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

Congressman’s Ties To Foreign Biotech Draw Criticism

Rep. Chris Collins’ enthusiastic investments in Australian biotech company Innate Immunotherapeutics preceded share purchases by the Buffalo Republican’s family members, associates and political donors — raising questions from Washington, D.C., to Sydney. (Emily Kopp and Rachel Bluth, 2/17)

Political Cartoon: 'Agree In Principle?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Agree In Principle?'" by Chip Bok.

Here's today's health policy haiku:

AID-IN-DYING NOW

I am my own death
Panel.  When my time is done,
Doctor, help me leave.

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:

Health Law

GOP Leadership Presents 'Smorgasbord' Of Repeal Options, But Few Concrete Details

House Speaker Paul Ryan met with rank-and-file Republicans to review a plan to dismantle and replace the health law on Thursday. Ryan told reporters leadership will introduce the legislation after the House's upcoming recess.

The Associated Press: GOP Leaders Unveil New Health Law Outline, Divisions Remain
At a closed-door meeting in the Capitol basement, House Speaker Paul Ryan, R-Wis., and other party leaders described a broad vision for voiding much of President Barack Obama's 2010 statute and replacing it with conservative policies. It features a revamped Medicaid program for the poor, tax breaks to help people pay doctors' bills and federally subsidized state pools to assist those with costly medical conditions in buying insurance. Lawmakers called the ideas options, and many were controversial. One being pushed by Ryan and other leaders would replace the tax increases in Obama's law with new levies on the value of some employer-provided health plans — a political no-fly zone for Republicans averse to tax boosts. (Fram, 2/16)

NPR: GOP Health Care Would Cut Coverage For Low-Income Families
The outline plan is likely to take away some of the financial help low-income families get through Obamacare subsidies, and also result in fewer people being covered under the Medicaid health care program for the poor. "In general this is going to result in fewer people covered nationwide," says Caroline Pearson, a senior vice president at Avalere, a health care consulting group. (Kodjak, 2/16)

The Washington Post: House GOP Discusses Obamacare Replacement Ideas — But Doesn’t Call Them A Plan
According to numerous lawmakers and aides in the room, as well as a policy memo distributed afterward, the House leaders laid out elements of a repeal-and-replace plan — including long-standing Republican concepts like health savings accounts, tax credits and state high-risk pools for the chronically sick. But they did not detail how those elements would fit together or get passed into law. “It’s sort of a smorgasbord right now,” said Rep. Daniel Webster (R-Fla.). (DeBonis and Snell, 2/16)

CQ Roll Call: House GOP Still Hazy On Strategy For Obamacare Repeal
Members, however, were not provided any concrete language at Thursday’s meeting. “I think they’ve got the outline of the things that will be a part of a bill and part of a reconciliation package going along,” Rep. Ann Wagner, R-Mo., said. “Now we’re getting down to some of the very specifics.” (Williams and Mershon, 2/16)

The Wall Street Journal: House Republicans Lay Out Health-Care Plan
The proposal seeks in addition to revamp the individual insurance market where millions of Americans who don’t get employer coverage buy insurance. It would replace the health-law subsidies with tax credits Americans could use to help pay for private insurance, and it would allow for skimpier health plans not permitted under the ACA, which some say would help bring down costs. (Hackman, Peterson and Armour, 2/16)

The Fiscal Times: Republicans Eye Medicaid Cuts To Help Finance Their New Health Plan 
The House GOP approach would preserve a number of features of the existing Obamacare law, including preventing insurers from discriminating against applicants with pre-existing medical problems and allowing children to remain on their parents’ private health care plans until they turn 26. And it would experiment with federally financed, state-run “high-risk pools” that provide coverage to older and sicker Americans who would have trouble finding affordable health insurance in the private market. (Pianin, 2/16)

Reuters: Trump, Republicans Set Timeframe For Introducing Obamacare Replacement
Ryan told reporters on Capitol Hill that House Republicans would introduce legislation to repeal and replace Obama's program after a 10-day recess that begins on Friday. "After the House returns following the Presidents Day break, we intend to introduce legislation to repeal and replace Obamacare," Ryan said at a press conference. Presidents Day is on Monday and the House returns on Feb. 27. (Cowan and Morgan, 2/16)

Roll Call: Emerging GOP Plan Would Replace Parts Of Obamacare As It’s Repealed
Ryan told reporters that the repeal and replace measure will be introduced after the Presidents Day recess. Asked if that meant the week of Feb. 27, the speaker demurred, saying that the bill’s drafters are waiting on cost estimates from the Congressional Budget Office and the Joint Committee on Taxation. “It’s after the recess … pending our drafting our issues,” he said. (McPherson, 2/16)

Politico: House Republicans Still Apart On Obamacare Repeal-Replace
Newly confirmed Health and Human Services Secretary Tom Price told lawmakers at Thursday's meeting that President Donald Trump “is all in on” repealing and replacing Obamacare at the same time. Earlier this week, the conservative House Freedom Caucus called on Republicans to repeal the law first and work on a replacement later. "Let's not miss this opportunity,” Price said, according to a source in the room. “Let's go shoulder to shoulder, arm to arm.” (Haberkorn, Cheney and Pradhan, 2/16)

CNN Money: Three Ways Republicans Want To Replace Obamacare
Republicans don't have the 60 votes in the Senate needed to enact broader changes to the law, including revising Obamacare's strict insurance rules which are critical to the GOP's promise to make health insurance more affordable. So they plan to repeal the mandates, penalties and taxes using the budget reconciliation process, which is limited to revenue and spending measures and requires only a simple majority to approve. (Luhby, 2/17)

CQ HealthBeat: Obamacare Repeal's Effect On Budget A Major Question For GOP
The short- and long-term budget impact of repealing and replacing the 2010 health care law is emerging as a central issue as House Republicans work out the details of their legislative package. The two House committees in charge of writing the reconciliation bill that would repeal and replace Obamacare have not publicly released the text. No official score from the Congressional Budget Office has been written. But several lawmakers on Thursday said they are waiting for the nonpartisan office to weigh in on how elements scrutinized as part of the bill would affect the budget outlook. (Shutt and Krawzak, 2/17)

McClatchy: GOP Lawmakers Get Details On Ryan Obamacare Repeal Plan And Advice On How To Sell It
[F]ormer Obama administration health advisers said the document and its strategy recommendations for GOP lawmakers couldn’t hide the fact that Republicans still hadn’t produced a definitive plan to replace Obamacare. “Because the vast majority of the public has been making clear they do not want their care ripped away from them with nothing else in its place, this is going to be an especially interesting recess period,” said Andy Slavitt, who was the Medicaid administrator under President Barack Obama. (Pugh and Clark, 2/16)

The Wall Street Journal: GOP May Trim Tax Break For Employer-Backed Insurance
House Republicans, looking for ways to pay for their plan to repeal and replace the Affordable Care Act, are considering changing the special tax treatment for employer-provided health benefits. Capping how much of employees’ health benefits can be shielded from income and payroll taxes is one of the ways GOP lawmakers might offset the cost of their emerging health plan. (Peterson and Rubin, 2/17)

Bloomberg: GOP May Cap Insurance Tax Break As ACA Repeal Bill Nears
The proposal, still under development, would limit the amount U.S. employers can exclude from workers’ taxes for the health benefits they provide, meaning Americans’ taxes would go up. Excluding premiums from taxes was worth about $250 billion in forgone tax revenue in 2013, according to the Congressional Budget Office. Some health economists have argued that the exemption artificially drives up health spending. (Edney, House and John, 2/16)

Stat: Latest GOP Obamacare Plan Targets Law's Tax On Drug Makers
The latest Republican plan to repeal and replace the Affordable Care Act, which leaked out Thursday, would target the health care law’s tax on drug makers. It’s not terribly surprising. The GOP has long pledged to undo all of the law’s taxes, and the tax was repealed as part of the test-run bill Republicans passed in 2015. (Scott, 2/16)

Morning Consult: Flake, Brat Head To White House To Talk Health Savings Accounts
Two Republican lawmakers met Thursday with National Economic Council Director Gary Cohn at the White House to discuss health savings accounts. Sen. Jeff Flake (R-Ariz.) and Rep. Dave Brat (R-Va.) were at the meeting. ... The measure, introduced last month, would nearly triple contribution limits to HSAs and allow for more universal participation in them. Health savings accounts are one of the primary features Republicans are pushing as part of their plan to replace the Affordable Care Act, although GOP leaders have not put forth legislative text. (McIntire, 2/16)

Roll Call: Ted Cruz Wants To Repeal Obamacare Now, Then Work Out Replacement Details
Even no with no consensus replacement for Obamacare in sight, Sen. Ted Cruz is pushing for action on the repeal long promised by Republicans. “What I think is critical at the outset is that we honor the promise we've made to voters for six years running now to repeal Obamacare. We've had three elections — 2010, 2014 and 2016 — that were referenda on repealing Obamacare, and we need to honor that promise,” Cruz said. “Once Obamacare’s repealed, then we need common sense health care reform that expands choices, that lowers prices, and empowers patients to make their own health care decisions." (Lesniewski, 2/16)

Republicans' Answer To Covering The Sickest Of The Sick: High-Risk Pools

The cost of caring for people with chronic, serious health conditions is immense and how to pay for it has plagued both parties for years. Republicans are touting high-risk pools as a way to do it, but past attempts have not proven successful. Meanwhile, Vox reporter Sarah Kliff talks about where everything stands after this week's general upheaval.

Stateline: ACA Repeal Could Mean Return To ‘High-Risk Pools’
In 2011, there were 226,615 people in high-risk pools nationwide. But the plans largely disappeared with the advent of the Affordable Care Act .... Now, as President Donald Trump and Republicans in Congress prepare to scrap the ACA, they are touting high-risk pools as a partial replacement. In a recent interview, [Lance Rice's] mother, Michelle, described the Indiana pool as “a lifesaver” that prevented the family from going bankrupt [after her son was diagnosed with hemophilia]. But in the other states with high-risk pools, especially the 20 that didn’t help people pay their premiums, the reviews weren’t so rosy. In those states, people struggled with expensive premiums, limited payouts and lifetime limits. (Ollove, 2/16)

WBUR: Where Are We Now On Affordable Care Act Changes
Vox health policy reporter Sarah Kliff (@sarahkliff) joins Here & Now's Meghna Chakrabarti to discuss how consumers might be affected by a new Trump administration proposal to limit sign-ups for individual health insurance plans under the Affordable Care Act. The new rules come as House Republicans meet Thursday to come up with a strategy to repeal and replace the ACA. (Chakrabarti, 2/16)

And in other news —

The Philadelphia Inquirer: Affordable Care Act Proposal Is A Good Start, Independence Blue Cross Chief Says
Rules proposed this week by the Trump administration to stabilize the individual health insurance market under the beleaguered Affordable Care Act are a good start, according to Daniel J. Hilferty, chief executive of Independence Blue Cross, the Philadelphia region's largest insurer. The proposal, the first concrete step by the Trump administration to deal with the ACA, would have little effect this year, but could bolster the market in 2018 by luring more insurers back into the market, said Hilferty, whose company was the only one to offer plans in Southeastern Pennsylvania this year. (Brubaker, 2/16)

The CT Mirror: CT Obamacare Exchange At A ‘Critical Crossroads,’ Leader Says
The federal health law and Connecticut’s Obamacare exchange are at a “critical crossroads,” the head of the state’s health insurance marketplace said Thursday, citing a host of potential changes that could affect Access Health CT’s viability. Among them: Plans by the Internal Revenue Service not to reject tax forms from filers who don’t report whether they had health insurance in the past year, Access Health CEO Jim Wadleigh told the exchange’s board, warning that it could “unwind” the Affordable Care Act’s individual mandate.  (Levin Becker, 2/16)

The CT Mirror: Here’s What We Know About CT’s Obamacare Insurance Customers
In all, 111,542 Connecticut residents signed up for private insurance plans through the state’s health insurance exchange, Access Health CT. That’s a 4 percent dip from last year. CEO Jim Wadleigh said Thursday that could reflect the fact that insurance companies stopped paying commissions to brokers for exchange plans – reducing the availability of help signing up for coverage – and confusion about changes to the Affordable Care Act at the federal level. (Levin Becker, 2/16)

Modesto Bee: People At Town Hall In Modesto Challenge Denham To ‘Show Your Face’ And Speak With Constituents About ACA Repeal
About 300 people gathered in a Modesto church for a town hall Wednesday evening, urging Republicans in Congress not to repeal the Affordable Care Act. Union groups and health advocates kept up pressure on Rep. Jeff Denham, R-Turlock, to not support dismantling the federal health program unless there’s a new plan that protects consumers and covers more people. (Carlson, 2/16)

Administration News

CMS Nominee Avoids Getting Pinned Down On Specifics About Medicaid, Drug Prices

During her confirmation hearing, lawmakers also grilled health care consultant and CMS nominee Seema Verma over her potential conflicts of interest.

The New York Times: Trump Health Pick Says Medicaid Needs A Major Overhaul
President Donald Trump's pick to run the government's major health insurance programs said Thursday that Medicaid needs a full overhaul but she doesn't support turning Medicare into a "voucher" plan. Indiana health care consultant Seema Verma testified before the Senate Finance Committee on her nomination to lead the Centers for Medicare and Medicaid Services, or CMS. The $1 trillion agency oversees programs that cover about 1 out of 3 Americans. (2/16)

Indianapolis Star: Pick To Head Medicare, Medicaid Gives Few Policy Views
Verma resisted efforts by Democrats, and some Republicans, to take positions on other potential changes including: Raising Medicare's eligibility age and requiring the government to negotiate with drug companies for lower prices. Changing the minimum benefits health plans must cover. Capping the amount of money states receive for their Medicaid programs. (Groppe, 2/16)

The Hill: CMS Nominee Breezes Through Confirmation Hearing 
Republicans have long wanted to repeal ObamaCare's Medicaid expansion and overhaul the way the program operates, and they hope Verma will be the one to help them do it. Some options Republicans support include block grants or per capita caps. But she declined to say Thursday whether she would support either of those reforms. "We can do a better job than what we have today in the [Medicaid] program," Verma said. (Hellmann, 2/16)

Politico Pro: Verma Endorses Medicaid Overhaul In Confirmation Hearing
“I’m endorsing the program being changed to make it better,” said Verma, who appears to be headed toward confirmation after a nearly four-hour hearing. “Whether that’s a block grant or per-capita cap, there are many ways we can get there, but at the end of the day the program isn’t working as it should.” (Cancryn, 2/16)

Modern Healthcare: CMS Nominee Wants To Protect States And Rural Providers, Opposes Vouchers For Medicare 
Verma told the Senate Finance Committee that one of her first priorities will be re-assessing a rule issued under the Obama administration that required states to more vigorously supervise the adequacy of plans' provider networks and encouraged states to establish quality rating systems for health plans. Verma said she wanted to determine whether the rule would burden states. (Dickson, 2/16)

Reuters: Trump's Pick To Lead Health Agency Calls EpiPen Issue 'Disturbing'
U.S. President Donald Trump's choice to lead an important health agency said on Thursday that the way pharmaceutical companies classify products as generic or branded needs to be reviewed in order to help hold down government spending, as she cited Mylan NV's EpiPen emergency allergy treatment. Seema Verma, Trump's nominee to lead the Centers for Medicare and Medicaid Services (CMS), did not answer questions about whether the U.S. government should negotiate with pharmaceutical companies over drug prices. (Cornwell, 2/16)

Stat: Pressed On Drug Prices, Nominee To Head Medicare And Medicaid Praises Competition
As Democrats pressed her on Trump’s support for drug-price negotiations under Medicare Part D during a Senate Finance Committee hearing, Verma didn’t let herself get pinned down. “I’m thankful that we have the (pharmacy benefit managers) and the Part D program performing that negotiation on the behalf of seniors,” Verma said, asked repeatedly about her stance by Senators Ron Wyden of Oregon and Debbie Stabenow of Michigan, both Democrats. (Farcher, 2/16)

Morning Consult: CMS Nominee Verma Supports Making Maternity Coverage Optional
Seema Verma, President Donald Trump’s pick to head the Centers for Medicare and Medicaid Services, said on Thursday that insurers should not have to provide maternity coverage, as is now required under the Affordable Care Act. Asked by Sen. Debbie Stabenow (D-Mich.) at her confirmation hearing, Verma said women should be able to choose between health plans that offer maternity coverage and others that do not. Under Obamacare, all health plans are required to provide maternity coverage. (Reid, 2/16)

CQ Roll Call:  Senators Press CMS Nominee On Medicaid, Drug Costs At Hearing
The largely friendly hearing was markedly different from the one Finance held last month for Verma’s likely boss, Health and Human Services Secretary Tom Price. Democrats vigorously opposed Price due in part to his positions on federal entitlement programs and his active investing in health care stocks while serving as an influential lawmaker. (Young, 2/16)

McClatchy: Medicaid Nominee Seema Verma Won’t Discuss New Proposals For Obamacare 
The Trump administration on Wednesday proposed cutting the sign-up period for marketplace enrollment in half. Sen. Ron Wyden, D-Ore., said the move could reduce program enrollment. Verma said she would have to review the implications of the proposal before she could comment on the possible effects. Wyden also expressed concerns about Verma’s dual role as a Medicaid consultant for Indiana and other states while she was under contract to several large Medicaid contractors. (Pugh, 2/16)

CNN: Trump Pick To Head Medicare And Medicaid Grilled On Obamacare Repeal
[Sen Orrin] Hatch asked Verma whether there were any conflicts of interests that lawmakers should be aware of -- a question that appeared to reflect numerous ethics concerns that arose during Price's confirmation process. Verma said she would recuse herself from any matter that would present potential conflict. Later in the hearing, she shared that the Office of Government Ethics had advised her against participating in any issues related to mental health services because her husband is a psychiatrist. (Lee and Luhby, 2/16)

The Washington Post: Medicaid Exposes Rifts Within The GOP Over The Program’s Future After The ACA
As congressional Republicans move from talking points to details of how to abolish the Affordable Care Act, behind-the-scenes jockeying over the future of Medicaid demonstrates the delicate trade-offs the GOP faces in trying to steer health policy in a more conservative direction. For years, many Republicans have railed against the ACA’s expansion of Medicaid, which has extended coverage to about 11 million people. But now that they have the political power to reverse those gains, internal disagreements have emerged. Some lawmakers want to preserve the federal money their states are getting under the expansion. Others argue that part of that money should be shifted to states that did not broaden their programs — or used for other purposes. (Eilperin, Goldstein and Snell, 2/16)

Capitol Hill Watch

House Votes To Roll Back Obama's Ban On States Defunding Planned Parenthood

Democrats are calling the move a "backdoor attempt to restrict access" to abortion.

The Wall Street Journal: House Votes To Let States Strip Money From Planned Parenthood
House Republicans took the first step Thursday to strip federal funding from Planned Parenthood and other abortion providers, starting what will become a broader battle over funding for the women’s health-services agency. The House voted 230-188 to rescind a regulation that bans states from denying certain funds to health-care providers that perform abortions, in essence freeing states to refuse to give the funds to Planned Parenthood Federation of America Inc. and similar organizations. (Andrews and Hackman, 2/16)

CQ Roll Call: House Passes Resolution On Family Planning Funds
Congress appropriated about $286 million in fiscal 2016 for what’s known as Title X funding, which is supposed to be spent on family planning and reproductive health. The Obama administration finalized its rule in December after 13 states passed laws to redistribute the funding away from reproductive health providers, such as Planned Parenthood, and spend it at more general community health centers. (Siddons, 2/16)

The Hill: House Votes To Let States Deny Federal Funds To Abortion Providers
Democrats argued the GOP's effort was aimed at defunding Planned Parenthood, even though the organization is legally prohibited from using federal funds for abortions. "It's no surprise that, once again, congressional Republicans are trying to undermine access to healthcare and basic family services," Rep. Barbara Lee (D-Calif.) said on the floor Thursday. Rep. Carolyn Maloney (D-N.Y.) called the resolution a "backdoor attempt to restrict access" to abortion. (Hellmann, 2/16)

Politico Pro: House Backs Bill Overturning Protections For Planned Parenthood
House Republicans argued that the measure upholds states' rights and is not an attack on Planned Parenthood. “We are not voting to defund Planned Parenthood or reduced funding for Title X programs,” sponsor Rep. Diane Black (R-Tenn.) said on the floor ahead of the vote. “We are voting to affirm the rights of states to fund health care providers that best suit their needs.” (Ehley, 2/16)

KCUR: In The Face Of More Missouri Abortion Restrictions, One Woman Tells Her Story
Anti-abortion groups in Missouri helped boost many Republican candidates to victory in November, and they’re now eagerly waiting to see how those lawmakers advance their cause. Missouri legislators have filed dozens of restrictive abortion bills, including two that would outlaw abortions after the 20th week of pregnancy rather than the current 21-weeks and six days. Supporters say late-term abortion bans protect the unborn, but opponents say they create undue hardships for women. One such opponent is a Missouri woman who had to leave the state to end her fraught pregnancy. (Smith, 2/16)

Lawmakers Move To Ease Obama-Era E-Cigarette Regulations

A proposal by Republican Reps. Tom Cole of Oklahoma and Sanford Bishop of Georgia would get rid of a "grandfather” clause that requires companies selling cigars, pipe tobacco, and vapor products such as e-cigarettes after Feb. 15, 2007 to disclose their ingredients and prove that their products meet the applicable public health standards set by the law.

Stat: E-Cigarettes Would Be Excluded From Some Regulations Under New Proposal
Congressional supporters of the tobacco industry have wasted no time in proposing legislation to help e-cigarette companies escape rules adopted under President Barack Obama. In what Republican Reps. Tom Cole (Okla.) and Sanford Bishop (Ga.) described as a “clarification,” the two introduced a bill Thursday that would revise Food and Drug Administration rules governing the sale and advertising of e-cigarettes and cigars. (Kaplan, 2/16)

In other news from Capitol Hill —

CQ Roll Call: Senate Appropriators Signal Interest In Mental Health Funding
Senate appropriators signaled an interest in supporting mental health funding at a hearing Wednesday, appearing particularly interested in finding a way to address provider shortages in underserved areas. Witnesses at the hearing of the Appropriations Subcommittee on Labor-HHS-Education told lawmakers that attracting professionals to the field is the most pressing need. Some urged Republicans to consider the importance of the Medicaid expansion under the 2010 health care law (PL 111-148, PL 111-152) in expanding coverage of mental health services. (Siddons, 2/15)

Kaiser Health News: Right-To-Die Fight Hits National Stage
Melissa Bailey reports: "Opponents of aid-in-dying laws are claiming a small victory. They won the attention of Congress this week in their battle to stop a growing movement that allows terminally ill patients to get doctors’ prescriptions to end their lives. The Republican-led effort on Capitol Hill to overturn the District of Columbia’s aid-in-dying law could fail by Friday. But advocates worry the campaign will catalyze a broader effort to fully ban the practice, which is legal in six states and being considered in 22 more." (Bailey, 2/16)

Kaiser Health News: Congressman’s Ties To Foreign Biotech Draw Criticism
When a small Australian biotechnology company, Innate Immunotherapeutics, needed a clinical trial for an experimental drug it hoped to turn into a huge moneymaker, the company landed a U.S. partner where it had high-level connections: Roswell Park Cancer Institute in Buffalo, N.Y. The company is partly owned by Rep. Chris Collins, a wealthy Republican entrepreneur from Buffalo, whose enthusiasm for Innate helped persuade others to invest. (Bluth and Kopp, 2/17)

The Baltimore Sun: Cummings Contradicts Trump Over Meeting On Drug Prices
President Donald Trump blamed Rep. Elijah E. Cummings on Thursday for failing to schedule a meeting about the cost of prescription drugs, suggesting the Baltimore Democrat didn't want to come to the White House because it was "bad politics." Cummings, the top Democrat on the House Oversight and Government Reform Committee, disputed that characterization, saying the president had made it up. The congressman said he has been waiting to schedule a meeting until he has crafted a prescription drug bill for the president to consider. (Fritze, 2/16)

Medicare

Lawsuit Alleges United Healthcare Overcharged Medicare For Advantage Plan Customers

The lawsuit, which was unsealed Thursday after a five-year investigation by the Department of Justice, suggests the company may have improperly collected "hundreds of millions" of dollars by claiming patients were sicker than they actually were.

Modern Healthcare: DOJ Joins Medicare Advantage Fraud Lawsuit Against UnitedHealth
The U.S. Justice Department has joined a whistleblower lawsuit claiming that UnitedHealth Group and affiliated health plans have been gaming the Medicare program and fraudulently collecting millions of dollars by claiming patients were sicker than they really were. The lawsuit, initially brought in 2011 and unsealed Thursday after a five year-long investigation by the Justice Department, alleges that Minnetonka, Minn.-based UnitedHealth has inflated its plan members' risk scores since at least 2006 in order to boost payments under Medicare Advantage's risk adjustment program. (Livingston, 2/16)

Medicaid

Kansas Committee Expected To Take First Vote On Medicaid Expansion Today

The issue has been swatted down repeatedly since the health law went into effect, but after moderates ousted several conservatives in last fall's elections, a legislative panel is scheduled to vote on a measure today. The committee's chairman, Rep. Dan Hawkins, a Wichita Republican, says it will be close. News outlets also report on Medicaid developments in Ohio, Alabama and California.

KCUR (Kansas City, Mo., Public Radio): Close Vote Expected On KanCare Expansion Bill 
Kansas lawmakers are getting ready to do something they have never done before: vote on a Medicaid expansion bill. For the past three years, conservative Republicans who controlled the Legislature refused to allow a vote on the issue. Things are different this session due to the ouster of several conservative incumbents by moderate Republican and Democratic challengers. (McLean, 2/16)

Toledo Blade: After Expansion, Medicaid Attracts More Older Men
Those enrolled in Ohio’s expanded Medicaid program in partnership with the federal Affordable Care Act turned out to be older than expected. Barbara Sears, Gov. John Kasich’s Medicaid director and former state representative from Monclova Township, said Thursday she was a little surprised to see how the population skewed older. “But when we knew we weren’t getting the younger folks into the [federal Obamacare private insurance] marketplace, we knew they probably weren’t getting into [the Medicaid expansion],” she said after speaking to the legislative Joint Medicaid Oversight Committee. (Provance, 2/16)

Modern Healthcare: Alabama Could Lose Medicaid Funding For Allegedly Rejecting Eligible Enrollees
The CMS may cut Alabama's Medicaid funding after learning state officials reject people eligible for Medicaid coverage if they are found to have engaged in fraud or abuse but were never convicted of any criminal act. The CMS said Alabama officials also had a practice of recouping funds from these individuals. Alabama has said it is simply trying to take action against those who lie on their applications about having been previously accused of criminal activity. (Dickson, 2/16)

California Healthline: Some Immigrants, Fearful Of Political Climate, Shy Away From Medi-Cal
Some foreign-born Californians are canceling their Medi-Cal coverage or declining to enroll in the first place, citing fears of a Trump administration crackdown on immigrants. Among those dropping coverage are people in the country legally but concerned about jeopardizing family members who lack permanent legal status, according to government officials, immigration attorneys and health care advocates. (Bazar, 2/16)

Marketplace

Exclusive CRISPR Licenses 'Bottleneck' Innovation, Legal Experts Argue

Licensing deals cut by UC Berkeley and Massachusetts’ Broad Institute may be limiting the potentially lie-saving applications of this gene-editing technology, according to assertions made by intellectual property experts in Friday’s issue of the journal Science.

Stat: Exclusive CRISPR Licenses Slow Development Of Therapies, Legal Experts Argue
The exclusive licenses granted to three for-profit companies on key discoveries about the revolutionary genome-editing technology CRISPR-Cas9 threaten to “bottleneck” its use “to discover and develop useful human therapeutics,” patent experts argued in a paper published on Thursday. What the exclusive licenses have done “is give an entire industry to … companies that will never be able to fully exploit it,” Jorge Contreras of the University of Utah, a co-author of the paper in Science, said in an interview. “And that may hold back the development of therapies.” (Begley, 2/16)

San Jose Mercury News: UC-Berkeley CRISPR License Could Hinder Innovation
A smart biotech company could have a great idea for how to use gene editing to develop a new lifesaving therapy — but because of the way licensing deals have been cut by UC-Berkeley and Massachusetts’ Broad Institute, it would never get a chance to try it. That’s the assertion of intellectual property experts in Friday’s issue of the journal Science, who criticize the licensing landscape around the taxpayer-funded and powerful new tool called CRISPR-Cas9, warning it could limit its promise. (Krieger, 2/16)

Public Health And Education

Mediocre Protection Rates Have Many Asking When We'll Get A Better Flu Vaccine

Though it was no worse than previous ones, the fact that this year's shot only cut the chance of infection in half highlights the need for a more effective vaccination.

Stat: Flu Vaccine Is Only Moderately Protective This Year, CDC Says
This year’s flu vaccine is offering moderate protection against the main family of viruses causing illness, data released Thursday by the Centers for Disease Control and Prevention show. The data come as what has been a pretty active flu season is near its apex in many parts of the country. “We won’t know when the peak has occurred until we’ve passed it and have a couple of weeks to look back,” said Lynnette Brammer, head of domestic influenza surveillance at the CDC. “We hopefully are approaching the peak but we may not be there yet.” (Branswell, 2/16)

Bloomberg: This Year's Flu Shot Only Cut Infection Risk By Less Than Half 
Americans who rolled up their sleeves for a flu shot this year cut their chances of coming down with the aches and fever of influenza by almost half, a level of protection that is disappointing for a vaccine but still better than in some recent years. As the virus continues to sweep across the U.S. at epidemic levels, vaccine effectiveness level was 48 percent against acute respiratory illness from the end of November through Feb. 4, according to an analysis of 3,144 people enrolled in the U.S. Influenza Vaccine Effectiveness Network. (Cortez, 2/16)

Fla. Law Barring Docs From Discussing Guns With Patients Violates Free Speech, Court Rules

The 11th U.S. Circuit Court of Appeals, in a 10-1 ruling, said, “Florida does not have carte blanche to restrict the speech of doctors and medical professionals on a certain subject."

The New York Times: Florida Doctors May Discuss Guns With Patients, Court Rules
A federal appeals court cleared the way on Thursday for Florida doctors to talk to their patients about gun safety, overturning a 2011 law that pitted medical providers against the state’s powerful gun lobby. In its 10-to-1 ruling, the full panel of the United States Circuit Court of Appeals for the 11th Circuit concluded that doctors could not be threatened with losing their license for asking patients if they owned guns and for discussing gun safety because to do so would violate their free speech. (Alvarez, 2/16)

U.S. Urged China To Crack Down On Synthetic Opioids Killing Hundreds Here

China is believed to be a major source for bootleg opioids, including the potent carfentanil, that are brought into the U.S. and contribute to the painkiller epidemic. In related news on the crisis, Georgia lawmakers consider regulations for opioid treatment centers.

The Wall Street Journal: U.S. Authorities Pressed China For Action On Deadly Opioid
China’s crackdown on an extremely potent synthetic narcotic came amid pressure from U.S. authorities and evidence linking it to hundreds of U.S. overdose deaths since it first emerged in Ohio in July. The drug, carfentanil, has been connected to at least 700 fatalities in states including Ohio, Michigan and Florida, according to data compiled by The Wall Street Journal from county medical examiners and NMS Labs, a private laboratory outside Philadelphia that performs toxicology testing for counties around the U.S. (Kamp and Campo-Flores, 2/17)

WABE: Ga. Lawmakers Look To Tighten Regulations On Opioid Clinics 
Georgia lawmakers are considering a bill that would further regulate opioid treatment centers in the state. The bill, sponsored by state Sen. Jeff Mullis, R-Chickamauga, would put into place new requirements for those wanting to open up centers in Georgia. The centers offer medical-assisted treatment and counseling to help treat patients with addictions to heroin and other opioids. (Yu, 2/16)

State Watch

State Highlights: Ga. Senate Panel Amends But OKs Surprise Medical Bill Measure; Conn. Non-Profit Hospitals Fight Bid To Make Them Pay Local Property Taxas

Outlets report on news from Georgia, Connecticut, Minnesota, Kansas, Texas, Massachusetts, Florida, Washington, Arizona, Wisconsin, Ohio and Louisiana.

Georgia Health News: After Tweak In Payment Formula, Senate Committee OKs Remedy For ‘Surprise’ Billing
A Georgia Senate panel Thursday passed legislation to halt ‘’surprise’’ medical billing – but not without a last-minute amendment that changed the contentious payment formula. The Health and Human Services Committee approved Senate Bill 8, which will address those situations in which patients get unexpected bills from providers who are not in their network, even though the hospital is a network facility. (Miller, 2/16)

The CT Mirror: CT Hospitals Launch TV Ad To Protest New Tax Proposal
Connecticut’s hospital industry launched a new television ad Thursday to protest Gov. Dannel P. Malloy’s proposal to end nonprofit hospitals’ exemption from local property taxation. The Connecticut Hospital Association announced the commercial will air starting today on network and cable television stations, and also can be seen at http://nomorehospitaltax.org. The commercial opens by listing a variety of occupations and one common thread among the people in all of them: they all pay a price when taxes rise on Connecticut hospitals. (Phaneuf, 2/16)

The CT Mirror: Budget Cuts Cost CT Medical Examiner’s Office Full Accreditation 
The Connecticut Office of the Chief Medical Examiner (OCME) has lost its full accreditation and was downgraded to provisional status because of staffing and facility shortcomings driven largely by budget cuts. The National Association of Medical Examiners (NAME), which ordered the downgrade, will reassess Connecticut’s status in September, the state office announced this week. (Phaneuf, 2/16)

The Star Tribune: Report On Minnesota Hospital Errors Sees Problems With Lost Tissue Samples 
The misplacing of irreplaceable biological specimens has proved to be a vexing problem for Minnesota hospitals, which reported 31 instances in the 12 months that ended last Oct. 6. The state’s 13th annual report on hospital “adverse events,” released Thursday, included 336 reportable mistakes, including operations on the wrong body parts and disabling medication errors. But few were as common as lost tissue samples, which also can have serious consequences. (Olson, 2/17)

KCUR: House Committee OKs Involuntary Hold Plan For Kansans In Mental Health Crisis 
A bill that would allow treatment centers to detain Kansans in mental health crisis for up to three days moved forward Thursday after months of work to develop a compromise. A similar bill proposed last year raised concerns that it would deprive Kansans with mental illnesses of their due process rights. A committee of law enforcement officers, treatment providers, mental health advocates and others met six times between legislative sessions to come up with a compromise bill that still fulfilled the original goal of providing short-term mental health care. (Wingerter, 2/17)

Stat: Texas Board Recommends Sanctions Against Stanislaw Burzynski
Along-running battle between the Texas Medical Board and controversial Houston doctor Stanislaw Burzynski could be coming to a head. The board said this week that it had proposed $380,000 in fines and a stiff set of sanctions for Burzynski’s failure to adhere to proper medical procedures in treating cancer patients. The decision is preliminary, and will be submitted and formally reviewed on March 3. (Tedeshci, 2/16)

Boston Globe: For This Hospital Chaplain, Work Is A Matter Of Life And Death 
As [Alyssa] Adreani, 41, likes to point out, [she] isn’t hanging out in the Newton hospital’s chapel and doesn’t wear a collar or a cross. She makes the rounds of the neonatal intensive care unit, oncology, ICU, orthopedics, and medical/surgical units, following her personal Golden Rule of chaplaincy: “Wear comfortable shoes.” The Globe spoke with Adreani about how hospital chaplains are considered part of the treatment team, sometimes even improving health outcomes. (Atoji Keene, 2/16)

Seattle Times: State Regulators Investigating Swedish’s Cherry Hill Hospital, Top Surgeon 
State health regulators have launched an investigation into the practices of Swedish Health Services’ Cherry Hill hospital, days after a Seattle Times report uncovered wide-ranging concerns about patient care at the facility. David Johnson, a spokesman with the state Department of Health, said Thursday a case-management team authorized the new investigation after reviewing The Seattle Times’ findings. Johnson added that the state Medical Commission, which handles issues involving specific doctors, was in the process of investigating complaints filed against Dr. Johnny Delashaw. (Baker, 2/16)

Arizona Republic: New Flu-Tracking App Uses Maricopa County As Beta Site
A California-based health diagnostics company has chosen Maricopa County as the pilot testing site for Communidy, a free web app that allows users to see the age and county of people who currently have the flu. The app, which displays real-time data from doctors’ offices, hospitals, clinics and labs, may encourage people to get vaccinated early, said Machrina Leach, nurse program manager at the Maricopa County Department of Public Health. (Bosch and Jha, 2/16)

Milwaukee Journal Sentinel: United Community Center Opens Third Residential Treatment Facility
This month, the United Community Center, commonly known as UCC, opened its third residential treatment facility for people working to overcome alcoholism and drug addictions. The $1.1 million residence, named Latinas Unidas II, will enable 16 more women to participate in UCC’s residential treatment program at any given time. The new residence, UCC’s second for women, also will treat women who are pregnant or who have infant children, and the program will include prenatal and post-partum care, child care coordination and parenting classes. (Boulton, 2/16)

Cleveland Plain Dealer: Summa Health Gift Establishes Traumatic Stress Chair 
Longtime philanthropists Jim and Vanita Oelschlager have donated more than $4 million to Summa Heath over the last three decades. This week, couple's foundation provided another donation to Summa Health to establish a Chair in Traumatic Stress. Dr. Patrick Palmieri, director of the Traumatic Stress Center, will serve as the first Oelschlager Chair. As director of the Summa Health Traumatic Stress Center, Palmieri is responsible for the center's clinical, training and research activities for patients experiencing post-traumatic stress disorder, anxiety and depression. (Becka, 2/16)

Health News Florida: Students Discover Lead In Tap Water May Be Common In Older Homes 
Last semester, the students in Laura Manke's community cares class embarked on a project, collecting samples of tap water from their homes.  And testing provided by University of South Florida researchers revealed that all of the 46 samples contained lead.Fortunately, the amount of lead in the water in their homes fell below levels that would trigger action under Environmental Protection Agency standards. But experts, including the EPA, say any amount of lead is not good for the body, especially in children under six. Damage can be permanent. (Ochoa, 2/16)

Pioneer Press: Forest Lake Nurse Avoids Jail Time For Stealing Patient's Medication
A Forest Lake nurse who pretended to check on a patient so he could steal the man’s medication evaded jail time for the offense. Gregory Thomas Welcher, 30, was sentenced in Ramsey County District Court Thursday to five years probation on one count of felony-level theft. He also was ordered to spend one day in jail, but was given credit for the day he already logged at the Ramsey County Correctional Facility. Welcher pleaded guilty to the charge this past December. (Horner, 2/16)

Shreveport Times: Workshop Lets Caregivers Take Care Of Themselves
Social workers seeking a moment of rest from careers steeped in others’ suffering participated in a free “Compassion Fatigue” workshop on Thursday. The workshop, presented by the Noel Memorial United Methodist Church’s arts program, aimed at offering those who take care of others a chance to center and to take care of themselves. (Talamo, 2/16)

Health Policy Research

Research Roundup: Medicaid Block Grants; Job Loss And The ACA; Growing HIV Coverage

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

Urban Institute: What TANF Can Teach Us About Block Granting Social Services
White House officials and congressional leaders have talked about seizing the opportunity to pass sweeping changes to federal antipoverty programs. One potential change is to give block grants of federal funds to states and allow states greater flexibility .... House Speaker Paul Ryan has long contended that expanding the block grant model to other facets of the safety net — such as Medicaid and food stamps — would afford states the flexibility to drive innovation in combating poverty. But examining the results of welfare reform after two decades presents a more cautionary tale .... Simply put, all states ended up with far fewer funds and a diminished ability to meet their residents’ needs. (Hahn and Coffey, 2/7)

The Kaiser Family Foundation: Current Flexibility In Medicaid: An Overview Of Federal Standards And State Options
This brief provides an overview of current federal standards and state options in Medicaid to help inform upcoming debates about increasing state flexibility in the program as part of efforts to restructure Medicaid financing. Today, states operate their Medicaid programs within federal standards and a wide range of state options in exchange for federal matching funds that are provided with no limit. Each state Medicaid program is unique, reflecting states’ use of existing flexibility and waiver authority to design their programs to meet their specific needs and priorities. As proposals to restructure Medicaid financing develop, it will be important to examine what additional flexibilities they would provide to states and what standards, accountability and enrollee protections would remain for states to access federal funds. (Artiga et al., 1/31)

Urban Institute/Robert Wood Johnson Foundation: Recent Evidence On The ACA And Employment: Has The ACA Been A Job Killer? 2016 Update
We find no evidence to support claims that the ACA has been a job killer. Through 2016, the ACA had little to no adverse effect on employment and usual hours worked per week. For both measures, levels in 2014, 2015, and 2016 are statistically identical to our projections based on patterns existing before 2014, the year the major provisions of the ACA went into effect. Our conclusion applies to the full sample of nonelderly persons and to subgroups of nonelderly persons based on gender and educational attainment. Levels of part-time work (29 or fewer hours per week) have fallen since 2014, but remain at somewhat higher levels than would be expected given recent declines in the unemployment rate and overall economic improvement. (Garrett, Kaestner and Gangopadhyaya, 2/16)

The Kaiser Family Foundation: Insurance Coverage Changes For People With HIV Under The ACA
This brief provides the first national estimates of changes in insurance coverage among people with HIV since the implementation of the ACA. It is based on analysis of data from the Centers for Disease Control and Prevention (CDC). We find that coverage increased significantly for people with HIV due to the ACA’s Medicaid expansion; indeed, increased Medicaid coverage in expansion states drove a nationwide increase in coverage for people with HIV. In addition, the share relying on the Ryan White HIV/AIDS Program also increased. (Kates and Dawson, 2/14)

Brookings/USC Schaeffer Center for Health Policy & Economics: Re-Balancing Medical And Social Spending To Promote Health: Increasing State Flexibility To Improve Health Through Housing
The health impacts of interventions that improve economic conditions such as household income are still the subject of considerable debate. Some economists find little support to show that public transfer payments improve health outcomes, while others argue that federal assistance frees family income to spend on better access to health care, and thereby improves population health. Some researchers have identified evidence that stressful work environments and educational disparities are social mechanisms with a deleterious impact on health, but the evidence that increased public spending targeting these mechanisms will improve health outcomes is nascent. In contrast, the research showing that expenditures that improve access to safe, affordable housing improve population health is relatively strong. (Butler, Matthew and Cabello, 2/15)

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

MedPage Today: Study: Beware The Snippy, Snarky Surgeon?
The more complaints lodged at surgeons, the more likely it was for their patients to suffer complications after going under the knife, a study found, helping explain why operators with the least favorable reviews get sued the most. Surgeons who had a history of unsolicited patient reviews -- often regarding rudeness and intimidation directed at patients and other healthcare professionals alike -- were tied to greater risks of: Complications for patients .... Surgical complications .... Patient readmissions. (Lou, 2/15)

Reuters: Salt Reduction Policies Cost-Effective Even Without Healthcare Savings
Government policies designed to reduce how much salt people eat may be cost-effective even without considering the potential healthcare savings, a recent study suggests. That’s because efforts to curb salt use through policies like public education and industry agreements would not cost that much relative to their potential to reduce mortality and disability, researchers estimate. (Rapaport, 2/10)

Editorials And Opinions

Viewpoints: GOP Health Plan Runs Contrary To Robin Hood's Rules By Redirecting Funding From Poor To Rich; The Town Hall Duck And Run

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

The Washington Post: Trump’s Toxicity Has Republicans Running Away From Their Constituents
As recent town-hall meetings of GOP Reps. Tom McClintock of Elk Grove, Jason Chaffetz of Utah, Gus Bilirakis of Florida, Diane Black of Tennessee and others turn into well-publicized tongue-lashings, their colleagues are ducking and running. ... The scene is reminiscent of the tea party summer of 2009, but the energy is on the other side this time. Now, as then, the victims say the perpetrators are outsiders – Chaffetz said those who protested him included “paid” people from out of state, an echo of Nancy Pelosi’s claim of “astroturfing” – but now, as then, the anger is real. (Dana Milbank, 2/15)

Los Angeles Times: Trump Tries To Save Obamacare Exchanges While Undermining Them
With the drive to “repeal and replace” Obamacare losing steam, the Trump administration quietly moved to shore up a key feature of the healthcare law this week: the state exchanges where people shop for non-group coverage. And to its credit, Trump’s Department of Health and Human Services zeroed in on some of the factors that have led a handful of major insurers to leave the exchanges. (Jon Healey, 2/16)

Bloomberg: A Sign That Obamacare Exchanges Are Failing
Yet more bad news for Obamacare this week: Molina Healthcare lost $110 million on the exchanges last year, and the CEO told investors, “There are simply too many unknowns with the marketplace program to commit to our participation beyond 2017.” At first glance, it’s hard to see why this piece of news is worth worrying about. UnitedHealth recently projected several times those losses, and it's a bigger player on the exchanges. Why spend so much time looking at one modest-size insurer? Because Molina is one of the companies that has been repeatedly pointed to, by virtually every health-care-policy wonk in the business, as one of the “bright spots” on the exchanges. (Megan McArdle, 2/16)

The New England Journal Of Medicine: Adjusting Risk Adjustment — Accounting For Variation In Diagnostic Intensity
In the U.S. health care system, payments and performance measures are often adjusted to account for differences in patients’ baseline health and demographic characteristics. The idea behind such risk adjustments is to create a level playing field, so that providers aren’t penalized for serving sicker or harder-to-treat patients and insurers aren’t penalized for covering them. For example, the private insurance companies that participate in Medicare Advantage and the Affordable Care Act (ACA) exchanges receive risk-adjusted payments from the U.S. government, with the rationale that insurers should be reimbursed more for enrollees with higher expected costs. (Amy Finkelstein, Matthew Gentzkow, Peter Hull and Heidi Williams, 2/16)

RealClear Health: A Small HSA Fix Could Produce Big Results
As Congress and the Trump administration begin laying the foundation for their replacement plan for the Affordable Care Act (ACA), their starting point should be ensuring all Americans have a ready path for enrollment in health insurance that, at a minimum, provides protection against major medical expenses. They should also promote broadened enrollment in Health Savings Accounts (HSAs) as an important means for paying for care before insurance coverage kicks in. (James C. Capretta, 2/17)

Louisville Courier-Journal: Demand For Medicaid Waivers Exceeds Funds
The “most vulnerable of our society” is a phrase that gets thrown around a lot. Politicians employ it in speeches and press releases to describe constituents who cannot take care of themselves. People with intellectual and developmental disabilities fall under this banner of protection. (Amanda Beam, 2/16)

Sacramento Bee: California Provides Model To Replace The Affordable Care Act
The new administration and Congress are under intense pressure to craft a market-based alternative to the Affordable Care Act. It won’t be easy. To achieve the financial stability required to make the market work, reformers should heed some important lessons from California. Health plans and risk-taking medical groups essentially made a “deal” with Congress to participate in the ACA. They agreed to cover applicants with pre-existing conditions without charging higher premiums in return for: an expanded individual market driven by a federal mandate that everyone buy insurance; premium and cost-sharing subsidies financed by insurers and the government; and three federal risk-mitigation programs to help stabilize the new marketplaces. (Leonard D. Schaeffer and Dana Goldman, 2/14)

Orange County Register: California Job Losses From Obamacare Repeal? Fear Not!
Obamacare was a cash cow for providers, which now argue it was a program for jobs and economic growth. They now say that repealing Obamacare will kill California jobs. That grabs any politician’s attention, but it is not true. According to a study by the UC Berkeley Labor Center, which is promoted by the California Hospital Association, “The majority (135,000) of these lost jobs would be in the health care industry, including at hospitals, doctor offices, labs, outpatient and ambulatory care centers, nursing homes, dentist offices, other health care settings and insurers. (John R. Graham, 2/16)

Cleveland Plain Dealer: Boost Funding To An Ohio Foster Care System Increasingly Burdened By The Opioid Crisis
Ohio Gov. John Kasich has been in the thick of the battle against deadly opioids, signing a bill this year to tighten restrictions on prescription opioids, speaking at conferences about heroin and even sending an Ohio Highway Patrol superintendent in April to Trumbull County after beleaguered officials there begged for help in quelling a rising tide of opioid overdoses and deaths. (2/17)

The Des Moines Register: A Second Chance To Pass Aid-In-Dying Bills
In a Gallup Poll conducted May 4-8, 2016, respondents were asked: “When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient’s life by some painless means if the patient and his or her family request it?” Sixty-nine percent of respondents answered yes. (John S. Westefeld, 2/16)

Lexington Herald Leader: Whooping Cough Making A Comeback
In the past few weeks, there have been several confirmed cases of whooping cough, also known as pertussis, in Fayette County schools and other surrounding counties. Many parents are concerned about exposure and have questions about preventing pertussis infection or recognizing symptoms. (Jessica Murray, 2/16)

The New England Journal Of Medicine: Addressing The Fentanyl Threat To Public Health
Fentanyl, a powerful synthetic opioid, poses an increasing public health threat. Low production costs encourage suppliers to “cut” heroin with the drug, particularly white powder heroin sold in the eastern United States. Fentanyl also appears as a prevalent active ingredient in counterfeit OxyContin (oxycodone) tablets. The result is that fentanyl plays a major role in rising mortality due to heroin or opioid overdose. It poses a serious overdose risk because it can rapidly suppress respiration and cause death more quickly than do other opioids. (Richard G. Frank and Harold A. Pollack, 2/16)