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: 'Walkie Talkie'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Walkie Talkie'" by Steve Kelley.

Here's today's health policy haiku:

CALIFORNIA’S TOBACCO TAX: HOW WILL THE MONEY BE SPENT

Is it straight forward?
Or do the details create
policy questions.

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

Trump Cherry Picks Stats When Citing 60-Percent Obamacare Premium Hikes

The Washington Post fact checks one of Donald Trump's go-to lines about the health law. In other election 2016 news, a look at the health policy experts both candidates have tapped for their transition teams and more out of the states.

The Washington Post's Fact Checker: Trump’s Claim That Obama Is Trying To ‘Delay’ Obamacare Enrollment Until After The Election
This is one of Trump’s go-to lines about premium increases under the Affordable Care Act, or Obamacare. He warns of premium increases of 40, 50, 60 percent — and alleges that the Obama administration is trying to delay open enrollment, scheduled for Nov. 1, until after the election because the drastic rate hikes will be “election-defying.” Are his claims accurate? (Lee, 9/26)

Modern Healthcare: The Next Administration Is Already Charting Its Healthcare Course
Neither camp has publicly floated names of the people likely to lead HHS and its component agencies, which include the CMS, the Food and Drug Administration, the Office of the National Coordinator for Health Information Technology, the Centers for Disease Control and Prevention and the National Institutes of Health. ... But Democrat Hillary Clinton and Republican Donald Trump have reportedly tapped policy experts with some healthcare experience for their transition teams. (Muchmore, 9/24)

California Healthline: Tobacco Tax Ballot Measure Would Fund Health Care For California’s Poor
At first blush, the tobacco tax measure on California’s November ballot looks pretty straightforward. Proposition 56 would raise the price of a pack of cigarettes by $2 and tax e-cigarettes for the first time. Proponents say the higher price would prevent kids from smoking and lower health care spending because people won’t suffer as much from tobacco-related illness.What’s not spelled out is how exactly money raised through the measure would be spent. (Bartolone, 9/23)

Kaiser Health News: Election Buzz: A Look At Brain Science As 5 States Vote On Legalizing Pot
Five states — California, Arizona, Nevada, Maine and Massachusetts — are voting this fall on whether marijuana should be legal for recreational use. That has sparked questions about what we know — and don’t know — about marijuana’s effect on the brain. Research is scarce. The U.S. Drug Enforcement Agency classifies marijuana as a Schedule I drug. That classification puts up barriers to conducting research on it. (Bebinger, 9/26)

Tampa Bay Times: Anti-Pot Group Spends $1.3M As Medical Marijuana Boosters Keep Fundraising 
State campaign finance records released Friday show that United for Care, the group behind the constitutional amendment, called Amendment 2, raised $20,000 last week, most of it from donations $1,000 or less.No on 2, the campaign opposing the measure, raised just $1, but they've started using major donations to produce and buy ads. Records show that Drug Free Florida, the political committee opposing medical marijuana, spent more than $1.3 million that same week, most of it going to Jamestown Associates, an ad buying firm. (Auslen, 9/23)

Capitol Hill Watch

Dems Accuse GOP Of 'Cynical' Opioid-Funding Ploy In Stopgap Bill

Because the $37 million that is included in the spending bill is pro-rated, the administration will only actually get about $7 million to begin implementing a measure to curb opioid abuse during the 10 weeks that the stopgap measure would be in effect. Meanwhile, the spending fight has shifted focus from Zika to Flint.

Morning Consult: Opioid Funding In CR May Be Less Than Expected
The administration will only receive a fraction of the $37 million that is provided in a short-term continuing resolution to implement a recently-passed law addressing opioids, Democrats say. Republicans and Democrats disagree over how much new opioid funding — which both sides support — is included as part of the stopgap spending measure. The GOP-backed continuing resolution to keep the government funded through Dec. 9 was introduced on Thursday. A procedural vote on the measure is slated for Tuesday. (McIntire, 9/23)

The Hill: Spending Fight Shifts From Zika To Flint
Democrats in both chambers are threatening to reject the GOP's latest budget proposal because it ignores the city's lead contamination but provides relief for flood victims in Louisiana. Republican leaders will have five days to avert a shutdown when they return to Capitol Hill next week. (Ferris, 9/26)

The Hill: Black Caucus Demands Flint Funding From GOP
Democrats in both chambers have threatened to reject the GOP’s latest budget proposal because it ignores the city’s lead contamination but provides relief for flood victims in Louisiana. The letter from caucus chairman G.K. Butterfield (D-N.C.), along with two other members from Michigan, does not specifically say they will vote against the spending bill if it doesn’t include the money for Flint. (Ferris, 9/23)

And in other news from Capitol Hill —

Morning Consult: Fight Over Pediatric Bill Ends In Tepid Compromise
A program that encourages the development of treatments for rare pediatric diseases could be extended until December under a compromise between liberal stalwarts Sens. Elizabeth Warren (D-Mass.) and Bernie Sanders (I-Vt.) and sponsors of a bill to extend the program for five years. As of now, there is language in a pending continuing resolution to extend the program through Dec. 9, the same time period as the stopgap spending bill. The Senate is slated to take a procedural vote on the bill, which Democrats oppose for other reasons, on Tuesday. (Owens, 9/22)

Health Law Issues And Implementation

Democratic Senators Press Aetna CEO About Decision To Leave Marketplaces

In a second letter to Mark Bertolini, the senators question whether the insurer's decision to pull back from many exchanges was related to the Justice Department's decision to challenge Aetna's planned merger with Humana. Also, Nebraska loses one of its marketplace insurers.

Morning Consult: Senate Democrats Again Question Aetna’s Exchange Withdrawal
A group of Democratic senators sent a second letter to Aetna’s CEO on Friday, demanding the company answer questions about its decision to pull out of Obamacare exchanges. The senators sent another letter to CEO Mark Bertolini earlier this month, but they said Aetna failed to answer their questions. Aetna announced this summer it would be withdrawing from most Obamacare exchanges after suffering losses. Some members have questioned the timing of the announcement, which came after the Department of Justice challenged Aetna’s proposed merger with Humana. (Owens, 9/23)

The CT Mirror: Senators Press Fight With Aetna Over Quitting ACA Exchanges
The senators had written Bertolini on Sept. 8, asking the Aetna chief about his decision to withdraw from 11 Affordable Care Act exchanges after the Justice Department challenged Aetna’s proposed merger with Humana. The senators asked Bertolini to respond to 12 questions, including “what exact costs Aetna will incur now that the Justice Department has challenged the merger” and how much it will cost the company if the merger is ultimately blocked. They also asked Bertolini why his company agreed to pay Humana a $1 billion breakup fee if the merger were not approved and whether the company was aware this payment would endanger its participation in the ACA exchanges. (Radelat, 9/23)

The Hill: Blue Cross Of Nebraska Dropping Out Of ObamaCare Market
Blue Cross Blue Shield of Nebraska announced Friday that is pulling out of the ObamaCare marketplace in the state, becoming the latest insurer to cite financial losses when reducing participation in the healthcare law. The move is especially significant given that it is a Blue Cross plan, which form the backbone of the ObamaCare marketplaces. Nebraska, though, will still have two insurers, Aetna and Medica, on its marketplace next year. (Sullivan, 9/23)

Medicare

Experts Raise Concerns About Medicare's Efforts To Bundle Payments In Wake Of New Study

“CMS is doubling down on bundled payments without a lot of evidence,” Dr. Chad Ellimoottil, an assistant professor at the University of Michigan who has studied alternative payment models, tells Modern Healthcare. Implementing payment reforms does not “flip a switch and all of a sudden hospitals are way more efficient.”

Modern Healthcare: Rapid Adoption Of Bundled Payments Remains An Act Of Faith
Bundled payments, by some estimates, are taking off more quickly than any other value-based payment scheme. But a dearth of data obscures the model's actual effect on the costs and quality of healthcare, a challenge underscored in the latest report on Medicare's voluntary Bundled Payments for Care Improvement initiative. ... Medicare's Comprehensive Care for Joint Replacement model, which began in April and is mandatory for 800 hospitals across 67 metropolitan areas, bundles payments for hip and knee replacements. In July, the CMS proposed introducing mandatory bundled payments for bypass surgery and heart attacks in 98 metro areas. Overall, the administration aims to tie 90% of traditional Medicare fee-for-service payments to quality or value by 2018. (Whitman, 9/22)

And on the issue of enrolling for Medicare Advantage plans --

North Carolina Health News: Letter from Insurer Could Contain Unwanted Medicare 'Conversion'
State insurance officials say that a letter from someone’s current insurance company could soon notify the beneficiary that the person has been automatically enrolled in a private “Medicare Advantage” plan instead of traditional Medicare. Under the process called “seamless conversion,” the letter says, the person has to take the active step of opting out to prevent the “conversion” from taking effect. (Goldsmith, 9/26)

Medicaid

Texas Supreme Court Allows Medicaid To Cut Therapists Pay For Disabled Children

The legislature approved $350 million in cuts last year, but therapists had sued the state, warning the changes in pay would drive many professionals from treating the children. The court declined to hear the case. News outlets also report on Medicaid cuts in Florida and an analysis of managed care programs in Medicaid.

Dallas Morning News: Court Will Let Texas Cut Medicaid Payments To Therapists For Disabled Children
Last year, the Legislature approved $350 million in Medicaid cuts, mostly toward therapy providers for disabled children. Opponents of the cuts warned that they would disrupt care for tens of thousands of disabled children, especially in rural areas of Texas. The high court temporarily blocked the cuts a week before they were scheduled to take place in July 2015. A state appeals court in April of this year ruled that providers and patients lacked jurisdiction to sue. The Supreme Court did not offer an explanation for its decision to allow the appeals court's ruling to stand. (Ketterer, 9/23)

Sarasota (Fla.) Herald Tribune: Medicaid Transition Causes Hardship
Born three months prematurely, Wyatt has struggled every day of his 22 months. But after nearly a year in the neonatal intensive care unit at Johns Hopkins All Children’s Hospital, continuous surgeries and in-home therapies covered by the Children’s Medical Services Medicaid program, Wyatt’s condition has vastly improved. Yet the program that the Ipes expected would help continue his recovery is in turmoil. In an effort to cut costs and scale down the program for children with special health care needs, lawmakers and administrators at the Florida Department of Health have laid off hundreds of department employees and disqualified nearly 13,000 previously eligible children. (Clark, 9/24)

Modern Healthcare: Only 11 Medicaid Managed-Care Plans Have More Than 1 Million Members
Consolidation in the insurance industry means Medicaid beneficiaries have fewer coverage options under managed care, according to a new analysis from PWC. Following the 26% growth in Medicaid over the past two years due, in part to expansion under the Affordable Care Act, 75.2 million Americans, or 23.4% of the nation's population, are now enrolled in the Medicaid program. Of those, 73% are now in private plans; that's up from 55% in 2013. (Dickson, 9/23)

Forbes: Insurers Add 3 Million Medicaid Patients Despite Election-Year Gridlock
The expansion of Medicaid benefits, thanks largely to the Affordable Care Act, helped increase enrollment in private health plans by 3.4 million in the last year, according to a new report from consulting firm PwC. Managed-care plans are taking on an unprecedented role in providing health coverage to poor Americans thanks in part to more states opting to go along with the ACA’s Medicaid expansion. (Japsen, 9/23)

Health IT

Patient Mix-Ups Leading To Dire Consequences

“This is a huge problem that the general public isn’t aware of,” said William Marella, executive director for operations and analytics at the ECRI Institute’s Patient Safety Organization.

The Wall Street Journal: Medical Record Mix-Ups A Common Problem, Study Finds
A patient in cardiac arrest was mistakenly not resuscitated because clinicians confused him with a patient who had a do-not-resuscitate order on file. Another patient was given an okay to undergo surgery based on a different patient’s records and was found dead in his hospital room the next day. Such patient-identification mix-ups are common and can have deadly consequences, according to a report from the ECRI Institute, a nonprofit research group that studies patient safety. (Beck, 9/25)

In other health technology news —

The Washington Post: Hey, Siri, Am I Drunk?
Are you sober enough to drive? The familiar way to test levels of blood alcohol (without actually drawing blood) is with breathalyzers. They are used by police trying to identify drunk drivers and in ignition-locking devices designed to prevent intoxicated people from starting a car. But breath analysis can be distorted by such factors as ambient humidity and the use of mouthwash. Research has shown that sweat might provide a more reliably accurate medium. (Szokan, 9/23)

Health News Florida: Have Questions About Your Doctor? State Website Has Answers 
The state’s Division of Medical Quality Assurance launched flhealthsource.gov last year, giving consumers a searchable database containing information about every doctor in the state. The Division of Medical Quality Assurance “strives to become the leader in health care quality regulation,” said director Lucy Gee. “The website redesign serves as another example of how (the agency) remains committed to serving the people of Florida. ”In addition to looking up a doctor’s criminal offenses and disciplinary action, consumers can see information about his or her education, training and specialty certifications. They can also find out where doctors have staff privileges and academic appointments. (9/23)

Quality

Emergency Care By Ambulance Crews Moves Away From Origins As 'Horizontal Taxicabs'

EMS crews today are better equipped than ever for the worst kinds of emergencies.

The Wall Street Journal: The Revolution In EMS Care
There’s a revolution taking place in emergency medical services, and for many, it could be life changing. From the increasingly sophisticated equipment they carry and the new lifesaving techniques they use, to the changing roles they play in some communities—providing preventive care and monitoring patients at home—ambulance crews today are hardly recognizable from their origins as “horizontal taxicabs.” (Landro, 9/25)

Pharmaceuticals

FDA Gives The OK To Biosimilar Version Of Humira

The Food and Drug Administration's approval of Duchenne Muscular Dystrophy drug also continues to attract news headlines.

The Wall Street Journal: FDA Approves Amgen’s Biosimilar Version Of Humira
U.S. regulators approved Amgen Inc.’s copy of the AbbVie Inc.’s anti-inflammatory treatment, Humira, which was the second-biggest selling drug in 2015. Amgen’s drug, known as Amjevita, is only the fourth so-called biosimilar—which are copies of complex biotech medicines—approved by the U.S. Food and Drug Administration. Biosimilars were authorized as part of the federal health-care overhaul to reduce spending on such biotech drugs, much like generics have cut the costs of pills. (Minaya, 9/23)

NPR: Duchenne Muscular Dystrophy Drug: Did FDA Make The Right Call?
When 15-year-old Billy Ellsworth stepped up to the microphone at a Food and Drug Administration public meeting in April, he had no way to know he was part of a historic shift in how the government considers the desires of patients and their advocates in evaluating new drugs. Ellsworth has Duchenne muscular dystrophy, a muscle-wasting disease, that mainly affects boys. And he was taking an experimental drug that the FDA was trying to decide whether to approve. (Harris, 9/24)

In other news related to drugs and drug development —

NPR: Could A Cheap, Simple Medication Head Off A Heart Attack?
When Harry Selker was working as a cardiologist in the 1970s, clot-busting drugs were showing great promise against heart attacks. But their life-saving properties were very time sensitive. "If you give it within the first hour it has a 47 percent reduction of mortality; if you wait another hour, it has a 28 percent reduction; another hour, 23 percent. And people were taking about 90 minutes to make that decision," he recalls. "So they were losing the opportunity to save patients' lives." (Rath, 9/23)

Columbus Dispatch: Ohio State Researcher Testing Drugs To Treat Lewy Body Dementia 
An Ohio State University researcher is enrolling patients in the first U.S. clinical trials of two drugs being tested in the treatment of Lewy body dementia, one of the most common but least talked about neurodegenerative diseases. "This disease is often misdiagnosed and undertreated and exacts a high toll on those who have it," said Dr. Brendan Kelley, a Wexner Medical Center neurologist who is leading the studies. Though not nearly as well-known as Alzheimer’s, which accounts for more than half of dementia diagnoses in the United States, Lewy body is the second-most frequent type of progressive dementia. Nearly 1.4 million Americans have the disease, but the number likely is higher because its symptoms often closely resemble other more-recognized disorders, Kelley said. (Pyle, 9/25)

Marketplace

Home Care Workers Paid 10 Cents An Hour Less Than They Were A Decade Ago

However it is among the nation's fastest-growing occupations. In other news, one of the largest home health care agencies in the country is facing a whistleblower lawsuit alleging massive fraud.

The New York Times: As Their Numbers Grow, Home Care Aides Are Stuck At $10.11
The analysts at P.H.I., a nonprofit research and consulting group, sift through federal data each year to see how the nation’s swelling corps of home care workers is faring. That’s how we know that the aides who care for disabled people and older adults in their homes — helping them bathe and dress, preparing their meals, doing laundry and housekeeping — earned a national median of $10.21 an hour in 2005, adjusted for inflation. (Span, 9/23)

The New York Times: Whistle-Blower Suit Accuses Visiting Nurse Service Of Fraud
The Visiting Nurse Service of New York, one of the largest nonprofit home health care agencies in the United States, likes to highlight a lineage going back to its founder, Lillian Wald, who began nursing the poorest immigrant New Yorkers in their homes in 1893. Whatever its outcome, a federal whistle-blower lawsuit served on the agency on Thursday showcases how far today’s billion-dollar entity has come from its early days, when Ms. Wald’s visiting nurses charged a dime, or nothing at all, for their services. (Bernstein, 9/23)

Public Health And Education

For Obese Patients, Doctors Too Often Giving One-Size-Fits-All Answer: Lose Weight

Studies show that doctors are often not able to move beyond the patient's weight when diagnosing a problem.

The New York Times: What Obese Patients Should Say To Doctors
The 37-year-old woman began to weep as she told her story to Dr. Michael L. Parks. Her job required her to be on her feet all day, Dr. Parks recalled, and she was in constant pain from knee arthritis. She had seen an orthopedic surgeon, hoping to discuss knee replacement, but he dismissed her complaints, telling her she was too fat and should just go on a diet. (Kolata, 9/2)

Patients Trying To Get Addiction Medication Run Up Against Insurer Brick Wall

"This is not the time to throw up barriers. We are struggling as it is to keep people alive," Dr. Jeremy Engel, a family physician, says of insurers denying payment for addiction treatment. Meanwhile, media outlets offer coverage of the epidemic out of Minnesota, Texas, Ohio, Tennessee and Massachusetts.

USA Today/Cincinnati Enquirer: Some Insurers Thwart Efforts To Use Medication Treatment For Addiction
Krista Sizemore's brain was crying out for heroin. But she knew she was pregnant. She knew her baby needed her to stay safe. She knew what could happen if she used again. ... But when Sizemore tried to get help from a top addiction doctor in Northern Kentucky, the insurance blocked the first attempt. ... During a nationwide epidemic in which one American dies every 19 minutes from opioid or heroin overdose, addiction doctors say insurance barriers to medication that can save lives are instead putting them at risk for death. (DeMio and O'Donnell, 9/25)

The Star Tribune: 30,000 Opioid Deactivation Pouches Being Distributed In Minn. 
In the first six months of this year, more than 80 people died from an overdose of heroin and other opioids. And the epidemic doesn’t appear to be slowing, according to law enforcement, health care and treatment officials who met for a roundtable on drug abuse and diversion in the Twin Cities last week. At the meeting, Mallinckrodt Pharmaceuticals, a St. Louis-based company, announced the donation of 30,000 drug deactivation pouches that will be handed out to people locally who want to easily dispose of opioids at home. Up to 1.35 million prescription pills, patches or liquid doses of opioids can be destroyed if every pouch is filled to its 45-pill capacity. (Chanen, 9/25)

The Christian Science Monitor: Opioid Crisis: Helping Children Who See Their Parents Overdose
A new video uploaded Friday shows another case of a child standing helplessly by an adult unconscious from a drug overdose. The scene, filmed by an onlooker in a supermarket, is the most recent public example of children who witness their parents' overdose. Earlier this month, the Ohio police department shared a graphic photo of a 4-year-old in a car with two overdosed adults sprawled out in the front seats, hoping to make a very public statement about the dangers of the continuing opioid overdose epidemic throughout the United States and its unintended consequences on children. (Tan, 9/23)

NPR: Carfentanil Overdoses Put Strain On Cincinnati
Jamie Landrum has been a police officer for two years in District 3 on the west side of the Cincinnati. In late August, the city was hit by 174 overdoses in six days. Landrum says officers were scarce. "We were literally going from one heroin overdose, and then being on that one, and hearing someone come over [the radio] and say, 'I have no more officers left,' " Landrum says. Three more people overdosed soon after that. (Harper, 9/25)

Nashville Tennessean: Tennessee Makes Inroads On Opioid Epidemic
Tennessee has made progress in fighting the opioid epidemic. The state has declared the massive problem the No. 1 public health crisis in the state and painkiller prescriptions have fallen from 8.5 million to 7.8 million over the past three years. Companies like BlueCross BlueShield Tennessee are funding efforts to keep prescription drugs from the wrong hands and medical schools are working with a future generation of doctors to curb overprescribing pills. (Plazas, 9/25)

The Washington Post: ‘Heartbreaking’ Video Captures Toddler Trying To Wake Mother After Apparent Overdose
The terrified toddler in the pink pajamas prods, pulls and cries, but she is powerless to wake her mother. The 36-year-old mother, identified by news outlets as Mandy McGowen, lies unconscious in the toy aisle of a Lawrence, Mass., Family Dollar store, after an apparent drug overdose, police said. Even for law enforcement veterans such as Lawrence Police Chief James Fitzpatrick, the dramatic video shot by a store employee Sunday is hard to watch. (Holley, 9/24)

New Tests May Help Doctors Pinpoint Cancer Faster With Higher Accuracy

In other oncology news, a cancer scientist is racing against his own diagnosis, experts caution against optimism over immunotherapy and more.

The Wall Street Journal: New Nuclear-Imaging Tests Show Promise In Locating Cancer
Cancer cells remain elusive and tough to locate, but a new crop of nuclear-imaging tests promises to lead to more accurate prognosis and treatment.  The tests use imaging agents that combine radioactive isotopes with targeted molecules that can spot cancer at the cellular level. The ability to accurately locate the cancers helps physicians make better and earlier diagnoses—and may eventually make possible targeted nuclear-medicine therapies that identify and kill cancer cells, but not the surrounding healthy cells. (Or, 9/25)

Stat: A Cancer Researcher Races To Find A Cure — For His Own Incurable Cancer
With two decades of cancer research under his belt, Tom Marsilje is no stranger to project deadlines. But he’s never faced one quite like this before. He’s racing against the clock in an improbable quest to cure his own incurable colon cancer before it takes him away from his wife and their two little girls. (Robbins, 9/26)

East Bay Times: Charlotte Maxwell Center Treats Cancer Patients’ Other Symptoms 
[Martina] Herrera, from San Pablo, is in remission from uterine cancer, a cancer that has been removed and one for which she underwent chemotherapy for eight months. Four months into her treatment, her legs froze. Herrera is also a client of the Charlotte Maxwell Clinic, a facility that offers alternative therapies like reiki (a form of touch therapy), massage, guided meditation, herbal treatments, acupuncture and other homeopathic treatments to patients who are also receiving traditional cancer therapies. Because Herrera has a low income, she receives her treatments for free. (9/23)

Philadelphia Inquirer: PSA Tests On The Ropes - But Not Gone
Free, walk-in PSA screening-fests, often at manly events such as car shows, became a big thing, especially during September, which is prostate cancer awareness month. Advocacy groups, urologists, and hospitals embraced the strategy, presuming that catching cancer early would save lives. But that strategy - like that presumption - is now seen as dangerously simplistic. (McCullough, 9/25)

News Roundup: Do Concussions Increase PTSD Risk?; Earlier Exposure To Eggs, Nuts May Help Allergies

More public health stories report about "bioidentical" hormone therapies for women, LED lighting's impact on sleep, water fluoridation, kidney stones, lice, cryotherapy and spinal cord injuries.

NPR: Concussions May Increase The Risk Of PTSD
There's growing evidence that a physical injury to the brain can make people susceptible to post-traumatic stress disorder. Studies of troops deployed to Iraq and Afghanistan have found that service members who suffer a concussion or mild traumatic brain injury are far more likely to develop PTSD, a condition that can cause flashbacks, nightmares and severe anxiety for years after a traumatic event. (Hamilton, 9/26)

WBUR: More Women Choose Custom-Made Hormone Therapy; Influential Docs Worry About Potential Harm
The term "bioidentical hormone" doesn't really have a standard definition. In general, it's taken to mean hormones that have the same chemical and molecular structure as hormones produced in the human body. These days, there are FDA-approved versions of bioidentical hormones, and there are alternative, custom-prepared varieties — like the one Foster uses — made in specialized "compounding" pharmacies. Studies show that up to a million or more women take the custom-made hormone medications, and the number is increasing. But the trend frustrates and even alarms many doctors because custom-compounded varieties aren't FDA approved, nor do they carry labels detailing the risks and possible side effects of all types of hormone therapy. (Zimmerman, 9/23)

The Washington Post: Some Cities Are Taking Another Look At LED Lighting After AMA Warning
If people are sleepless in Seattle, it may not be only because they have broken hearts. The American Medical Association issued a warning in June that high-intensity LED streetlights — such as those in Seattle, Los Angeles, New York, Houston and elsewhere — emit unseen blue light that can disturb sleep rhythms and possibly increase the risk of serious health conditions, including cancer and cardiovascular disease. (Ollove, 9/25)

Kaiser Health News: It’s In The Water: The Debate Over Fluoridation Lives On
Many people take for granted the addition of fluoride into public drinking water systems that aims to prevent tooth decay. It’s a seven-decade-old public health effort. But it’s not nearly as universally accepted as one might think. At least seven cities or towns across the country debated it just this summer. (Tan, 9/26)

Los Angeles Times: Got Kidney Stones? Try Riding A Roller Coaster To Dislodge Them
Just ask any one of the 300,000 Americans who, in any given year, develop kidney stones: What if the excruciating pain of passing one of those little devils could be prevented by strapping yourself into a make-believe runaway mine train, throwing your hands in the air and enduring G-forces as high as 2.5 for about three minutes? Would you do it? (Healy, 9/26)

Miami Herald: A Popular New Treatment For An Old Case Of Lice
According to the Centers for Disease Control and Prevention, an estimated 6 million to 12 million infestations occur each year in the United States among children 3 to 11. Lice are white, sesame seed-sized parasites that attach themselves to hair and feed on blood. They can live on hair found on the head, body and in the pubic area. If allowed to reproduce, a proliferation of lice will cause an itching sensation that can only be stopped once the lice and their eggs — called nits — are removed. (Hsieh, 9/23)

Mercury News: UCSF: Human Cell Transplants Treat Mice With Spinal Cord Injury
Researchers have successfully transplanted healthy human cells into mice with spinal cord injuries, bringing the world one step closer to easing the chronic pain and incontinence suffered by people with paralysis. The research team did not focus on restoring the rodents’ ability to walk; rather, it helped remedy these two other debilitating side effects of spinal cord injury. If successful in humans, the findings could someday ease the lives of those with these distressing conditions, said Dr. Arnold Kriegstein, co-senior author of the study and director of the Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research at UC San Francisco. (Krieger, 9/23)

State Watch

In Minn., Striking Nurses, Allina Return To The Bargaining Table

In other state hospital news, two Connecticut state agencies rule against a challenge by hospitals within the state to a tax's legality. The next step will be for the hospitals to take the state to court.

The Star Tribune: Respected By Nurses, Allina CEO Wheeler Is Tested By Strike 
In her first round of nurse contract talks since becoming Allina’s CEO, [Penny] Wheeler has become a lightning rod, deciding to take on the nurses’ costly health insurance benefits even as competing hospital systems punted on the issue and quickly reached three-year contracts that only changed nurses’ wages.Her stance, to some, has put her in conflict with her own views. In the past, she has questioned the value of high-deductible health insurance, and yet now she wants to move nurses from their low-deductible union plans to a menu of lower-cost Allina corporate options. Two of those options are high-deductible plans.

The CT Mirror: State Rejects Challenge To The Hospital Tax 
Two state agency heads have ruled against Connecticut hospitals’ claims that the state tax on hospitals is illegal, clearing the way for the industry to take the state to court. Hospitals have long bristled at the tax, imposed during a budget crisis in 2011 and increased by hundreds of millions of dollars since then. Last year, 24 hospitals and the Connecticut Hospital Association challenged the tax, seeking declaratory rulings on its legality from the departments of social services and revenue services. On Thursday, Social Services Commissioner Roderick L. Bremby and Revenue Services Commissioner Kevin B. Sullivan issued a 179-page ruling rejecting the hospitals’ arguments that the tax violated the Connecticut and U.S. constitutions, as well as state statute. (Becker, 9/23)

And in Washington state -

Seattle Times: Legionnaires’ Disease Outbreak At UW Medical Center Appears Contained
An outbreak of Legionnaires’ disease at the University of Washington Medical Center that sickened four people, including two who died, appears to be contained, King County health officials said Saturday. It has been 11 days since UW Medicine officials installed filters, flushed water systems and took other steps in the hospital’s Cascade Tower to prevent the spread of Legionella bacteria, which cause the type of serious pneumonia. (Aleccia, 9/24)

State Highlights: Calif. Governor Signs Surprise Medical Bills Measure; Miami Herald Suing For Zika Information

Outlets report on health news from California, Florida, Massachusetts, Maryland and Ohio.

San Francisco Chronicle: Brown Signs Raft Of New Health Laws 
California consumers will have the strongest protections in the nation against getting blindsided by unexpected out-of-network medical bills as part of legislation signed into law by Gov. Jerry Brown.AB72 was one of 10 consumer-protection measures — eight related to health care — signed Friday by the governor. They include a law that will require health insurers to notify their policyholders when regulators think their price hikes are too high, and one that will allow people to be informed of their rights to timely access to health care and to an interpreter. The surprise medical bill legislation is designed to prevent patients, many of whom checked in advance to make sure their doctor and hospital were in their insurer’s list of contracted providers, from getting hit with out-of-network charges after undergoing a procedure or agreeing to services. (Colliver, 9/23)

Miami Herald: Attorney Says State Told Them Not To Disclose Locations Of Zika Mosquitoes 
At a court hearing Friday for the Miami Herald’s lawsuit against Miami-Dade seeking the locations of traps in Miami Beach where mosquitoes carrying the Zika virus were captured, a county attorney said the Florida Department of Health had instructed local officials not to disclose the information — a statement the state agency strongly denied afterward. The suit seeks disclosure of the Zika-positive mosquito trap locations on grounds that the information would help the public make decisions about precautions to take if they live or work nearby, and also inform the community debate on the use of the controversial insecticide naled. (Chang, 9/23)

San Jose Mercury News: Mosquitoes In North San Jose Test Positive For West Nile Virus
Summer is over in the Bay Area, but the West Nile virus season is sticking around. Adult mosquitoes recently collected in portions of the 95112, 95131 and 95133 ZIP codes have tested positive for the virus, which can sicken and in severe cases kill humans. In response, the Santa Clara County Vector Control District plans to fog the area. (Green, 9/23)

Boston Globe: $3B Drive To End Diseases Apt To Tap Boston Area’s Talent 
Like Bill and Melinda Gates before them, the Chan Zuckerberg Initiative, as the couple’s philanthropic organization is known, will bolster the tens of billions of dollars spent each year by the federal government on life sciences, a field in which the Boston region’s universities, hospitals, research institutes, and biotech companies are second to none. There was a touch of envy that the new project, announced Wednesday, is being launched in the San Francisco Bay Area, where a $600 million research “Biohub” will link the University of California San Francisco, University of California Berkeley, and Stanford University. How could the Manhattan Project of medicine not be based here? But regional bragging rights aside, the effort will be a huge opportunity for Boston’s biomedical research complex. (Dayal McCluskey and Weisman, 9/25)

Sacramento Bee: Nursing Home Magnate Rocks Humboldt County With Plans To Close Three Of The Area’s Six Facilities 
In the next four days, the California Department of Public Health will decide for the second time whether the state’s largest nursing home operator can stop accepting patients at three of his five skilled nursing facilities in Humboldt County and begin closing the homes. Rockport Healthcare Services, the management company for Los Angeles nursing-home magnate Shlomo Rechnitz, did not spell out in its notification letters why it wants to close the homes. However, Rockport spokesman Stefan Friedman told The Sacramento Bee on Friday that the company has experienced a “severe staffing shortage” in the region, and “we have been unable to recruit and retain sufficient numbers of permanent staff to meet our patients’ needs.” (Lundstrom, 9/24)

Cleveland Plain-Dealer: Cuyahoga County Discovers $9.5 Million Health Care Plan Shortfall 
Cuyahoga County has frozen its regional health insurance program after discovering a $9.5 million budget shortfall -- plus the depletion of a $12 million health care reserve fund. The problems are in the county's health insurance programs for employees as well as in a regional program, in which municipal governments and other public agencies take advantage of the county's buying power to get low rates. Employee claims in the county employees program, which is self-insured, have been higher than anticipated, County Executive Armond Budish told cleveland.com Wednesday. (Farkas, 9/23)

Mercury News: More Children Infected At California Dental Clinic Losing Permanent Teeth
As the outbreak of infections among children treated at an Anaheim pediatric dental clinic climbed to 20 cases Friday, a doctor at Children’s Hospital of Orange County said the affected children have not only undergone extensive surgeries and received powerful antibiotics, but many have also lost permanent teeth. Five doctors and a team of hospital staff have been caring for the 20 children, who remain hospitalized at CHOC for several days now, said Antonio Arrieta, the hospital’s Director of Pediatric Infectious Diseases. Doctors and staff have been taking X-rays of the children’s jaws and chest area to detect infected areas, and all children have required surgery to rid their bones of the infection, he said. (Bharath, 9/24)

Los Angeles Times: Health Officials Confirm Riverside County Child Has Leprosy
Health officials in Riverside County confirmed Friday that an elementary schoolchild has Hansen’s disease, also known as leprosy. The child appears to have contracted the rare disease from “someone that had been diagnosed with Hansen’s disease who had prolonged, close contact with the child,” said Barbara Cole, director for disease control for the Riverside County Department of Public Health. (Karlamangla, 9/23)

Columbus Dispatch: Neuroscience Experts In Central Ohio Say Advances, Research Pushing Brain Treatments
Imagine an annual physical that includes a blood test and brain imaging that reveal whether you are predisposed to Alzheimer's or Parkinson's disease. Then, imagine that any prognosis does not terrify you, but instead empowers you to take simple measures to prevent illness. Physicians and researchers in central Ohio and around the world are working to make that a reality. Such discoveries would represent the Holy Grail of neurological research, said Dr. Brendan Kelley, associate professor of neurology and psychiatry at Ohio State University's Wexner Medical Center. (Viviano, 9/25)

Mercury News: Golden Gate Bridge Suicide Barrier Cost Could Rise To $198M
The project to build a suicide barrier on the Golden Gate Bridge could escalate to as much as $198 million and continues to be delayed as officials seek more money for construction. The bridge board voted Friday to formally delay the project until Jan. 9 so a funding plan can be revised. Bridge officials were stunned in July when bids came in almost double the $76 million estimate. Now span officials are noting the project could be as much as $198 million, but caution that that figure is likely high. (Prado, 9/24)

Editorials And Opinions

Thoughts On The Role Of Health Policy In The Debates, On The Campaign Trail

Opinion writers share ideas about how health policies are fitting into this year's election.

The New York Times: Health Care Deserves More Attention On The Campaign Trail
The reaction to opening a medical bill these days is often shock and confusion — for the insured and the uninsured. Prices and deductibles keep rising, policies are drowning in fine print, and doctors are jumping on and off networks. So why hasn’t the growing burden of health care gotten more attention in the presidential campaign? (9/23)

Philadelphia Inquirer: Awareness Essential To Our Staying Healthy
It is an election year. Once again, health care comes to the forefront with the public and the candidates speaking out for and against the Affordable Care Act. But how much do patients really know about how our health-care system works and how current policies affect health care? (Mark Lopatin, 9/25)

Modern Healthcare: Thank You For That Question, Lester
“Health insurance premiums and out-of-pocket costs are rising rapidly. What would you do to control them?” If I were advising a candidate on how to respond to that question, here's what I'd recommend he or she say. (Merrill Goozner, 9/26)

Perspectives On Obamacare: Where Millennials Stand; Overlooking The Health Law's Merits And Examining Its Flaws

News outlets explore the federal health law's implementation.

The Wall Street Journal: A Millennial’s ObamaCare Lament
ObamaCare won’t work without young Americans like me, and the Obama administration knows it. That’s why the president is holding a Millennial Outreach and Engagement Summit focused on the Affordable Care Act at the White House on Tuesday. But no matter what the president says, many young Americans simply aren’t buying what he’s selling—mainly because we can’t afford it. (David Barnes, 9/25)

The New York Times: It’s Easy For Obamacare Critics To Overlook The Merits Of Medicaid Expansion
But it’s important to remember that many, if not most, of the newly covered Americans became insured through an expansion of Medicaid. Here, too, you hear a lot of bad news: that Medicaid offers poor quality and little choice of providers, that it is expensive for the states to administer and that its growing cost will eventually bankrupt states. As of today, 19 states have still refused to participate in the expansion. Such declarations consider only one side of the equation, though. In most ways, Medicaid offers an excellent return on investment. (Aaron E. Carroll, 9/26)

The New York Times: Football Team At The Buffet: Why Obamacare Markets Are In Crisis
Insurers have announced that they are sharply raising prices or pulling out entirely. Many consumers will have fewer choices of insurance plans, and many insurance plans will include fewer doctors and hospitals. The turmoil can’t be explained by one factor alone. But many of the most important problems can be understood if you think of an Obamacare marketplace as a particular kind of restaurant: an all-you-can-eat buffet. It can be a solid business, but it’s hard to get the pricing right. (Margot Sanger-Katz, 9/23)

San Antonio Press Express: Why Expanding Medicaid Is A Bad Idea For Texas
Since the ACA mandates that everyone have health insurance, the federal government provided health insurance to citizens who earn too much to be eligible for Medicaid but too little to pay for insurance. Whether the state created its own exchange or relied on the federal exchange, citizens are allowed a subsidy by the federal government if their income is less than 400 percent of the federal poverty limit. A family of four would have to make slightly less than $100,000 to be eligible for a federal subsidy.If Texas were to expand the Medicaid offering, the result would likely be similar to what California experienced. That was a 51 percent increase in Medicaid recipients. (Alan Preston, 9/24)

Viewpoints: Ending Fee-For-Service; The Senate Should Move On Mental Health Reform

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

The Wall Street Journal: Three Cheers For The End Of Fee-For-Service Health Care
A change in how physicians are paid is bringing many benefits to patients. Since the dawn of modern medicine and until recently, payment was generally based on the volume of services doctors provided, a ‘fee-for-service” plan that incentivized doctors to maximize testing and interventions to a level that actually can do harm. (Howard Forman, 9/25)

Milwaukee Journal Sentinel: The Senate Must Act On Mental Health Reform
Time and time again, research has shown that with treatment, people with severe mental illness are less likely to experience tragic consequences, and even return to leading productive lives. The only glimmer of hope that we and other family members have is seeing the nearly unanimous vote earlier this summer, when Congress passed the Helping Families in Mental Health Crisis Act. The legislation creates a mandatory assisted outpatient treatment program. It empowers providers to take patients before judges in special courts, who can order them to stay on their treatment plans or face hospitalization. ... Sen. Ron Johnson must take action and bring mental health reform to a vote. He cannot afford to stand by while families such as mine continue to suffer. We cannot afford to wait. (Paula John, 9/24)

The Wall Street Journal: A Simple Change That Could Transform Health Care
[H]ere I’ll present a simple modification of health-care payment policies that I think could yield large dividends, too — in health, in finances and in patient satisfaction. The principle is straightforward: Pay physicians a bonus for providing continuity of care. In other words, insurers (including Medicare) would pay a bit extra to a physician who sees a particular patient multiple times over a long period, versus a physician seeing the same patient for the first time. (John Sotos, 9/25)

Stat: Why Can't Nurses Get A Break?
When I started my nursing career nine years ago, I was confident that my nursing education prepared me with the fundamentals of the profession — anatomy and physiology, pharmacology, clinical skills, and more. What I wasn’t prepared for was that some of the basic aspects of health that we ensure for our patients, like nutrition, rest, and removal from constant stressors, aren’t necessarily guaranteed for nurses. ... nurses need undisturbed break time on each shift to balance the emotional and physical demands required to provide high-quality care to patients and to keep more front-line nurses at the bedside. (Vanessa Patricelli, 9/23)

Bloomberg: FDA's Dangerous Deals With Reporters
Sometimes a source gives information to journalists before a public announcement in exchange for an agreement that the journalist won't publish the information until an agreed-upon time. This process -- called an embargo -- is actually reasonable and beneficial to the public, because it gives reporters time to dig into a technical subject without feeling that they have to only skim the paper quickly and dash off an article so they can be the first to publish and get the scoop. The FDA's “close hold” embargo is an innovation I’d never heard of, however: It forbids reporters to talk to any third parties until the embargo date and time. (Megan McArdle, 9/23)

Stat: Food That Is 'Generally Recognized As Safe' Is Not Good Enough
Most of the chemicals added to food and beverages — from cheese to chips to chicken soup — are never reviewed by the Food and Drug Administration (FDA) before those products are sold in grocery stores. ... Responding to a court-approved settlement agreement, the FDA recently issued a final rule on its process for handling substances in food that are “Generally Recognized as Safe,” also known as GRAS. The problem is, generally recognized as safe is an oxymoron. Under the GRAS process, ingredients can bypass FDA safety reviews, and the manufacturers themselves can determine a substance is safe without ever informing the FDA that they are using it in food. (Sen. Edward J. Markey, D-Mass., 9/23)

Albuquerque (N.M.) Journal: Underfunding Medicaid Is A Foolish Decision
Currently, New Mexico receives four dollars in federal funds for every state dollar invested in Medicaid. This money goes directly into patient care and supports over 50,000 mostly private-sector jobs in the state. Rather than maximizing this $4 to $1 return on investment, New Mexico underfunded the Medicaid budget in the 2016 legislative session. (Abuko Estrada And Sireesha Manne, 9/26)

The New York Times: The Trouble With Tylenol And Pregnancy 
If you’re a pregnant woman and have a backache or headache, or a fever, your options for over-the-counter treatment basically boil down to one medication: the pain reliever acetaminophen, better known as Tylenol. Doctors advise against using nonsteroidal anti-inflammatories, like ibuprofen and aspirin, during late pregnancy because they can compromise fetal circulation and have other adverse consequences. (Moises Velasquez-Manoff, 9/24)

The Washington Post: ‘Contraception Deserts’ Are What You Get When You Cut Off This Little-Known Federal Program
The Zika virus has arrived in the United States, threatening reproductive-age American women with the prospect of compromised pregnancies — and returning the country to its decades-long debate over reproductive rights. If a pregnant American woman wanted to end a Zika-compromised pregnancy, could she? If she wanted to prevent pregnancy until she knew that any Zika risk was past, could she find the contraception she would need? (Rebecca Kreitzer and Candis Watts Smith, 9/26)

Sacramento Bee: Supporting But Not Inhaling Marijuana Legalization
California made 465,873 marijuana-related arrests between 2006 and 2015. Nationwide, despite spending billions on the war on drugs, drug abuse remains at unacceptable levels. Illegal production has degraded the environment, often in pristine wilderness areas, and black market producers do not pay taxes. As a law professor, I also am troubled that respect for the law diminishes when we criminalize conduct that so many people engage in, especially when people of color are arrested on marijuana charges far more frequently than white offenders, despite similar use across racial groups. Still, the more extravagant claims that some proponents of legalization make leave me skeptical. (Michael Vitiello, 9/24)

Georgia Health News: Piedmont’s Expanded Presence To Change Care In Athens Area
On Oct. 1, the honeymoon ends for Piedmont Healthcare and Athens Regional Medical Center (ARMC), and the realities of their marriage will set in. Next week Athens Regional, with 350 beds, will become the second-largest facility in Piedmont’s system and the only one with a residency program. ARMC will be Piedmont’s seventh hospital. (Meera Naqvi, 9/24)

The Seattle Times: Bring Heroin Injection Sites Indoors, Off The Streets
Allowing heroin users to shoot up at a government-sanctioned medical facility is a radical idea. When a King County task force studying the regional heroin and opioid crisis proposed a so-called “safe injection site,” it appropriately generated controversy. But peel back the skepticism and fear. Reams of research in Canada, Europe and Australia show that such a facility could reduce rates of overdose and HIV infection, increase rates of treatment and cut down on public drug consumption and the health hazard of discarded needles on the street. It could even save money. It is a radical idea that King County should try. (9/22)