KHN Morning Briefing

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Health Law

GOP Senators Going Home A Fractious Party With No Path Forward On Health Care

Many had hoped they would be leaving for recess with repeal under their belts. Meanwhile, Senate Finance Committee Chairman Orrin Hatch announces that his committee will start holding health care hearings when lawmakers return in September.

Politico: Republicans Leave Town With No Clear Path On Obamacare
Republicans are leaving Washington Thursday for a month of recess with no clear direction on what they’ll do next on Obamacare. Senate leaders want to just drop the issue altogether. Conservatives say they’re still fighting for repeal. Moderates want to launch a bipartisan effort to fix the shaky Obamacare system. The reality is that, after seven years of unity on repealing Obamacare, Republicans are rudderless on how to talk about or address the defining domestic policy issue of nearly the past decade for their party, and they have no clear plans despite holding all the levers of power in Washington. Now, they face a month away from the Capitol, answering to their home-state voters about their lack of progress. (Haberkorn and Demko, 8/3)

The Hill: Finance Committee Announces Healthcare Hearing In September
Senate Finance Committee Chairman Orrin Hatch (R-Utah) announced Thursday that the panel will hold a healthcare hearing in September, in the wake of a failed vote on repeal of ObamaCare. The hearing will be a chance for members of both parties to discuss the healthcare law, and it comes amid calls for a return to regular order and the committee process. (Sullivan, 8/3)

Modern Healthcare: Bipartisan Moves To Steady Insurance Market Face Same Old Conflicts Over Regulation
Fledgling efforts in the Senate and U.S. House of Representatives to develop bipartisan legislation to stabilize the individual insurance market could founder over clashing views on deregulating health plans. Democrats and a growing number of Republicans are eager to steady the struggling individual market covering nearly 20 million Americans to prevent an exodus of insurers and healthy customers. (Meyer, 8/3)

The New York Times: With Few Wins In Congress, Republicans Agree On Need To Agree
Most people do not become United States senators to pass a resolution declaring National Lobster Day. But Congress has had to settle largely for small-bore victories since President Trump was sworn into office, ostentatiously failing to pass a bill to repeal his predecessor’s health care law and achieving little substantive policy legislation. (Steinhauer, 8/4)

In other news from the Senate —

Detroit Free Press: Stabenow Wants Medicare More Widely Available
With health care reform to be looked at again by a U.S. Senate committee next month, U.S. Sen. Debbie Stabenow, D-Mich., is proposing letting younger Americans buy into Medicare coverage now limited to older people. Stabenow today introduced legislation that would provide an option for people between the ages of 55 and 64 to purchase Medicare coverage, saying more than a million people in Michigan fit that age bracket and many are "burdened by high insurance premiums, unaffordable deductibles and limited options." (Spangler, 8/3)

The Hill: Zinke Shares Beers With Murkowski After Alleged Threats Following Healthcare Vote 
Interior Secretary Ryan Zinke shared a picture of him drinking a beer with Sen. Lisa Murkowski (R-Alaska) on Thursday, after reports surfaced that the secretary threatened to cut economic development funds in the Alaska over her vote on the healthcare bill. "I say dinner, she says brews. My friends know me well. Thanks Lisa Murkowski," Zinke tweeted while including picture of them both holding Alaskan brand beers. (Beavers, 8/3)

Capitol Hill Watch

Bill Renewing FDA's Authorization To Charge Drug And Device Makers User Fees Passes Senate

The fees account for about $1.4 billion of the FDA’s approximately $5 billion annual budget and help pay for agency reviews that get the products to the marketplace.

The New York Times: Senate Passes F.D.A. Funding And ‘Right To Try’ Drug Bills
The Senate on Thursday gave final approval to legislation to finance the Food and Drug Administration, clearing the measure for President Trump and tapping drug manufacturers once again to help pay for the federal review of prescription drugs and medical devices. The 94-to-1 vote came just hours after the Senate passed a separate bill expanding access to experimental treatments for people with terminal illnesses. This bill, the Right to Try Act, will now go to the House, where more than three dozen lawmakers have endorsed similar legislation. (Pear and Kaplan, 8/3)

The Associated Press: Senate Passes Legislation To Ensure No Halt In FDA Reviews
Drug and medical device makers would pay higher user fees under legislation the Senate approved and sent to the president on Thursday. ... The legislation rejects the Trump administration's recommendation to fund FDA reviews entirely through user fees. Doing so would have upended several months' worth of negotiations over the fees, which will generate between $8 billion and $9 billion over five years. The administration had argued that "in an era of renewed fiscal restraint, industries that benefit directly from FDA's work should pay for it." (Freking, 8/3)

Modern Healthcare: Senate Passes FDA User Fee Reauthorization
The FDA user-fee agreements, which are renegotiated every five years with the makers of prescription brand drugs, medical devices, generic drugs and biosimilars, fund more than half of the FDA's operations. The agency would have to layoff more than 5,000 employees if the agreements are not reauthorized before the end of September. A reauthorization delay would also postpone the review of many drugs and devices. The bill passed 94-1, with Sen. Bernie Sanders (I-Vt.) as the lone holdout. (Kacik, 8/3)

Stat: Senate Approves Key FDA Legislation, Sending Bill To Trump's Desk
[T]he easy passage on Thursday belies tougher behind-the-scenes negotiations. Senate leaders, along with Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), who together lead the Senate health committee, spent this week fending off controversial amendments that could otherwise have slowed the package’s path to the president’s desk, staff and health industry lobbyists said. (Mershon, 8/3)

CQ Roll Call: Senate Clears FDA User Fee Renewal Bill
“This is a bill that’s been done the right way,” said Sen. Lamar Alexander, R-Tenn., who oversees the Health, Education, Labor and Pensions Committee. “It’s an example of the way the Senate is supposed to work." (Siddons, 8/3)

The Hill: Senate Passes Key FDA Funding Bill 
The White House hasn’t said if it will sign the user fee bill. In a statement of administrative policy issued in July after the bill passed the House, the White House expressed concern with some minor provisions, though it did not threaten a veto. (Weixel, 8/3)

CQ Roll Call: Senate Confirms Former Indiana Health Leader As Surgeon General
As surgeon general, Jerome Adams is expected to serve as a spokesman for President Donald Trump's health agenda. Adams, a practicing anesthesiologist, was appointed in 2014 by former Indiana governor and current Vice President Mike Pence to run that state’s department of health. Adams oversaw the state’s response when about 180 residents contracted HIV and hepatitis C as a result of  injecting heroin and prescription opioid painkillers. Adams worked to convince Pence to allow an emergency needle exchange program to help stop the outbreak. (Siddons, 8/3)

Senate Passes 'Right-To-Try' Legislation, But Critics Say Bill Is 'Inherently Deceptive'

The legislation says terminally ill patients can ask drug companies for experimental treatments, but companies often are reluctant to provide unapproved products for a variety of reasons. And the FDA has a system to handle requests for such drugs.

The Washington Post: Senate Passes ‘Right To Try’ Bill To Help Terminally Ill Patients Get Experimental Drugs 
The “right-to-try” legislation has been championed by the libertarian Goldwater Institute, which has worked to pass similar legislation in 37 states. The federal version, now headed to the House, would bar the government from blocking patients from getting access to medications that have undergone only preliminary testing in humans. Patients first would have to try all other available treatments and be ineligible for clinical trials. The bill would provide drug companies some legal protection if a treatment results in harm. (McGinley, 8/3)

Politico: Libertarians Score Big Victory In 'Right-To-Try' Drug Bill
The bill, S. 204 (115), passed swiftly and easily in a Senate bitterly divided over health care. The powerful pharmaceutical lobby, which had quietly opposed an earlier version, kept an unusually low profile. The industry has been focused on fighting off any efforts to go after drug pricing, which President Donald Trump has said he would tackle. (Karlin-Smith, 8/3)

Stat: Senate Approves 'Right To Try' Bill Barring Federal Intervention In State Laws
The new version emphasizes that drug companies wouldn’t be held liable for problems patients face using the drugs and that results from those patients couldn’t be used to undermine other clinical trials. It does, however, explicitly require the companies to report any problems to FDA — and adds exemptions that would let the agency use the results if it saw a public health risk or if the companies themselves request the consideration. The new version also makes it much more explicit that the bill doesn’t create any new “entitlements” for terminally ill patients, and that companies don’t have to provide the drugs. (Mershon, 8/3)

Pharmaceuticals

Emails Reveal Behind-The-Scenes Drama Of FDA's Drug Approval Process

Last year, a fierce battle emerged over Sarepta's new muscular dystrophy drug, in which FDA official Janet Woodcock approved the treatment -- overruling the recommendations of a review team and an advisory committee. Newly released emails show what happened next.

In other pharmaceutical news —

The Associated Press: FDA OKs New Drug To Treat All Forms Of Hepatitis C
U.S. regulators have approved the first drug to treat all forms of hepatitis C in as little as eight weeks. The pill combination from AbbVie Inc. was approved Thursday by the Food and Drug Administration for adults without significant cirrhosis, a type of liver disease, and many patients who were not cured by prior treatment. (8/3)

Marketplace

Aetna Smashes Second-Quarter Expectations With 52 Percent Profit Jump

Aetna added Medicare customers and grew the health plans it provides for large employers. A pullback from the Affordable Care Act's health insurance exchanges also helped its business improve compared to last year's quarter.

The Wall Street Journal: Aetna Profit Rises On Better Pricing; Company Raises Outlook
Aetna Inc. reported a stronger profit for its second quarter, boosted by limited medical spending and better-than-expected results from Affordable Care Act programs intended to reduce insurers’ risk on health-law insurance plans. The insurer, which joins others in the industry that have previously reported positive results, highlighted the growth and future prospects in its government business, particularly its continuing expansion in Medicare Advantage, the plans sold by private insurers under the federal program, as it continued detailing its strategy after the failure of its effort to buy Humana Inc. That deal was terminated in February after a federal judge ruled it would violate antitrust law. (Wilde Mathews and Vasquez, 8/3)

Bloomberg: Drama With Obamacare And Humana Over, Aetna Results ‘Crush’
After dropping a deal for one of its biggest rivals and largely quitting Obamacare, health insurer Aetna Inc. may have been better off sticking to its knitting all along. The insurer raised its full-year forecast after posting second-quarter results that exceeded analysts’ expectations, helped along by its core business running health benefits for employers. Earlier this year, it called off a takeover with Humana Inc., and it has also pulled back from doing business in the Affordable Care Act -- insulating itself from Washington’s health-care turmoil. (Tracer, 8/3)

Massachusetts Officials Take Control Of Health Insurance Co-Op Formed By ACA

Minuteman Health Inc., which served customers in Massachusetts and New Hampshire, was one of the small customer-owned insurance companies established by the federal health law. News outlets also look at other Obamacare insurance issues elsewhere.

Boston Globe: State Places Minuteman Health Into Receivership
State officials said Thursday that they have seized control of Minuteman Health Inc., a small Boston-based insurer created under a program of the Affordable Care Act to provide low-cost policies. Officials at the Division of Insurance said the unusual step was necessary because Minuteman’s level of capitalization — or cash — is too low. (Dayal McCluskey, 8/3)

New Hampshire Union Leader: Court Places Largest Insurer In NH Exchange Into Receivership As Cash Dwindles
Minuteman Health, the company with the largest number of New Hampshire residents insured on the Obamacare exchange, is now under the control of the Massachusetts Insurance Department. Bay State Insurance Commissioner Gary D. Anderson announced on Friday that a court granted his request to place Minuteman Health into receivership to protect policyholders and health care providers. Anderson has been named “receiver” for Minuteman, which essentially puts him in control of the company. (Solomon, 8/3)

Sacramento Bee: Want A Better Obamacare Rate? You May Have To Call The Movers.
Under preliminary Obamacare rates announced by Covered California, premiums on exchange plans will rise by an average of 5.7 percent in Sacramento, Placer, El Dorado and Yolo counties. That’s less than half of the statewide average of 12.5 percent, and consumers could virtually avoid an increase altogether if they shop around. (Miller, 8/4)

Miami Herald: Insurers Request Average 14 Percent Rate Increase For 2018 Obamcare Plans
Florida health insurers are seeking double-digit rate hikes for 2018 Affordable Care Act coverage, but this week state regulators asked insurers to submit backup plans to raise premiums even higher next year because of uncertainty surrounding the future funding of subsidies that help low-income Americans pay their out-of-pocket costs. The Office of Insurance Regulation said insurers need to account for the potential elimination of the subsidies, whose future funding has become an increasingly complex political question. (Chang, 8/3)

Health News Florida: Chart: See How Much Health Individual Insurance May Rise In 2018
The federal government released more details Wednesday about how much health insurance rates could increase next year in Florida — and the spike could be dramatic for some. For individuals buying plans on HealthCare.Gov exchanges, the increase is 17.8 percent on average. But now the U.S. Centers for Medicare and Medicaid Services have released a breakdown of all the different polices in Florida, and how much each of those plans will go up. (Aboraya, 8/3)

Politico Pro: Tax Writers See Peril In Trump's Obamacare Persistence
President Donald Trump has dropped hints that he might stop the Affordable Care Act’s cost-sharing reduction (CSR) payments, through which federal funds flow to insurance companies to keep down coverage costs for low-income people. ...That’s left key Senate tax writers frustrated that there’s potentially another issue to take precious time away from their tax reform efforts. (Becker and Lorenzo, 8/4)

Bloomberg: Obamacare Startup Oscar Hires Clinical Chief For Care Push 
Startup health insurer Oscar Insurance Corp. hired Dennis Weaver as chief clinical officer to oversee work with doctors and hospitals and help build tighter partnerships with health systems. Weaver, a physician who was previously chief medical officer at health and education consultant Advisory Board Co., will start at Oscar on Aug. 14. The role is new, though he will take on some responsibilities previously held by Shaden Marzouk, the chief medical officer who left Oscar late last year. (Tracer, 8/3)

Despite Turmoil Over ACA, Employer-Provided Health Care Not Budging Any Time Soon

"I think a company — any size company — would be incredibly afraid to just cancel its insurance policy and say the hell with it," says business owner Walt Rowen.

The Associated Press: Employer-Based Health Coverage Likely To Stay Awhile
If you are like roughly half of Americans who get their health insurance through an employer, relax. The turmoil around "Obamacare" all but guarantees you'll still be able to do that. The reasons? Unemployment is low, skilled workers are hard to find — and people expect employers to provide health care. (Kellman and Rosenberg, 8/4)

Meanwhile, insurers see a well of profit in the Medicare Advantage program —

Bloomberg: Insurers Think They’ve Found The Perfect Patients For Profits 
The turmoil around the Affordable Care Act has created heartburn for health insurers. The industry is betting that a different government program will soothe its ills. Big insurers have retreated from Obamacare’s individual market, where fighting over the future of the health law has contributed to financial losses. They’re focusing instead on Medicare Advantage, a politically popular program that’s being embraced by a growing population of older Americans. (Tracer, 8/4)

Quality

Feds Back Down Over Rule Requiring Accreditors To Release Reports On Hospital Errors, Mix-Ups

The decision did not go over well with supporters of the rule. ““The public deserves full transparency on how the health care industry performs. Instead, transparency has been sacrificed to accommodate special interests that lobby to avoid disclosing embarrassing information about health care quality,” said Leah Binder, president and CEO of The Leapfrog Group.

ProPublica: Accreditors Can Keep Their Hospital Inspection Reports Secret, Feds Decide
Federal health officials have backed down from a controversial proposal that would have required private accreditors to publicly release reports about errors, mishaps and mix-ups in the nation’s hospitals and health care facilities. The Centers for Medicare and Medicaid Services had proposed in April that accreditors publicly detail problems they find during inspections of hospitals and other medical facilities, as well as the steps being taken to fix them. (Ornstein, 8/3)

In other news concerning hospitals —

Modern Healthcare: CHS To Sell Additional Hospitals Worth $1.5 Billion In Revenue 
Community Health Systems expects to sell another group of its hospitals with combined revenue of $1.5 billion, not including the 30 hospitals previously announced, CEO Wayne Smith said during a second-quarter earnings call Wednesday. Buyer interest is strong for an undisclosed number of hospitals, which carry mid-single digit margins for earnings before interest, taxes, depreciation and amortization, like the first 30 hospitals being divested, Smith said. (Barkholz, 8/2)

Modern Healthcare: CMS Gives Hospitals $2 Billion Raise, Finalizes Unpopular Uncompensated-Care Plan
The CMS will give a $2.4 billion raise to inpatient hospitals in fiscal 2018. The increase is less than the $3.1 billion the agency proposed in April, but exceeds the $746 million bump hospitals received in fiscal 2017. In its final rule for the inpatient prospective payment system, released late Wednesday, the CMS also announced it was moving forward with plans to change the way it reimburses uncompensated care even though the approach was panned by the hospital industry. (Dickson, 8/2)

Kaiser Health News: Under Trump, Hospitals Face Same Penalties Embraced By Obama
Amid all the turbulence over the future of the Affordable Care Act, one facet continues unchanged: President Donald Trump’s administration is penalizing more than half the nation’s hospitals for having too many patients return within a month. Medicare is punishing 2,573 hospitals, just two dozen short of what it did last year under former President Barack Obama, according to federal records released Wednesday. Starting in October, the federal government will cut those hospitals’ payments by as much as 3 percent for a year. (Rau, 8/3)

Stat: Hospitals Brace For Security Risks That Could Come With Using Wearables For Patient Care
Hailed as the future of preventive care, wearable health devices allow doctors to keep closer tabs on the health of patients as they go about their daily routines. But as health systems consider these medical-grade devices, hoping to lower costs associated with hospital readmissions, they have also raised concerns about potential security risks to patients and to the hospitals connected with them. (Blau, 8/4)

Veterans' Health Care

Lack Of Access To Care In Rural Areas Particularly Hard For Veterans

There are veterans who are making hours-long car trips just to get chemotherapy treatment. Pilot programs, such as offering van rides to those who don't have transportation, are being instituted across the country, but funding for them can be tight to nonexistent. Meanwhile, President Donald Trump praises a new telehealth program to try to address that problem.

Stateline: For Rural Veterans, New Approaches To Health Care
While long drives and limited access to health care are familiar burdens for many rural residents, the problem is particularly acute for veterans in those areas. They are far older than other rural residents, and far more likely to be disabled, meaning more of them are in need of medical care. And there are a lot of them—one in four veterans lives in rural areas, compared to one in five adults in the general population, according to 2015 census data. (Fifield, 8/3)

USA Today: Trump Touts Veterans Affairs 'Tele-Health' Program With New Appointment Scheduling Application
President Trump touted a new program to increase veterans' electronic access to medical care as part of a broader tele-health push at the Department of Veterans Affairs. The initiative connects veterans with health providers via mobile phones or computers, and is intended to improve medical care especially for those needing mental health and suicide prevention services, Trump said. (Przybyla, 8/3)

In other veterans' health care news —

Nashville Tennessean: New Poll Results Fuel Fresh Debate Around Future Of VA's Choice Program
A new poll shows veterans overwhelmingly support reforms to the VA's coveted health care program, but others say it's another attempt to advance efforts to privatize the VA, further fueling the brewing debate around the program itself. The poll, from the conservative veterans organization Concerned Veterans for America, shows that 98 percent of veterans polled and 95 percent of registered voters polled believe veterans should have greater ability to choose health care options outside the VA system. (Lowary, 8/3)

The Fiscal Times: How Could The VA Make $5.5 Billion In Improper Payments Last Year?
[Missouri Sen. Claire] McCaskill, the ranking member of the Senate Homeland Security and Government Affairs Committee, says she is disturbed by the IG’s finding that the VA made $5.5 billion of improper payments in 2016 or $500 million more than the previous year. The IG’s report issued in May, said the improper payments, for the most part, were made through two VA health care programs last year: VA community care, which allows veterans to seek care in the private sector rather than go to a VA health center, and a program that helps the elderly and chronically ill. (Pianin, 8/3)

Public Health And Education

Trump Blaming Mexico For N.H.'s Opioid Crisis Exposes Lack Of Understanding Of The Epidemic

In a phone call with Mexico's leader, President Donald Trump called New Hampshire a "drug-infested den," and placed the blame on Mexican cartels. However, the crisis has its roots in prescription drug abuse, which can come from a local doctor.

The Washington Post: Whoops: Trump Made A Few Mistakes By Calling New Hampshire A ‘Drug-Infested Den’
It sounds obvious, but apparently not obvious enough to President Trump: Don't insult an entire state. Especially one that's critical to you and your party's future election hopes. But just six days after getting inaugurated, Trump went there. “I won New Hampshire because New Hampshire is a drug-infested den,” Trump told Mexican President Enrique Peña Nieto in a phone call between the two world leaders. The call was private, but The Post's Greg Miller obtained the transcript — plus an equally eyebrow-raising one of a call with Australian Prime Minister Malcolm Turnbull. (Phillips, 8/3)

The Associated Press: New Hampshire Is No 'Drug-Infested Den,' State Leaders Say
New Hampshire's four-member, all-Democratic Congressional delegation expressed outrage at Trump's comments, as did Republican Gov. Chris Sununu. The governor said the state is making progress in addressing its heroin and opioid crisis on multiple fronts, including greater resources for law enforcement and drug abuse prevention, treatment and recovery. "The President is wrong. It's disappointing his mischaracterization of this epidemic ignores the great things this state has to offer," he said in a statement. (8/3)

The New York Times: Trump Called New Hampshire A ‘Drug-Infested Den,’ Drawing The Ire Of Its Politicians
There were an estimated 470 drug overdose deaths in New Hampshire in 2016, compared with 439 in 2015. In 2012, there were 163, according to statistics compiled by the New Hampshire Department of Health and Human Services. On Thursday, Mr. Sununu described the opioid epidemic in an email as “one of the worst health crises this state has ever experienced.” He said the government had doubled the resources devoted to prevention, treatment and recovery efforts. (Stack, 8/3)

Concord Monitor: Trump Called N.H. A ‘Drug-Infested Den’; Sununu Says ‘The President Is Wrong’
President Donald Trump is under fire from New Hampshire’s political leadership following a report that he said the state was a “drug-infested den” in a call to Mexican president Enrique Peña Nieto. During the Jan. 27 call, the transcript of which was published by the Washington Post on Thursday, Trump pressured Peña Nieto to stop saying publicly that Mexico would not fund Trump’s proposed border wall, a key campaign promise. (Duffort, 8/3)

The Wall Street Journal though looks at Mexico's ties to the heroin trade —

The Wall Street Journal: U.S. Heroin Trade Rooted In Mexico’s ‘Corridor Of Death’
A lethal combination of corruption and criminal gangs fighting for control of a booming heroin trade has turned one two-lane road in Mexico’s Guerrero state into what many call “the corridor of death. ”The road links Chilpancingo, the Pacific Coast state’s capital, to heroin-producing mountains nearby, where rival gangs are vying for a bigger share of the lucrative heroin market in the U.S. Nearly 1,200 people were killed in the state this year through June after 2,200 died last year. Officials say nearly all were linked to organized crime. (Althaus, 8/4)

Most Effective Opioid Addiction Treatment Banned From Majority Of Jails

Much of the criminal justice system still takes a punitive approach to addiction. Many who work in corrections believe, incorrectly, that treatments like methadone, itself an opioid, allow inmates to get high and simply replace one addiction with another. In other news on the crisis: driving under the influence; answers about the epidemic; how health law repeal would hurt those fighting addiction; and more.

The New York Times: Opioid Users Are Filling Jails. Why Don’t Jails Treat Them?
When Dave Mason left jail in October 2015 after his 14th criminal conviction, the odds were good that he would end up dead. A man with a longtime heroin addiction, Mr. Mason was entering one of the deadliest windows for jailed users returning to the streets: the first two weeks after release, when they often make the mistake of returning to a dose their body can no longer handle. (Williams, 8/4)

USA Today: Opioid Crisis: Proportion Of Drivers Killed While Under Influence Spikes
In one of the latest examples of the growing opioid epidemic, researchers found a seven-fold increase in the proportion of drivers killed while under the influence of prescription opioids since 1995. Researchers at Columbia University examined drug testing results for 36,729 drivers in California, Hawaii, Illinois, New Hampshire, Rhode Island and West Virginia who died within an hour of being in a car crash. (Toy, 8/3)

The Associated Press: Homeless And On Heroin, But Turned Away From Treatment
Nearly two decades of using heroin and a year of living on the streets of Philadelphia had led Steven Kemp to a simple conclusion: It was time to get sober. But when he staggered into a detox facility on a recent Friday night, his head brimming with the thought that suicide would end the pain, he was told he couldn't be admitted because he didn't have a photo ID. (Izaguirre, 8/4)

NPR: Longtime Heroin Addict Fights For Recovery
Two summers ago, we met a woman who went by the name Teacup. "I'm an active heroin user," she told us. "Thirty-three years as a matter of fact." We were in West Baltimore, reporting on a citywide effort to stop a growing opioid crisis. On a street corner known for its open-air drug market, health workers trained anyone passing by on how to use naloxone, a medication that can reverse an opioid overdose. They were trying to get naloxone kits into as many hands as possible. (Cornish and Hsu, 8/3)

The New York Times: Short Answers To Hard Questions About The Opioid Crisis
This week, President Trump’s commission on combating the opioid crisis, led by Gov. Chris Christie of New Jersey, recommended that the president declare a national emergency. The problem has become significantly worse recently, so you might feel that you could use a little catching up. Here are 11 things you need to know. (Katz, 8/3)

The Baltimore Sun: ACA Repeal At Odds With Trump Response To Opioid Crisis, Former Drug Czar Says 
The former White House drug czar questions the Trump administration’s commitment to dealing with the nation’s deadly opioid crisis while President Donald J. Trump continues to call for repeal of the Affordable Care Act. The 2010 law defined addictions treatment as an “essential benefit” that must be covered through insurance policies sold in ACA marketplaces and through the expansion of Medicaid. (Rodricks, 8/3)

Denver Post: Drug Addiction Treatment Center Investors Buy Lodge At Cordillera
A $136 million plan to convert the upscale Lodge and Spa at Cordillera into a high-end drug treatment facility is moving forward. The investment group behind the project closed on the lodge this week and the $20 million first-phase of renovation is slated to begin in September as the new owners, led by Concerted Care Group, convert the 56-room lodge, restaurant and spa into a private drug rehabilitation center. (Blevins, 8/3)

The Philadelphia Inquirer/Philly.com: What It's Like To Make Art On The Front Lines Of Philly's Opioid Epidemic
Along Kensington Avenue these days, people are dispensing with the niceties. A man panhandling on a recent Tuesday morning made his pitch, in Sharpie on cardboard, simple and clear: “Dope sick.” Dealers openly sought clients on the sidewalk. Users slouched against walls. And artist Kathryn Pannepacker stood outside the Kensington Storefront, inviting them all inside. There was air-conditioning in there, she told them, peanut butter and jelly sandwiches in plastic baggies, hot tea and cookies, and a craft project to complete. (Melamed, 8/4)

Kansas City Star: How Will Missouri Pay For Troppers To Have Opioid Overdose Drugs?
In his push against the opioid epidemic, Missouri Gov. Eric Greitens last month signed an executive order that would equip Missouri state troopers with an anti-overdose drug. What remains unclear is how long it will take to train troopers and other state law enforcement officers to use the drug, naloxone, and where the money will come from. (Sanderson, 8/3)

Kaiser Health News: To Grow Market Share, A Drugmaker Pitches Its Product To Judges
Philip Kirby said he first used heroin during a stint in a halfway house a few years ago, when he was 21 years old. He quickly formed a habit.“You can’t really dabble in it,” he said. Late last year, Kirby was driving with drugs and a syringe in his car when he got pulled over. He went to jail for a few months on a separate charge before entering a drug court program in Hamilton County, Ind., north of Indianapolis. But before Kirby started, he says the court pressured him to get a shot of a drug called Vivitrol. (Harper, 8/4)

Doctor Tackles Internet's Most Dubious And Dangerous Medical Advice With Empathy And Snark

Dr. Jennifer Gunter is loved and loathed by many for taking on Republicans, President Donald Trump and Gwyneth Paltrow's lifestyle brand Goop. In other public health news: seniors who don't take their meds, back pain, transgender police recruits and flame retardants.

Stat: This Gynecologist Is Taking On Trump, Goop — And Wacky Health Trends
In posts that careen between empathy, outrage, and snark, Dr. Jennifer Gunter presses a provocative crusade to protect women’s health, preserve reproductive freedoms — and, while she’s at it, dismantle all the dubious, dangerous medical advice she comes across in the wilds of the internet. (No, she recently explained to her male readers, you should not forgo condoms in favor of taping your penis shut during sex.) Gunter, a Bay Area gynecologist, shot into the media spotlight in recent months by taking on actress Gwyneth Paltrow, whose lifestyle brand, Goop, peddles — among other gynecologically suspect “wellness” items — jade eggs that women are advised to tuck into their vaginas to improve their spiritual and sexual health. (Keshavan, 8/4)

Stat: Here's Where Seniors Are Most — And Least — Likely To Take Their Meds
For a window into these broader patterns, we turned to a 2016 study from the Centers for Disease Control and Prevention, which looked at 18.5 million seniors taking medication for high blood pressure. The stakes here are high: When patients don’t take these drugs as directed, they’re at elevated risk of having a stroke or heart attack, being hospitalized, and dying early. The government researchers examined when patients filled and refilled their prescriptions, defining non-adherent patients as those who had access to their medication for fewer than 80 percent of the days after their first fill. (The seniors were all covered by Medicare’s Part D program and the data collected were from 2014.) (Robbins, 8/4)

Nashville Tennessean: Want To Prevent Back Pain? Smart Underwear Could Help, Vanderbilt Engineers Say
Back pain is an excruciating fixture in millions of lives, but Vanderbilt University engineers are developing something that might be able to prevent it: smart underwear. They are developing a device, designed to be worn under regular clothing, that would activate elastic bands to relieve stress on back muscles when people are doing physical tasks. The project is supported by funding from Vanderbilt, the National Science Foundation and the National Institutes of Health, according to a statement from the university. (Tamburin, 8/3)

The New York Times: Police Say They Welcome Transgender Recruits Even If Trump Doesn’t
In the week since President Trump declared that transgender Americans would no longer be allowed in the military, some municipal officials have responded with an invitation: join our police force instead. Several cities — including Houston; Austin, Tex.; Aurora, Colo.; and Cincinnati — have encouraged transgender people to apply to their police departments. In Austin, San Diego, Seattle and other places, transgender officers already serve openly. (Astor, 8/3)

San Francisco Chronicle: Flame Retardants Linked To Lower Child IQ
Increased exposure among pregnant women to a class of flame-retardant chemicals found in older furniture and other everyday consumer products is linked to lower IQs in their children, UCSF researchers found in a study that is certain to further ignite the debate over the chemicals. Examining data from nearly 3,000 mother-child pairs from previous studies done around the world, the authors concluded that every tenfold increase in women’s exposure during pregnancy to chemicals known as polybrominated diphenyl ethers, or PBDEs, was associated with a 3.7-point decrease in their children’s IQ. (Tucker, 8/3)

State Watch

State Highlights: Texas Takes Steps To Partially Restore Funds For Disabled Children; University Of Vermont Med School Adopts 'Active Learning'

Outlets report on news from Texas, Vermont, Georgia, Maryland, Minnesota, California, Illinois, Florida, Kansas, Ohio and Louisiana.

Texas Tribune: House Gives Early OK To Reversing Cuts To Disabled Children's Therapy Services
The Texas House gave tentative approval Thursday to a measure that would partially reverse a controversial cut to disabled children’s therapy services that was ordered by the 2015 Legislature. ... The $350 million funding cut outraged therapy providers and the families of children who receive their services, and a group of concerned Texans quickly filed a lawsuit seeking to block the cuts. (Wilson and Najmabadi, 8/3)

NPR: University Of Vermont To Phase Out Lectures In Med School
For students starting medical school, the first year can involve a lot of time in a lecture hall. There are hundreds of terms to master and pages upon pages of notes to take. But when the new class of medical students begins at the University of Vermont's Larner College of Medicine next week, a lot of that learning won't take place with a professor at a lectern. (Cornish and Gringlas, 8/3)

Texas Tribune: Texas House Approves More Abortion Reporting Requirements
Doctors performing abortions on minors would be required to report additional information to the state under a new measure given early approval by the Texas House Thursday. ... Under Murphy's House Bill 215, doctors would have to document how the minor obtained authorization to get an abortion. (Smith, 8/3)

Minnesota Public Radio: Minnesota Struggles To Catch Up As Minority Mental Health Needs Grow
Despite the state's growing racial and ethnic diversity and a yawning need for mental health services among people of color, Minnesota's health professions remain overwhelmingly white and seemingly walled off to diverse clients hoping to talk to providers who look like them. ... Minnesota and mental health officials don't deny there's a problem and say they're working on efforts to increase diversity, from exposing students of color to mental health careers to expanding college loan forgiveness program for providers who open practices in urban areas. (Sapong, 8/3)

Los Angeles Times: After A Rocky Start, USC Verdugo Hills Hospital Reports Better Health Under New Chief Executive
By the time Keith Hobbs, a 23-year employee at Children’s Hospital Los Angeles, joined USC Verdugo Hills Hospital in Glendale as its chief executive, the once independent hospital had already spent more than two years under the Keck Medicine of USC banner. Along with the usual growing pains associated with an acquisition, Verdugo Hills Hospital had spent 2014-15 negotiating a new contract with unionized nurses who complained about staffing shortages as well as unsafe conditions and patient care. (Landa, 8/3)

Chicago Tribune: University Of Chicago Medicine Severs Ties With Medicaid Insurer IlliniCare
Thousands of low-income patients may have to scramble to find new doctors this month after University of Chicago Medicine became the latest major health system to break up with IlliniCare Health, an insurer that administers benefits for the state's Medicaid program. U. of C. Medicine follows Northwestern Medicine and Advocate Health Care in walking away from IlliniCare Health, one of 12 Medicaid managed care organizations in the state. Medicaid managed care organizations are insurers that handle benefits for Medicaid, a state- and federally funded health insurance program for the poor. (Schencker, 8/3)

Kaiser Health News: Florida Law Will Let Patients Get All Their Drug Renewals At The Same Time
For people who take multiple medications to manage chronic conditions, traipsing back and forth from the pharmacy to pick up pills can make it harder to stick to their doctors’ orders. But because insurers often don’t allow consumers to fill partial prescriptions to make  medication renewal dates align, patients sometimes have no choice but to frequently shuttle to the drug store for refills. (Andrews, 8/4)

KCUR: KU Cancer Center Fails In Quest For ‘Comprehensive” Status But Certification Renewed
The National Cancer Institute (NCI) has denied the University of Kansas Cancer Center’s campaign for a much coveted “comprehensive” designation. But the center's certification as a nationally recognized center has been renewed for five years. "We were disappointed but not surprised to learn that we did not receive comprehensive status,” Dr. Roy Jensen, director of the KU Cancer Center, said in a statement. “On average, it takes an NCI-designated cancer center 15 years to achieve comprehensive status, and we received our NCI designation just five years ago.” (Margolies, 8/3)

Kansas City Star: KU Cancer Center Partnership With Children's Mercy Hospital Approved
The National Cancer Institute has denied the University of Kansas Cancer Center’s application to upgrade its NCI designation but approved the addition of Children’s Mercy Hospital to KU’s research consortium. Michael Artman, the chairman of the Department of Pediatrics at Children’s Mercy, said that means innovative cancer treatments like immunotherapy for more kids. (Marso, 8/3)

Columbus Dispatch: Ohio Fails On Cancer-Control Policies, Study Finds
Ohio has failed a recent evaluation by the Cancer Action Network of the American Cancer Society, meeting just three of the network’s nine public-policy goals aimed at reducing cancer diagnoses and deaths. The state was highly criticized in three areas: for not prohibiting minors from using tanning beds; for allocating just 10.3 percent of the federal government’s recommended funding level for tobacco-control programs; and for appropriating less than one-third of matching funds to a federal award for breast and cervical cancer screening programs. (Viviano, 8/3)

Columbus Dispatch: Legionella Cases Confirmed In Two Whitehall Nursing Home Residents
Two Whitehall nursing home residents were hospitalized last month with respiratory infections caused by legionella bacteria. The Manor at Whitehall is now working with Franklin County Public Health and a private contractor to determine whether the bacteria came from the water systems inside the 150-bed facility on Langley Avenue. (Widman Neese, 8/3)

California Healthline: Taking Stock Of California’s Big Week In Health Care
This has been a momentous week for health care in California.The Covered California exchange announced that its premiums will likely rise by an average of 12.5 percent statewide next year. On top of that, the exchange may add an average 12.4 percent surcharge to silver level plans if President Donald Trump stops funding critical subsidies that help reduce some consumers’ out-of-pocket expenses — or if uncertainty over their fate persists. (8/3)

Georgia Health News: Many Migrant Farmworkers Face Medical Challenges, Barriers To Care
The farmworkers who move through the region, harvesting and packing the produce, are at a higher risk for certain health problems — particularly diabetes and hypertension, says Judy Wold, clinical professor of nursing at Emory University, who directs a two-week program of health care services for farmworkers there during summers. The farmworkers also often face barriers to health care. (Simonton, 8/3)

Houston Chronicle: Texas Lawmakers Remain At Odds Over Retired Teacher Health Care Costs 
A bill that would stabilize health care costs for tens of thousands of Texas' retired teachers for the next two years sailed through the House on final reading Wednesday, although its future is far from certain in the Senate as the political drama between the two chambers intensifies. Lawmakers in both Republican-led chambers have said the state should bear some of the rising costs for premium, deductible and out-of-pocket health expenses facing the state's retired teachers, who are expecting to see their health care expenses soar in 2018. However, the two sides are at odds about how to pay for it. (Zelinski,  8/3)

KQED: Despite Marijuana Legalization, California’s Black Market Could Remain Huge
Legalizing marijuana, California voters were told last year, would create a “safe, legal and comprehensive system” allowing adults to consume the drug while keeping it out of the hands of children. ...But as state regulators prepare to begin offering licenses to marijuana businesses on Jan. 1, it turns out that a huge portion of the state’s weed is likely to remain on the black market. (Rosenhall, 8/4)

Health Policy Research

Research Roundup: Value-Based Payment; ACOs; And Medicare Advantage

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

JAMA: Social/Medical Risk And Practice Performance In Medicare Value Modifier Program
Was there an association between the social or medical risk of patients treated at physician practices and performance during the first year of the Medicare Physician Value-Based Payment Modifier Program? Practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs. These patterns were associated with fewer bonuses and more penalties for high-risk practices. As value-based payment programs continue to increase in size and scope, practices that disproportionately serve high-risk patients may be at particular risk of receiving financial penalties. (Chen, Epstein, Orav et al, 8/1)

JAMA Internal Medicine: Extending CareFirst’s Medical Home Program To Medicare Patients 
Does CareFirst’s medical home program, which provides financial incentives to primary care practices and care coordination for high-risk patients, improve quality of care and reduce hospitalizations, emergency department visits, and spending for Medicare patients? In a difference-in-differences analysis with 52 intervention practices and matched comparison practices, the program was not associated with outcome improvements for Medicare patients. Hospitalizations declined by 10%, but this was matched by similar changes in the comparison group, suggesting that outside market factors drove the decline in the treatment group. This medical home model needs further adaptions and testing before being scaled broadly for Medicare patients. (Peterson, Geonnotti, Hula et al, 7/31)

JAMA Cardiology: Changes In Medication Use And Adherence In Accountable Care Organizations
In this population-based study of Medicare beneficiaries from before the start of accountable care organization contracts to 2014, ranging from approximately 4.5 million to 10.8 million person-years, depending on drug class, differential changes in the use of and adherence to common antihypertensive, lipid-lowering, and hypoglycemic medications were minimal for accountable care organization patients vs patients of non–accountable care organization providers. Through its third year of operation, the Medicare Shared Savings Program has not meaningfully increased the use of or adherence to medications that improve outcomes for patients with cardiovascular disease or diabetes. (McWilliams, Najafzadeh, Shrank et al, 7/12)

The Henry J. Kaiser Family Foundation: Some Counties May Lack An ACA Marketplace Insurer Next Year – But Many More Lack Medicare Advantage Plans Today
With efforts to repeal and replace the Affordable Care Act (ACA) apparently on hold, some policymakers may ramp up efforts to strengthen the individual market, particularly in areas with few if any insurers. During the recent debate, a fair amount of attention was focused on counties at risk of having no health insurers in the ACA markets in 2018. As of July 31, 2017, 19 ACA marketplaces nested in mostly rural parts of Nevada, Indiana, and Ohio are at risk of having no insurer next year, according to the latest Kaiser Family Foundation analysis. Critics of the ACA say that the potential lack of insurers in these counties offers proof that the ACA is failing. But, does it? We analyzed these counties to see whether the story looks similar for Medicare Advantage plans, and found relatively few insurers offering Medicare Advantage plans in the counties that could have no exchange plans next year. In 7 of these 19 counties, there are no Medicare Advantage insurers, and in another 8 counties, there are two or fewer firms now offering a Medicare Advantage plan – well below the national average. (Jacobsen and Neuman, 8/1)

Editorials And Opinions

The Debate On Health Care: The Need For Bipartisanship; The Origin Of The Rage

Opinion writers analyze where Congress turns now on the health law and the factors affecting the political decisions.

The New York Times: Let’s Stop The Bickering And Fix The Health Care System
If either of us were building the American health care system from scratch, we’d probably end up in different places. We have contrasting ideas — one of us is a Democrat, the other a Republican — about what ails the system and how to reshape it. But this is not the time for more partisan fighting. It’s time to build a better system, even if incrementally, because that’s what the American people deserve. It’s time to put aside blame and stabilize a health care marketplace where premiums are expected to rise by more than 15 percent in most states and millions of people are worried about obtaining or affording coverage. (Reps. Josh Gottheimer (D-N.J.) and Tom Reed (R-N.Y.), 8/4)

Boston Globe: Pushing The Reset Button On Health Care
The Senate’s defeat of this most recent attempt to repair America’s health care system gives Congress a golden opportunity to start over by applying a much smarter approach — not repeal or replace, but “reset.” Throughout my career in public office, I’ve learned that meaningful change happens only with bipartisan support, open debate, and the normal push and pull of the legislative process. (Ohio Gov. John Kasich, 8/3)

Reuters: Why Republicans Will Always Struggle To Repeal Obamacare
With John McCain’s dramatic “no” vote, the Health Care Freedom Act (HFCA) died early last Friday morning and with it any hope of repealing the Affordable Care Act (ACA) for the foreseeable future. While conservatives might prefer to blame incompetent vote-whipping in the Senate, the ACA could prove resilient for the same reason Medicare and Social Security have: most voters prefer not to wonder if they will be able to eat when hungry or see a doctor when sick. Any program that gives more economic security to a broad, politically powerful group will be dangerous to meddle with, even in these polarized times. (Scott Lemieux, 8/3)

The New York Times: Obamacare Rage In Retrospect
Why did Obamacare survive? The shocking answer: It’s still here because it does so much good. Tens of millions have health coverage — imperfect, but far better than none at all — thanks to the Affordable Care Act. Millions more rest easier knowing that coverage will still be available if something goes wrong — if, for example, they lose their employer-sponsored plan or develop a chronic condition. Which raises a big question: Why did the prospect of health reform produce so much popular rage in 2009 and 2010? (Paul Krugman, 8/4)

Forbes: Put Out The Fire Instead Of Burning Exchanges To The Ground: Extend Cost-Sharing Reduction Payments
The 6 percent of Americans who buy their insurance on the individual market are the small business people, contract workers, entrepreneurs, musicians, stay-at-home parents, job seekers, and the millions of Americans who can’t receive coverage through their employers. They are Republicans, Democrats, and Independents. Trump supporters and Hillary voters. And their ability to purchase coverage on the exchanges is in jeopardy, as mixed signals from Congress and the Administration have left insurers scrambling to decide whether to hike already costly premiums or pull out entirely—triggering the beginnings of collapse in some regions. (Bill Frist, 8/3)

The Washington Post: This Is Not How Mitch McConnell Wanted To Head Into Recess
It’s as if the summer turned into the perfect storm against the best-laid plans of Senate Majority Leader Mitch McConnell. Soon after Memorial Day, McConnell (R-Ky.) drew up a game plan around approving a rewrite of the Affordable Care Act by the end of June. The benefits were twofold, providing House Republicans a few weeks to approve the Senate version and send it to President Trump. (Paul Kane, 8/3)

Bloomberg: Defining Success Or Failure For Obamacare
It is fair to say that I’m more bearish on Obamacare than people to the left of me. But you can be bearish on Obamacare without thinking that it is going to melt down in a cataclysm so utter that the living will envy the dead (at least until a premium-induced heart attack causes them to join that happy group). You can be bullish on Obamacare without thinking that this program has achieved the platonic ideal of health insurance, leaving our citizenry with little to do except stroll around this new heaven, singing songs of praise for the almighty Cost-Sharing Reduction. Unfortunately, both sides of the debate are too fond of attributing these ultra-strong opinions to their opponents, and then triumphantly proving them untrue. (Megan McArdle, 8/3)

And on the health debate in California --

Sacramento Bee: The Real Barrier To Single Payer Health Care
Under SB 562, a Medicare-for-all bill, not only would every Californian be guaranteed health coverage, but all premiums, as well as deductibles and copays, would be eliminated. ... Revenue to achieve a truly universal system could be raised with two fair taxes with exemptions for low-income residents and small businesses. (Deborah Burger, 8/3)

Viewpoints: Medicaid And Doctors Are Key Weapons In Fight Against Opioid Epidemic

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

The Washington Post: How To Reverse A Catastrophe
President Trump’s newly appointed Commission on Combating Drug Addiction and the Opioid Crisis, led by Gov. Chris Christie of New Jersey (R), issued its preliminary report Monday — and the recommendations were generally worthy. ... the president and both houses of Congress have spent the bulk of 2017 so far debating how much to cut Medicaid, which happens to pay for about a quarter of all addiction treatment. The House version of Obamacare repeal-and-replace legislation also could have watered down the requirement to include addiction treatment as an essential health-care benefit for private plans sold on the exchanges. Cutting health care amid an opioid epidemic makes no sense. (8/3)

USA Today: How Doctors Can Stop The Opioid Crisis At Its Source: Quit Overprescribing
For most of my surgical career, I gave out opioids like candy. My colleagues and I were unaware that about one in 16 patients become chronic users, according to new research by doctors at the University of Michigan. Even more alarming, research shows that relapse rates after opioid addiction treatment could be as high as 91%. In addition to expanding treatment, it’s time we address the root of the problem — overprescribing. My own aha moment came recently after my father had gallbladder surgery and recovered comfortably at home with a single ibuprofen tablet. (Marty Makary, 8/4)

The New England Journal of Medicine: Cyberattack On Britain’s National Health Service — A Wake-Up Call For Modern Medicine
As you would expect in a pandemic, the headlines were alarmist: we were reportedly locked in a race against time to protect millions of patients from a new virus of unprecedented virulence that had crippled the United Kingdom’s National Health Service (NHS) and was spreading rapidly across the country. Except in this case, the virus was not organic but digital. ... For NHS staff, the attack was stressful, grueling, and exhausting — not least for the legions of NHS IT workers who toiled all night to update and then patch thousands of health service systems. For doctors, it was a wake-up call. Underfunding ultimately left us horribly exposed to a predictable attack that threatened not just privacy but patient safety. (Drs. Rachel Clarke and Taryn Youngstein, 8/3)

USA Today: Betsy DeVos Is Right: In College Sexual Assault Cases, Due Process Matters
In a series of meetings this month, Education Secretary Betsy DeVos signaled strong disagreement with the Obama administration’s aggressive erosion of due process protections for college students accused of sexual assault. While deploring the horrors of the offense, DeVos added that “a system without due process protections … serves no one.” This was a welcome change from the decrees issued by the Obama-era Office for Civil Rights (OCR), which had told colleges to avoid any due process safeguards that would “restrict or unnecessarily delay the protections provided by Title IX” to accusers. (KC Johnson and Stuart Taylor, 8/2)