinsettia exposure reported to poison control centers. None were fatal, and the most severe reactions were stomachaches. This is just one of the supposed medical facts that the website knocks down as myth. (Shapiro, 10/21)

Researcher At National Cancer Institute Was Late Notifying Authorities About Deaths In Study

The delay in reporting the problems in a study of drugs to treat lymphoma is troubling, said National Institutes of Health Director Francis Collins. In other news, a look at the racial disparities in breast cancer survival rates and issues surrounding the HPV vaccine recommendations.

The Washington Post: National Cancer Institute Researcher Was Months Late In Notifying Authorities About Deaths
A National Cancer Institute researcher running a lymphoma trial was late by several months in notifying authorities that two patients had died of fungal infections that might have been caused by the experimental treatment, officials have concluded. The reporting lapses were described Friday by National Institutes of Health Director Francis Collins, acting NCI Director Doug Lowy and other officials at a meeting of a new board that is advising Collins on patient safety and other issues at NIH's flagship hospital, the Clinical Center. (McGinley, 10/21)

The Philadelphia Inquirer: Looking For Answers On Gap In Breast Cancer Survivors
The disparity is as troubling as it is profound. Eight percent of Caucasian women die within five years of being diagnosed with breast cancer. Among African American women, the toll is 21 percent. But what about women who do survive? Recently, researchers at Villanova University and the Sidney Kimmel Cancer Center at Thomas Jefferson University published a study looking at issues affecting African American women after treatment for breast cancer. (Bauers, 10/23)

Kaiser Health News: Is 20-Something Too Late For A Guy To Get The HPV Vaccine?
Television is making me anxious about sex — more anxious than usual. I keep seeing scary ads featuring young people asking their parents why they didn’t get the vaccine to protect against the human papillomavirus — HPV. If you’re unfamiliar with HPV, it’s a sexually transmitted infection that has been linked to various cancers, including cervical cancer in women. I didn’t get vaccinated. So lately I’ve been wondering: Now that I’m 29, is it too late for me to get the vaccine? (Harper, 10/24)

Columbus Dispatch: Local Doctors Embrace New HPV Vaccine Recommendation
Despite its proven ability to help protect against cervical and other cancers, families and even some doctors have been slow to embrace the HPV vaccine. So local advocates cheered this week when a government panel said kids younger than 15 need just two shots — down from three — to develop immunity to the most worrisome strains of human papillomavirus. (Price, 10/21)

Sharp Lines Drawn Over Hospitals' Decision To Not Sell Sugary Beverages

Some say it's practicing what they preach, while others cry, "Just give 'em a Coke."

Stat: Hospitals Are Refusing To Sell Sugary Drinks, Drawing Grumbles
With obesity rising, more hospitals across the country are dropping sugary drinks from cafeterias and vending machines — and angering employees and visitors in the process.“ It’s ridiculous,” said Terry Vincent, a surgical technologist eating lunch one recent afternoon in a hospital cafeteria at the University of California, San Francisco, which stopped selling sugar-sweetened drinks on its campuses one year ago. Many visitors spend long, stressful hours at the hospital sitting vigil with loved ones, he pointed out, adding: “Give ‘em a Coke!”Officials at UCSF say the policy is popular among staff, and is helping to trim their waistlines, but many workers on their lunch break begged to differ. (Bailey, 10/24)

In other news on nutrition —

The Hill: Salt Guidelines Draw Heavy Backlash 
The Food and Drug Administration (FDA) is picking a food fight with an effort to reduce the amount of salt in the American diet. The agency says a typical American eats about 3,400 milligrams of sodium each day, most of which is already in the food before it is purchased at a store or restaurant, giving consumers little control over the salt they consume. The FDA wants to change that and is drafting voluntary guidelines that encourage food manufacturers to limit the sodium content in all of their products. (Devaney, 10/21)

Legal, Ethical Questions Arise Over Patients Who Stop Eating, Drinking To Speed Death

Sometimes patients aren't willing to go through the process of securing aid in dying legally, or they live in a state where it is not allowed. Instead, they decide to just stop eating and drinking. In other public health news, a warmer ocean is leading to the spread of a flesh-eating bacteria, experts warn that letting dogs lick their owners face is dangerous, hydration therapy comes under scrutiny from skeptics and more.

The New York Times: The VSED Exit: A Way To Speed Up Dying, Without Asking Permission
At 91, Ms. Greenfield told her family she was ready to die. ... Then her son-in-law, a family physician who had written such prescriptions for other patients, explained the somewhat involved process: oral and written requests, a waiting period, two physicians’ assent. “I don’t have time for that,” Ms. Greenfield objected. “I’m just going to stop eating and drinking.” In end-of-life circles, this option is called VSED, for voluntarily stopping eating and drinking. It causes death by dehydration, usually within seven to 14 days. (Span, 10/21)

The New York Times: Should You Let Your Dog Lick Your Face?
It seems harmless enough. You get nose to nose with your dog and talk to it as it laps at your mouth and cheeks with its tongue, or you come home from work and bring your lips to your dog’s in a greeting to say hello. It may feel like the ultimate display of affection, but when it comes to such kisses, experts caution: Beware of dogs. (Mele, 10/21)

Kaiser Health News: Skeptics Question The Value Of Hydration Therapy For The Healthy
Yana Shapiro is a partner at a Philadelphia law firm with an exhausting travel schedule and two boys, ages 9 and 4. When she feels run-down from juggling everything and feels a cold coming on, she books an appointment for an intravenous infusion of water, vitamins and minerals.“ Anything to avoid antibiotics or being out of commission,” the 37-year-old said. After getting a 100-milliliter drip of a liquid the clinic calls immune protection pumped directly into her bloodstream via a needle in her arm, Shapiro said she feels like “a new person.” (English, 10/24)

The Augusta Chronicle: AU Team Tries To Alter Genes To Fight Disease
The AU team has a five-year, $2.6 million grant from the National Institutes of Health to build a multi-step process in mice that they hope will correct a model of Duchenne muscular dystrophy, a progressive muscle-destroying disease. The muscles deteriorate because they lack a key element called dystrophin. Scientists located the gene and the mutation that causes it nearly 30 years ago but have been unable to exploit that until very recently, said Dr. Mark Hamrick, Regents' professor of cellular biology and anatomy. The Food and Drug Administration last month approved the first drug to treat muscular dystrophy, but the drug applies only to a particular form of the disease that affects about 13 percent of the patients with Duchenne muscular dystrophy, the agency said. (Corwin, 10/23)

Miami Herald: Zika Virus: Pregnant Couples In Miami-Dade Deal With Danger In Different Ways 
In Miami, where the Zika virus continues to be transmitted by mosquitoes, pregnant women are taking all sorts of measures to deal with the potential threat. Some barricade themselves inside, others leave town and a few, like [Sloane] Borr, take other precautions.When she took the photo in September, Borr was trying to be a little light-hearted with her worry about the virus, which can cause microcephaly in fetuses, leaving infants with severe physical and mental disabilities... She fled to Boston to be with family and was tested for Zika by an obstetrician there. The test showed she was Zika-free. (Harris, 10/21)

State Watch

The Missing Element In Tennessee's Executive Health Care Landscape: Women

Women — often nurses, health aides and administrators — comprise about 80 percent of the national health care workforce, but the presence of women dwindles on the higher rungs of the corporate ladder.

Nashville Tennessean: Health Care Still A Man's World
Just five out of 100 health care companies and health systems across Tennessee are currently run by a woman, a Tennessean analysis found. The survey included Saint Thomas Health and UnitedHealthcare Community Plan of Tennessee, which are locally based subsidiaries of larger companies. None of the publicly traded health care companies have female CEOs. ... Relative to the pool of workers, health care is far behind other industries, said Corbette Doyle, a lecturer at Vanderbilt University who is writing a dissertation on women in health care leadership. Yet the presence of women dwindles on the higher rungs of the corporate ladder. There are several companies that have only male executives listed on websites, and a few with no women on the corporate boards. (Fletcher, 10/23)

Nashville Tennessean: The Way Forward For Women In Health Care From Those Who Rose The Ranks
The disconnect between health care consumers and executive decision-makers is a hitch, especially since the industry needs more people to get preventative care and pay bills. Basic things, really, for an industry that needs to get paid for keeping people alive and well. Women make up about 80 percent of the health care workforce and make about 85 percent of families' health care decision. Yet, out of 100 companies, health systems and Tennessee-based subsidiaries, only five are run by women. (Fletcher, 10/23)

State Highlights: Flint Crisis Continues To Shape Residents' Lives; Rikers Embraces Telemedicine For Inmates

Outlets report on health news from Michigan, New York, Maryland, New Hampshire, Tennessee, Ohio, Washington, Louisiana, Virginia, Florida and California.

The Washington Post: ‘If I Could Afford To Leave, I Would.’ In Flint, A Water Crisis With No End In Sight.
Even now, the people of Flint, Mich., cannot trust what flows from their taps. More than one year after government officials finally acknowledged that an entire city’s water system was contaminated by lead, many residents still rely on bottled water for drinking, cooking and bathing. Parents still worry about their kids. Promised aid has yet to arrive. In ways large and small, the crisis continues to shape daily life. (Dennis, 10/22)

Modern Healthcare: Telemedicine Goes Behind Bars To Help Jail Inmates At Rikers 
Inmates can spend six to eight hours shackled in holding pens and sitting in traffic as they travel to NYC Health & Hospitals' Bellevue campus for five minutes with a doctor...[Dr. Vinh] Pham and his colleagues came up with a solution. Earlier this year, they introduced telemedicine to Rikers Island, which has some 55,000 inmates come through its doors annually. Since the initiative began in May, 52 inmate patients have had virtual checkups and information visits with Bellevue's infectious disease, gastroenterology and urology specialists. They allow Pham and others to spend up to 30 minutes with a patient answering questions and ordering treatment when necessary. (Teichert, 10/22)

The Baltimore Sun: Drug To Protect Against HIV Not Reaching Those Most At Risk
Many of the people most at risk of contracting HIV in Baltimore know nothing about a drug that is 92 percent effective in preventing the infection, according to new research from the Johns Hopkins Bloomberg School of Public Health. Only about 40 percent of gay and bisexual men with no HIV diagnosis had heard of pre-exposure prophylaxis medication, or PrEP, according to findings published this month in the American Journal of Preventive Medicine. (McDaniels, 10/21)

NH Union Leader: GOP Lodges Right-To-Know Suit, Claims Hassan Holding Back Hitchcock Contract Info 
The New Hampshire Republican State Committee will launch a Right-to-Know lawsuit today, charging that Gov. Maggie Hassan and key state agency heads refused to turn over damaging information about the controversial, Dartmouth-Hitchcock contract to staff the state psychiatric hospital. The suit being filed in Merrimack County Superior Court comes after the Hassan administration answered Right-to-Know requests from GOP State Chairman Jennifer Horn about the $37 million contract for New Hampshire Hospital. (Landrigan, 10/23)

Nashville Tennessean: Business, Health Care Execs To Steer Frist's Health Initiative
Nashville health care and business leaders — from HCA, Bridgestone Americas and Bank of America, among others — have joined the board of former Sen. Bill Frist's initiative to not only make the city healthier but a model for other cities trying to tackle bad health. NashvilleHealth, Frist's one-year-old organization, is trying to tackle the gulf between the health care expertise in Davidson County and the health of residents, which lags many of its metro peers. The state, too, is struggling with years of residents with poor health and chronic disease despite being home to many top health care companies. (Fletcher, 10/23)

Columbus Dispatch: Grief, Questions Linger In Infection Death After Heart Transplant 
The room at UPMC Presbyterian, known as a negative-pressure room, is intended to house patients with an infectious disease so any air they might infect does not flow to other areas. The ventilation system, which is designed to pull outside air into a room, could increase infection probability for a transplant patient taking immunosuppressant drugs. A Centers for Disease Control and Prevention report in December advised UPMC not to house transplant patients with compromised immune systems in negative-pressure rooms... The report was issued after three transplant patients who contracted fungal infections at Montefiore or Presbyterian died within a year. (Schmitt, 10/24)

Seattle Times: Seattle Pain Centers Director Denies State’s Claims In Patients’ Deaths 
The former medical director of a shuttered chain of Washington pain clinics is forcefully denying allegations he failed to properly monitor Medicaid patients’ opiate use, possibly contributing to 18 deaths since 2010. In a 19-page response to charges by the state Medical Commission, Dr. Frank Li contends he never saw five of the patients himself, treated eight of the 18 only one or two times and shouldn’t be held liable for the acts of providers he supervised at Seattle Pain Centers. In addition, Li, 48, denied that his business model focused on hiring newly licensed practitioners with little pain-management experience or that he ordered excessive numbers of urine screenings and unnecessary medical equipment to boost fees. (Aleccia, 10/21)

St. Louis Post Dispatch: DaVita Encouraged Some Low-Income Patients To Enroll In Commercial Plans
Internal emails from DaVita HealthCare Partners Inc. show the Denver-based company targeted some patients in a campaign to get them to buy insurance they didn’t necessarily need, saying their monthly premiums would be paid by a nonprofit foundation. DaVita, one of the nation’s largest dialysis providers, with a major presence in St. Louis, had a financial incentive to get certain Medicaid-eligible dialysis patients to enroll in private insurance. Medicaid, the government-run health insurance program for low-income Americans, pays significantly less than traditional commercial insurance for dialysis treatment. (Liss,10/23)

Richmond Times Dispatch: Care Of Preemies: VCU Health Operates Two Of HCA's Neonatal Intensive Care Units
For the past three years, HCA Virginia has contracted with VCU to operate the NICUs at HCA Virginia’s Johnston-Willis and Chippenham hospitals and bring its neonatologists and specialists to those hospitals. Officials with both health systems describe the relationship as a partnership — an example of an academic medical institution partnering with community hospitals to bring evidence-based practices and the newest research advances to the general public faster. The cooperation comes despite the hesitancy among Richmond’s three major health systems in recent years to join together for children’s issues, particularly in the development of an independent children’s hospital in the area. (Demeria, 10/22)

Detroit Free Press: Fraud Case Against Port Huron Doctor Grows
Dr. Demian Naguib was charged in December 2015 following an investigation by the U.S. Department of Health and Human Services, the Michigan Attorney General's Office and Blue Cross Blue Shield of Michigan. Naguib, who was employed through Physician HealthCare Network, is charged by the Attorney General's office with conducting a criminal enterprise, a 20-year felony; nine counts of Medicaid fraud, 4-year felonies; and nine counts of health care fraud, also 4-year felonies. He is alleged to have billed Medicaid, Medicare and Blue Cross Blue Shield for pricey procedures that were not actually completed or providing unnecessary procedures to patients to result in higher pay. (Smith, 10/22)

Health News Florida: EMT Working Group Takes A 'Balance' Approach
Consumer advocates are heralding a new Florida law that bans most balance billing. But legislators left ambulance services out of the legislation, largely because local governments play such a big role. Insurance Consumer Advocate Sha Ron James says it’s too early to say whether the group will recommend expanding a balance billing ban to cover ambulances. (Ash, 10/23)

Miami Herald: Patient’s Mangled Penis Gets South Florida Doctor In Trouble Again
One of South Florida’s most notorious plastic surgeons — linked to a string of high-profile botched surgeries and two patient deaths over the years — pleaded not guilty Friday to allegations he mangled a man’s penis during an illegal cosmetic surgery in Hialeah. A Miami-Dade judge also ordered that Mark Schreiber must post a $250,000 bond and remain on house arrest while he awaits trial for what a prosecutor called the “butchery of a human being.” (Ovalle, 10/21)

New Hampshire Union Leader: Suit Alleges Perm At Hampton Nursing Facility Led To Elderly Woman's Death
A Portsmouth woman is suing a Hampton nursing facility, claiming a chemical reaction from a perm that her mother was given in a hair salon eventually led to her death.Betty Ann Fraser filed suit earlier this month against Genesis Health Care LLC, which operates Oceanside Center. The facility provides short-stay rehabilitation and long-term care, skilled nursing and dementia services. According to the suit in Rockingham County Superior Court, Fraser’s mother, Betty M. Pettigrew, suffered a reaction after getting her hair done while she was a resident of the facility in November 2014. (Schreiber, 10/23)

California Healthline: California Releases Latest ‘Report Cards’ On Health Plans, Doctor Groups
California’s Office of the Patient Advocate Friday released its annual report cards on health plans and medical groups — tools meant to help guide consumers and employers as they shop for coverage during the upcoming open enrollment season. The report cards assign ratings to the 10 largest HMOs and five largest PPOs in the state, based on quality of care and patient experience. It also rates more than 200 physician groups. Quality of care measures include ensuring that heart patients’ blood pressure is well managed and that children get their immunizations. (Ibarra, 10/24)

Health News Florida: Campaign Against Marijuana Measure Puts A Cloud Over Existing Businesses 
After nearly four decades of a war on drugs, Americans’ opinion of marijuana appears to be changing dramatically. This month Pew Research found 57 percent of Americans support full legalization. A June Quinnipiac Poll returned a slight majority in favor of legalization as well. But it’s the narrower question of medical cannabis where the numbers are truly striking. The same nationwide Quinnipiac poll showed 89 percent favor medical use—with strong majorities in all categories whether political party, age, race, or education. (Evans, 10/23)

Editorials And Opinions

Viewpoints: Obamacare Product Problems; Health Care's Costs And Disparities

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

The Wall Street Journal: ObamaCare Catches Fire
Outside of politics, perhaps the worst new-product launch of 2016 was the Samsung Galaxy Note 7. Released in August, it was recalled twice and finally withdrawn from the market last week, all because the device has a tendency to catch fire or explode. It’s an apt analogy for the Patient Protection and Affordable Care Act, known colloquially as ObamaCare—and that’s not our opinion but that of President Obama himself. (James Taranto, 10/21)

Boston Globe: Disparities And High Costs Fuel The Health Care Crisis 
America's health crisis is really three crises rolled into one. The first is public health: America’s life expectancy is now several years below that of many other countries, and, for some parts of the population, life expectancy is falling. The second is health inequality: The gaps in public health according to race and class are shockingly large. The third is health care cost: America’s health care is by far the costliest in the world. Obamacare certainly did not solve these crises. Its main positive contribution has been to expand health coverage. (Jeffrey Sachs, 10/24)

Forbes: Hillary's Right: Obamacare Reduces Medicare Spending
After Donald Trump declined to offer a Medicare reform plan when presidential debate moderator Chris Wallace asked him last week, Hillary Clinton reminded Americans the Affordable Care Act spares seniors cuts to their health benefits for at least another decade. While this year’s election campaign has focused on rising premiums for Americans buying individual private coverage on public exchanges under the health law, key reforms to a much larger outlay of federal dollars from the Medicare entitlement wasn’t largely discussed until Fox News’ Wallace brought it up. (Bruce Japsen, 10/23)

Modern Healthcare: Predicting Medicare Spending Is Hard, Especially If It's In The Future
The debates are over, but let's not pick on the candidates. Let's take a closer look at the nonsense spouted by Fox News moderator Chris Wallace on the state of our “entitlements,” which I prefer to call retirement benefits after a lifetime of hard work and paying taxes. Medicare, Wallace said, “is going to run out of money in the 2020s … and at that time, recipients are going to take huge cuts in their benefits.” That's not true. (Merrill Goozner, 10/22)

Des Moines Register: Branstad's Unproven Medicaid Claims Piling Up
Iowans do not know what is being saved, gained or improved by the privatized Medicaid model Branstad foisted on this state. What we do know: Health care for vulnerable people has been disrupted, providers have been run out of business and for-profit insurers are pocketing millions of public dollars. And the governor says things are great. (10/22)

Boston Globe: Children’s Hospital Expansion Effort Didn’t Have To End This Way 
For months I have railed against the Children’s expansion plan. Not necessarily because the services this new medical monument will provide aren’t needed, but because the hospital has deftly crafted a false choice.Its message? You can have your 23,000-square-foot patch of emerald green with its bunny rabbits and tinkling fountains, or we can save dying kids — our little patients fighting for their lives. That’s always been a bogus argument. (Thomas Farragher, 10/21)

U.S. News & World Report: The Enemy Of The Good
The economics of American health care is undergoing a profound shift. Employers, policymakers and other purchasers of health care are increasingly paying health care providers based on the benefit to the patient. For instance, the Centers for Medicare & Medicaid Services, or CMS, the agency that runs Medicare, adjusts payments to hospitals based on how well they perform on measures of patient experience, readmissions and patient safety. Private payers, too, are increasingly negotiating contracts tied to quality and safety performance. (Leah Binder, 10/21)

USA Today: Marijuana On The Ballot: Our View
As voters in five states consider ballot measures next month to legalize marijuana for recreational use, supporters and opponents can pluck a statistic to back just about anything they want to argue about the issue. But amid a gaggle of dueling studies, the truth is that the state experiments in legalizing recreational use are still too new to yield definitive results about the harms and benefits to society. (10/23)

USA Today: NORML: Marijuana Is Here To Stay
Contrary to the fears of some, these policy changes are not associated with increased marijuana use or access by adolescents, or with adverse effects on traffic safety or in the workplace. Marijuana regulations are also associated with less opioid abuse and mortality. In jurisdictions where this retail market is taxed, sales revenue has greatly exceeded initial expectations. (Paul Armentano, 10/23)

Stat: How My Forever Moments Have Shaped Me As A Doctor
Health care is filled with forever moments for patients and their family members, who often feel vulnerable and isolated during these stressful experiences. One of the many important jobs of health care providers is to help patients and families through these times by being sensitive to and supportive of what they are going through. ... Complicating matters further is that time with patients is often dominated by digital distractions and measured productivity pressures. (Nathan Merriman, 10/21)

Los Angeles Times: Ensuring Access To Safe Drinking Water Ought To Come Before A Push For Soda Taxes
Tobacco executives must be thrilled that soda has become a prime target of public health activists. These days, it is seen as a slow-acting poison that contributes to type 2 diabetes, obesity and other health disorders. To some health officials, it is as threatening as cigarettes. ... But before they determine that such taxes are the appropriate policy prescription everywhere, public health advocates need to know that consumers have affordable, accessible, healthy alternatives to soda. ... Drinking water is clearly the best answer, but that assumes everyone has access to clean water. They don’t. (10/21)

Bloomberg: House Republicans Wage War On Medical Research
The House Energy and Commerce Committee has a Select Investigative Panel on Infant Lives that has held only two hearings since it was created a year ago. Its meetings are marked by walkouts and little substantive discussion. Many House members, including some Republicans, hope it will expire by year-end. Some medical experts say this special committee may seem like a joke but is nonetheless having a chilling effect on important medical research. The issue is the use of fetal tissue taken from aborted fetus that would otherwise be discarded. (Albert R. Hunt, 10/23)

St. Louis Post-Dispatch: Why Medical Research Advocates Are So Concerned About Amendment 3
Missouri Cures and its coalition partners have deep concerns that the proposed tobacco tax initiative known as Amendment 3 will adversely affect patient care, medical research and innovation in our state. Our coalition includes BioSTL, Missouri Biotechnology Association, Stowers Institute for Medical Research and Washington University and thousands of disease groups and patients. (Dena Ladd, 10/23)

RealClear Health: When Good Intentions Do Bad Things
Breast cancer is a common disease – 1 in 8 women and a small number of men will be afflicted over their lifetimes. This year alone, approximately a quarter of a million new cases will be diagnosed and 40,450 women will die. That means everyone is more and more likely to have a wife, mother, daughter or friend with the disease. Naturally, we want to “do something” about it. A just released study in the New England Journal of Medicine by Dartmouth researchers suggests that mammography screening, as presently practiced, may be the wrong prescription. (Joel M. Zinberg, 10/24)