KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Political Cartoon: 'On Track?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'On Track?'" by Joel Pett, Lexington Herald-Leader.

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Tell me the reason
Why you refuse home health care.
Older, not wiser?

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Summaries Of The News:

Health Law

GOP Secrecy Breeding Frustration, Criticism: 'If They Liked The Bill, They’d Have Brass Bands' Celebrating It

Democrats, as to be expected, are on the attack over the way Republicans are crafting the health law replacement legislation in secrecy, but even some GOP lawmakers are voicing concerns. Meanwhile, conservatives start to raise red flags about the measure's failure to curb spending.

The New York Times: Secrecy Surrounding Senate Health Bill Raises Alarms In Both Parties
As they draft legislation to repeal the Affordable Care Act, Senate Republican leaders are aiming to transform large sections of the American health care system without a single hearing on their bill and without a formal, open drafting session. That has created an air of distrust and concern — on and off Capitol Hill, with Democrats but also with Republicans. (Kaplan and Pear, 6/15)

The Wall Street Journal: Conservatives Sound Alarm About Senate Health Bill
Conservatives inside and outside the Senate GOP are sounding alarms over the emerging shape of the chamber’s bill to dismantle the Affordable Care Act, a sign that the faction’s support may be increasingly difficult to secure. Pressure from outside groups has intensified in recent days, and conservative lawmakers have signaled their concern that the Senate bill doesn’t do enough to curb spending on the Medicaid federal-state program for the poor or to reduce health-care premiums—two of their top goals. (Peterson, Radnofsky and Armour, 6/15)

The Hill: Rand Paul Denounces 'New Entitlements' In Emerging Health Bill 
Sen. Rand Paul (R-Ky.) sharply criticized central elements of the emerging Senate Republican healthcare bill on Thursday, indicating that he will vote against it unless dramatic changes are made. Paul denounced as “new entitlements” two core elements of the Republican bill in both the House and Senate: a refundable tax credit to help people buy insurance and a “stabilization fund” of money to help bring down premiums.  (Sullivan, 6/15)

The Hill: Murkowski: 'I Just Truly Do Not Know' If I Can Support GOP Health Bill 
Sen. Lisa Murkowski (R-Alaska), a potential key swing vote on an ObamaCare repeal-and-replace plan, isn’t sure she could support the emerging Senate Republican healthcare bill. When asked Thursday if she had confidence she could eventually support a bill, Murkowski said she didn’t know...Murkowski wouldn’t commit when asked if she would support a seven-year phaseout of the Medicaid expansion, which some moderate GOP senators are pushing. Nor would she say whether she would support a slower phaseout or a faster one.  (Weixel, 6/15)

In more news —

The Wall Street Journal: What May Be In The Senate’s Health Bill
The Senate health bill is still a work in progress, with no official text yet. The Senate’s Republican leadership has been hammering out the bill behind closed doors, so there has been scant information about the legislation. But its outline so far is said to resemble a more expansive version of the legislation passed last month by the House. (Armour, 6/15)

Reuters: Senate May Keep Some Obamacare Taxes In U.S. Healthcare Overhaul
Republican senators trying to repeal Obamacare are forming consensus to keep some of the U.S. healthcare law's taxes they long criticized, in hopes of delaying more drastic funding cuts, particularly to the Medicaid program for the poor and disabled. First proposed by moderate Republicans, the idea is gaining traction among party members, according to five sources involved in or briefed on internal discussions. (Abutaleb, 6/15)

CQ Roll Call: Senate Republicans Wrestle With Approaches On Health Bill
Senate Republicans on Thursday continued to debate different approaches to revising a House-passed health bill, with their extended deliberations making their goal of a June vote on the measure increasingly elusive. “I don't think we're close” to completing a bill yet, Senate Finance Chairman Orrin G. Hatch, R-Utah, told reporters Thursday morning. That has been apparent this week, especially after Senate Majority Whip John Cornyn of Texas said he was hoping for action by the end of July rather than the original GOP goal of a vote by the July 4 recess. (Young and Raman, 6/15)

Stat: It's The Most Costly House Race Ever, And It May Hinge On Health Care
The most expensive congressional race in U.S. history may hinge on the wonky topic of preexisting conditions. Democrat Jon Ossoff, trying to seize a suburban Atlanta seat held by Republicans since 1979, has spent weeks railing against the GOP health care bill passed by House lawmakers this spring. In debates, he’s repeatedly trotted out the story of Matt, a 7-year-old with a heart condition, saying his parents would have to pay “tens or hundreds of thousands of dollars” a year to keep their son alive if Congress repeals the Affordable Care Act, commonly known as Obamacare. Responding with her own polished anecdote, Republican Karen Handel tells voters she’s well-aware of the importance of covering preexisting conditions because her sister was born without an esophagus. (Blau, 6/16)

It's Looking Less Likely That Republicans Will Hit Ambitious End-Of-June Deadline For Health Bill

Even if they resolve their biggest policy disagreements, senators still have to write the rest of the bill, send the full text to the Congressional Budget Office, await the agency’s score and keep 50 Republicans together through a lengthy series of procedural votes.

Politico: Senate Likely To Miss Its Obamacare Repeal Deadline
Senate Republicans are getting dangerously close to missing their deadline to hold a Senate health care vote by month’s end, potentially derailing fulfillment of their 7-year-old campaign promise to repeal Obamacare. The Senate left Washington on Thursday with a seemingly insurmountable health care to-do list: When they return on Monday, Republicans will have just two weeks before the Fourth of July recess to overcome the remaining big divides on policy — including what year to roll back Medicaid expansion and how deeply to cut the program that covers health care for people with low incomes. (Haberkorn, 6/16)

The Washington Post: GOP Senate Leaders Aim To Bring Health-Care Legislation To The Floor By End Of June
Senate Republican leaders are aiming to bring a major revision to the nation’s health-care laws to the Senate floor by the end of June even as lingering disagreements, particularly over Medicaid, threaten to derail their efforts, several Republicans familiar with the effort said Thursday. President Trump and Senate Majority Leader Mitch McConnell (R-Ky.) are pressing for an ambitious timeline to complete the bill, although it is being drafted in the Senate with little assistance from the White House. (Sullivan and Snell, 6/15)

Atlanta Journal-Constitution: Halfway Through June, Still No GOP Health Bill In Senate 
Republican Senators left Washington, D.C. on Thursday in much the same position that they have been in for over a month, saying that they are making progress on a bill to overhaul the Obama health law, but seemingly not ready to unveil the details, or predict when a vote might happen, as Democrats pressed the GOP to reveal the fine print of their Senate bill. ... Even as they try to work out the details, Republicans say they are not backing off their plan to make major changes. (Dupree, 6/15)

Price Dodges When Asked If GOP's Health Plan Is 'Mean'

“It’s not a yes or no answer,” Health and Human Services Secretary Tom Price says. Meanwhile, Republicans on Capitol Hill downplay the reports that the president called the House-passed bill just that.

Stat: Is The House Health Care Bill 'Mean'? Secretary Tom Price Declines To Say
Is the health care bill House Republicans passed last month “mean”?  President Trump reportedly thinks so. Health and Human Services Secretary Tom Price won’t say. ... The meeting in question was a gathering among Trump and a group of Republican senators involved in crafting their chamber’s version of a bill to repeal much of the Affordable Care Act. During the closed-door session, the president was reported to have urged the lawmakers to craft a version of the bill that would be more “generous” than the legislation approved by their House counterparts. (Facher, 6/15)

The Hill: Republicans Brush Off Trump Calling Health Bill 'Mean' 
House Republicans are publicly brushing off comments from President Trump about the House's healthcare bill being "mean." Several lawmakers said they do not regret voting for the legislation and questioned whether Trump even made such a remark. That comment, first reported by the Associated Press and confirmed by The Hill, came Tuesday during a private meeting between Trump and Republican senators. Trump also said during the meeting that he wanted the Senate’s version of the bill to be more generous. (Sullivan and Roubein, 6/15)

Spiking Premiums In Volatile Marketplace Give Ammunition To Both Democrats, Republicans

Insurers all over the country are seeking increases averaging about 20 percent. While the GOP says rates have been trending this way for years, Democrats counter that the prices are high because Republican lawmakers and the Trump White House have destabilized the marketplace.

The Wall Street Journal: Insurers Look To Ramp Up Premiums In Health Law Exchanges
A growing number of major insurers are seeking premium increases averaging 20% or more for next year on plans sold under the Affordable Care Act, according to rate proposals in more than 10 states that provide the broadest picture so far of the strains on the marketplaces. As Republicans try to pass a health-care bill to overhaul the ACA, the attention has focused on insurers’ withdrawals from a few states that risk leaving some consumers with no exchange plans next year. But the rate requests by major insurers show stress on the marketplaces stretches beyond those trouble spots. (Wilde Mathews and Radnofsky, 6/16)

The Hill: Insurers Confront Big ObamaCare Decision
Insurers are nearing the deadline for deciding whether to propose massive rate hikes or leave the ObamaCare markets altogether in the face of immense uncertainty over the future of the law. The federal deadline for insurers to file rate proposals with the federal government is June 21. Many insurers had been hoping that the Trump administration would say for certain whether it would continue to pay cost-sharing reduction (CSR) subsidies for covering low-income enrollees. (Hellmann, 6/15)

The CT Mirror: Vulnerable Access Health Keeping An Eye On Other States 
With Connecticut’s health insurance exchange teetering — with just two insurers left and neither yet committed for 2018 — the exchange’s board is beginning to watch innovations being considered in other states, including a single-payer system and Medicaid-for-all. Currently, the exchange, Access Health CT, is hoping to keep both its insurers and begin its open enrollment period on Nov. 1 (Werth, 6/15)

Meanwhile, a top Republican is pushing his colleagues to help stabilize the exchanges —

CQ Roll Call: Alexander Presses HHS To Continue Cost-Sharing Subsidies
Sen. Lamar Alexander, who chairs an influential committee, asked the Trump administration on Thursday to commit to paying cost-sharing insurance subsidies created by the Democrats’ 2010 health law for another two years, a move that might help stabilize these markets. Health and Human Services Secretary Tom Price responded to the Tennessee Republican's question by noting the Trump administration’s budget calls for paying these subsidies for two years. Alexander raised the issue with Price at a Senate Labor-HHS-Education Appropriations hearing on the department's fiscal 2018 request. Alexander is the chairman of the Senate Health, Education, Labor and Pensions Committee as well as a senior appropriator. (young, 6/15)

The Hill: GOP Chairman Pushes For ObamaCare Payments To Be Made
Alexander has been urging Congress to temporarily “repair” ObamaCare as Republicans work to dismantle and replace it. “The payments will help to avoid the real possibility that millions of Americans will literally have zero options for insurance in the individual market in 2018,” Alexander said at a Senate Appropriations subcommittee hearing on the HHS budget request. (Roubein, 6/15)


Lines Between Payer, Provider Blur With New Alliance Between Cleveland Clinic, Oscar

The prestigious hospital is joining forces with the insurer to sell plans on the Affordable Care Act exchanges.

The Washington Post: The Cleveland Clinic Is Partnering With Josh Kushner's Start-Up To Participate In Obamacare
At a time when many health insurers are exiting the exchanges created by the Affordable Care Act or thinking about it, one of the top-ranked hospitals in the country is jumping in — and they're doing it through an alliance with a health insurer co-founded by Ivanka Trump's brother-in-law, Joshua Kushner. Cleveland Clinic, a nonprofit academic medical center, is partnering with Oscar Health to sell individual insurance plans in five northeast Ohio counties. The plans will be available on the exchanges, where people can use government subsidies to purchase health coverage as well as off the exchanges, where people bear the full cost of their health coverage. (Johnson, 6/15)

Modern Healthcare: Cleveland Clinic Jumps Into Insurance Biz With Oscar Health
Despite the instability of the market, Cleveland Clinic and Oscar are betting that a narrow network plan focused on keeping patients out of the hospital with help from care coordinators will keep their product afloat. "If you put a product out in the market that is less like traditional health insurance and sick-care oriented, and much more a consumer product that people want to engage with, that they like to tell their friends and family about, that pays them a dollar day to walk steps and things like that, you are going to attract … plenty of 25- and 35-year old's who just want to have good healthcare," Oscar CEO and co-founder Mario Schlosser said. (Livingston, 6/15)


With Medicaid A Chopping-Block Favorite, Advocates Look To Humanize Program

Patients who have benefited from Medicaid speak out and put a human face to what some might see as just a budget line.

Cleveland Plain Dealer: Health Groups Put "A Face To Medicaid" In National Anti-AHCA Campaign Kickoff
Lajuan Black was one of a handful of local residents who shared their stories during a public comment period at the national kickoff of a campaign health groups are leading against current healthcare reform efforts. ... In its current form, the AHCA would reduce Medicaid spending by roughly $839 billion over 10 years, according to estimates by the Congressional Budget Office. Republicans say the plan will force states to more efficiently run the program, which some conservatives see as an "open-ended entitlement." (Christ, 6/16)

In other Medicaid news —

KCUR: State Officials Seek Feedback On KanCare, But Few Attend First Public Meetings 
Given all the controversy about KanCare – Kansas’ privatized Medicaid program – it would be reasonable to expect big crowds at public hearings about renewing the program. But that wasn’t the case Wednesday when relative handfuls of health care providers and consumers turned out in Topeka for the first in a series of forums scheduled across the state. The sparse turnout disappointed state officials and legislators who attended. (Mclean, 6/15)

The Oregonian: Oregon House Passes $550 Million Tax Bill To Fund Medicaid 
Lawmakers in the Oregon House voted Thursday to pass a $550 million health care tax plan they said was necessary to prevent cuts to the state's Medicaid program. The legislation, which now goes to the Senate, includes a tax increase on hospitals and new taxes on health insurance plans. Gov. Kate Brown supports the bill, and said last week it's among her three top priorities for lawmakers to approve before going home by July 10. The Democrat-majority chamber also turned down an effort by Republicans to authorize only one year of funding, instead of the normal two, for the state health authority because it hasn't been able to verify tens of thousands of Oregonians' eligibility for Medicaid. (Borrud, 6/15)


Trump Expected To Issue Executive Order Aimed At High Drug Prices

President Donald Trump will meet Friday with health and budget officials to discuss the proposals, according to news reports. The White House may issue one order soon and then another, longer one down the road.

Bloomberg: Trump Administration Prepares A Drug Pricing Executive Order, Sources Say 
President Donald Trump’s administration is preparing an executive order aimed at lowering U.S. drug costs, according to people familiar with the matter, a move that could come within weeks on a campaign issue that has been largely left out of Republican legislative efforts in Congress. Top health and budget officials in the administration will meet Friday to discuss the issue, according to the people, who asked not to be identified because the session is private. Trump sought recommendations from the nation’s health agencies on reducing medication costs, Health and Human Services Secretary Tom Price told senators last week. (Edney and Sink, 6/15)

The Hill: Trump Administration Preparing Executive Order On Drug Pricing 
The Trump administration is preparing an executive order aimed at lowering drug prices, according to sources familiar with the process. President Trump is set to meet on Friday with key officials including Health and Human Services Secretary Tom Price and White House budget director Mick Mulvaney to discuss the order, which is expected to be issued in the coming weeks, possibly before the July 4 congressional recess, the sources said. (Weixel, 6/15)

Politico Pro: Trump Order On Drug Prices May Not Match Criticisms Of Pharma 
Trump administration officials will huddle Friday as part of a push to issue an executive order addressing rising drug prices, but few are expecting its punch to match the president’s often blistering rhetoric about the pharmaceutical industry. President Donald Trump made drug costs a prominent issue during his campaign and beefed up his criticisms after the election, saying in January that the industry was “getting away with murder." (Karlin-Smith, 6/16)

And on Capitol Hill —

Stat: Drug Pricing Moves Toward Center Stage On Capitol Hill, This Time In House
A key House committee is preparing for a hearing on drug pricing, as Republicans show an increasing willingness to examine an issue frustrating their constituents. Rep. Michael Burgess of Texas, who helms the health subcommittee of the Energy and Commerce Committee, told STAT Thursday his subcommittee will hold a hearing on the drug pricing issues, as well as the related “supply chain.” Neither he nor the full panel chairman, Rep. Greg Walden of Oregon, suggested the hearing had yet been scheduled. (Mershon, 6/15)

In other news on the pharmaceutical industry —

Stat: Cancer Patient Sues Celgene For Thwarting Generic Versions Of Pricey Meds
In what may be a first, a patient has filed a lawsuit accusing a drug maker of hiding behind a mandated safety program to thwart generic competition. The company, in this case, is Celgene. The lawsuit, which was filed by a cancer patient and consumer advocate named David Mitchell, accused the biotech of exploiting a Food and Drug Administration program that is designed to boost safety. Typically such a program, known as a Risk Evaluation and Mitigation Strategy, requires drug makers to develop a plan to educate physicians and monitor distribution. (Silverman, 6/15)

The Associated Press: Nevada Forces Drugmakers To Reveal Insulin Pricing, Profits
Nevada Gov. Brian Sandoval signed into law Thursday the nation’s strictest requirements for pharmaceutical companies to reveal how they set certain prescription drug prices. The bipartisan legislation focuses on insulin — one of many life-sustaining prescription treatments sold in the U.S. at prices that have skyrocketed over the last decade. The law requires drugmakers to annually disclose the list prices they set, profits they make and discounts they give market middlemen on insulin. (Noon, 6/16)

The Associated Press: Suit Over Life-Ending Drugs For Terminally Ill Gets Hearing
A judge on Friday is expected to weigh whether a challenge can proceed to California's law letting terminally ill patients seek prescriptions for life-ending drugs. Riverside County Judge Daniel A. Ottolia is expected to hear arguments over whether a lawsuit by doctors challenging the state's 2016 law permitting medically-assisted death can move forward. (6/16)

Veterans' Health Care

Core VA Services Neglected In Trump's Budget, Democrats Say

Lawmakers say the president's proposed budget increases money for private services, but does little to help Veterans Affairs clinics, hospitals and other veteran care.

The Associated Press: Democrats Criticize Trump's Budget Plan As Hurting VA Care
Congressional Democrats on Thursday sharply criticized President Donald Trump's proposed budget for the Department of Veterans Affairs, saying it would harm veterans by rapidly expanding private care while neglecting core VA hospitals and programs. The report from top Democrats on the Senate and House committees overseeing the VA pointed to proposed double-digit increases to expand veterans' access to private doctors as funding for VA services remains mostly flat. (Yen, 6/15)

In other news —

The Associated Press: Ex-VA Exec ‘Astounded’ By Cost Of Hospital
A former Veterans Affairs Department executive who was harshly criticized by Congress for massive cost overruns at a new Colorado VA medical center said he was never told the price had ballooned to more than $1.7 billion before he left the agency, and does not know how it happened. “I’m just astounded, quite frankly, I’m absolutely astounded,” Glenn Haggstrom told The Associated Press in a rare interview. Haggstrom, who was the VA’s top construction official when the project nearly collapsed amid legal disputes and skyrocketing costs, said the last estimate he heard from the builder before he was removed from the project was about $890 million. (Elliott, 6/15)

Public Health And Education

With Hundreds Dying Each Week, A Panel To Study Opioid Crisis Is Just Waste Of Time, Experts Say

President Donald Trump's special commission will hold its first meeting Friday, but experts say it's not necessary. “What we need is an enormous federal investment in expanding access to addiction treatment, and for the different federal agencies that have a piece of this problem to be working in a coordinated fashion," said Dr. Andrew Kolodny, of Brandeis University.

The New York Times: As Opioid Panel Meets, Some Say Action, Not Study, Is Needed
Weeks before the presidential election, at a packed rally in New Hampshire, Donald J. Trump recounted the story of a young woman and her boyfriend who had fatally overdosed within a year of each other. He promised not just a border wall to keep drugs out, but also more access to treatment. “We’re going to take care of it,” he said of the opioid addiction epidemic, which has disproportionately hit states that were crucial to his election victory. “What’s taking so long?” (Goodnough, 6/16)

Boston Globe: Charlie Baker To Attend Opioid Panel Meeting In DC 
Governor Charlie Baker will travel to Washington on Friday for the inaugural meeting of President Trump’s commission on drug addiction and the opioid crisis, aides said Thursday... The commission meeting, scheduled for two hours in the Eisenhower Executive Office Building, according to a White House agenda, will serve largely as an introductory session. (O'Sullivan, 6/15)

In other news about the epidemic —

Boston Globe: Influential Word-Usage Guide Changes The Language Of Addiction 
The Associated Press Stylebook, a word-choice and grammar bible for journalists, recommended May 31 that journalists use “addiction” instead of “substance abuse,” and “person with addiction” instead of “addict” or “abuser,” among other changes expected to influence writers, editors, and students around the globe. ... The words chosen to describe addiction, according to advocates, affect how the people who suffer from it see themselves, and how others see them. (Freyer, 6/15)

CQ Magazine: Odd Bedfellows Assail Opioid Marketing
Katherine M. Clark, a Democrat in her second full term representing a suburban Boston House district, is getting good at forging ties with Kentucky Republicans in her efforts to combat the opioid epidemic. After teaming with Senate Majority Leader Mitch McConnell last year on a new law to combat opioid addiction among infants, she last month joined Kentucky GOP Rep. Harold Rogers in organizing a letter to Margaret Chan, director-general of the United Nations’ World Health Organization, to make the case that opioid marketing qualifies as a global health emergency. (Zeller, 6/19)

Texas Tribune: Amid Opioid Epidemic, Texas Joins Multistate Investigation Into Drugmakers' Role 
Texas Attorney General Ken Paxton has joined a group of state attorneys general who are investigating the marketing and sales of prescription painkillers, as they work to determine whether drugmakers have broken any laws amid a nationwide epidemic of opioid addiction. Paxton and his counterparts are tapping a variety of legal tools — including issuing subpoenas for documents and testimony — to pull back the curtain on the role of opioid manufacturers in creating or prolonging the epidemic, the Republican announced Thursday. (Malewitz, 6/15)

Advocates Cheer Drop In Teen Tobacco Use As Potential Turning Point In War Against Smoking

“This is unimaginable, extraordinary progress,” said Matthew Myers, president of the nonprofit Campaign for Tobacco-Free Kids.

The Washington Post: Teenagers’ Tobacco Use Hits A Record Low, With A Sharp Drop In E-Cigarettes
Teenagers' use of e-cigarettes fell sharply last year, while overall tobacco use declined to a new low, according to data that some antismoking advocates said could signal a turning point in the decades-long effort against youth smoking. The Centers for Disease Control and Prevention's annual report on youth and tobacco found that 11.3 percent of high school students used e-cigarettes in 2016, compared with 16 percent the year before. That's the first drop since the CDC started keeping track of e-cigarettes in 2011. (McGinley, 6/15)

NPR: Teen Use Of E-Cigarettes Declines For The First Time
"It's actually quite remarkable from a public health standpoint," says Brian King, deputy director for research translation in the Centers for Disease Control and Prevention's Office on Smoking and Health, which produced the report. Before the drop, the CDC had documented an exponential increase in the use of e-cigarettes by young people between 2011 and 2015, King says. That prompted widespread alarm among public health authorities. The devices were first imported into the U.S. from China in 2006. (Stein, 6/15)

Beyond Paint And Pipes: Lead Found In 20 Percent Of Baby Food Samples

Though it was at low levels, scientists say that even a small amount can be detrimental to a child's development.

Kaiser Health News: Lead Detected In 20% Of Baby Food Samples, Surprising Even Researchers
Pediatricians and public health researchers know they have to be on the lookout for lead exposure from paint chips and contaminated drinking water. A new report suggests food — particularly baby food — could be a problem, too. The Environmental Defense Fund, in an analysis of 11 years of federal data, found detectable levels of lead in 20 percent of 2,164 baby food samples. The toxic metal was most commonly found in fruit juices such as grape and apple, root vegetables such as sweet potatoes and carrots, and cookies such as teething biscuits. (Zuraw, 6/15)

The Washington Post: Environmental Watchdog Group Warns Of Lead In Baby Food
While the amount of lead found in most samples was tiny, Sarah Vogel, vice president for health at the Environmental Defense Fund, said the results were “concerning” especially for children younger than 6. Years of studies have shown that children exposed to lead can experience behavioral problems and develop lower IQs and that the damage can be irreversible. (Cha, 6/15)

In Arms Race Against Superbugs, Returning To Tried-And-True Technique May Be Key To Winning

Although it's been said that soil has been "over-mined" for antibiotics, some think that new technology could rejuvenate the old practice. In other public health news: Lyme disease, wounds to the hip, elder abuse, IVF and sepsis.

The Washington Post: In The Hunt For New Antibiotics, Scientists Hit Pay Dirt
Scientists have discovered a new kind of antibiotic — buried in dirt. Tests in animals show that it is effective against drug-resistant bacteria, and it could lead to desperately needed treatments for deadly antibiotic-resistant infections. Almost our entire arsenal of antibiotics was discovered in soil, but scientists haven’t gone digging for drugs in decades. That’s because, “screening microbial extracts from soil is thought to be a tapped-out approach,” said Richard Ebright, a scientist at the Waksman Institute of Microbiology at Rutgers. Soil has been “over-mined,” agreed Kim Lewis, director of the Antimicrobial Discovery Center at Northeastern University. But there is still a wealth of useful compounds under foot; we just have to take a closer look. (Gallegos, 6/15)

The Washington Post: Dangerous Unproven Treatments For ‘Chronic Lyme Disease’ Are On The Rise
An increasing number of Americans with medically ambiguous symptoms are being misdiagnosed with “chronic Lyme disease” and prescribed dangerous and often expensive treatments that do not work, according to a new report. In some instances, patients have died after receiving intensive, long-term and inappropriate courses of intravenous antibiotics that led to septic shock. In other cases, misdiagnosis caused dangerous delays in treatment of a patient’s actual underlying condition. (Sun, 6/15)

The Washington Post: Why A Single Gunshot To Steve Scalise’s Hip Can Be A Life-Threatening Injury
For those of us who experience gun violence via movies or television, the single bullet wound to the hip that House Majority Whip Steve Scalise suffered in a ballfield shooting Wednesday would seem less serious than what could have happened to him. After all, he wasn't hit in the head or chest, which can be immediately fatal. But even a single penetrating wound to the pelvic region, which is densely packed with blood vessels, organs and other structures, is extremely dangerous, according to trauma surgeons and emergency medical personnel. (Bernstein, 6/15)

Stat: To Improve IVF, These Scientists Are Looking At Adding Some Womb Fluids
Data has shown that infants conceived via IVF are at a slightly higher risk for some birth defects and genetic disorders, and are more likely to be born at low birth weight. One possible cause for these differences is epigenetics — that is, the markers that turn genes on and off. Scientists have noticed that IVF embryos have subtly different epigenetic patterns than naturally conceived embryos. And one of the prime differences between the process of IVF and natural conception is the early embryonic environment. So, researchers trying to improve IVF have begun looking at how to make the Petri dish environment more like that of the Fallopian tubes. (Sheridan, 6/16)

California Healthline: The New War On Sepsis
Dawn Nagel, a nurse at St. Joseph Hospital in Orange, Calif., knew she was going to have a busy day, with more than a dozen patients showing signs of sepsis. They included a 61-year-old mechanic with diabetes. An elderly man recovering from pneumonia. A new mom whose white blood cell count had shot up after she gave birth. Nagel is among a new breed of nurses devoted to caring for patients with sepsis, a life-threatening condition that occurs when the body’s attempt to fight an infection causes widespread inflammation. She has a clear mission: identify and treat those patients quickly to minimize their chance of death. Nagel administers antibiotics, draws blood for testing, gives fluids and closely monitors her charges — all on a very tight timetable. (Gorman, 6/16)

Slight Mutations To Bird Flu Virus Would Make It Easier To Spread Between Humans

Right now, it's not easy for humans to pass the virus to each other. And scientists aren't bracing themselves for the next pandemic quite yet. “[W]e’ve got to be careful that we separate the elegance of the science and the likelihood" of it happening, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Stat: Changes To Bird Flu Virus Could Make Human Transmission More Likely
The H7N9 bird flu virus has influenza scientists on edge, due to an unexpected surge of human infections — hundreds of cases — caused by the virus this spring. Some new scientific findings aren’t likely to ratchet down those concerns. Scientists at the Scripps Institute in La Jolla, Calif., reported Thursday that the accumulation of several mutations in the main gene on the virus’s surface may be able to give H7N9 the ability to spread like human flu viruses do, passing from person to person through coughing and sneezing. The study, funded by the National Institutes of Health, was published in the journal PLOS Pathogens. (Branswell, 6/15)

NPR: Small Genetic Tweaks Could Transform This Bird Flu Into A Human Pandemic
Public health officials have been worried about this bird flu virus, called H7N9, because it's known to have infected more than 1,500 people — and killed 40 percent of them. So far, unlike other strains that more commonly infect humans, this deadly virus does not spread easily between people. The fear is that if it mutates in a way that lets it spread more easily, the virus will sweep around the globe and take a heavy toll, because people's immune systems haven't ever been exposed to this type of flu before. Past pandemics caused by novel flu viruses jumping from animals or birds into people have killed millions. (Greenfieldboyce, 6/15)

State Watch

Texas Gov. Vetoes Legislation To Create A Public Defender Office For People With Mental Health Disorders

Republican Gov. Greg Abbott did sign measures that give a boost for telemedicine and provide for postpartum depression screening for low-income women, among others. Meanwhile, guns and abortion measures have been hot topics in Kansas.

Houston Chronicle: Telemedicine Industry Expects Boost From New Texas Law 
The multimillion-dollar telemedicine industry is poised for a lucrative run across Texas now that some of the toughest restrictions in the nation have finally been lifted by the state. A new law signed by Gov. Greg Abbott, who has championed the issue, opens a huge market that could potentially connect millions of Texans to doctors who can now diagnose patients by video chat. This is welcome news in a state where elbow room is measured in the hundreds of miles and doctor shortages are chronic. (Deam, 6/15)

Texas Tribune: Postpartum Depression Screening Bill Gets Abbott's Signature 
Texas mothers taking their new babies for checkups through Medicaid or the Children's Health Insurance Program will be able to get postpartum depression screenings and counseling under a bill Gov. Greg Abbott signed Thursday. The goal of House Bill 2466 is to get low-income mothers screened for postpartum depression early — during their baby's initial doctor visits. (Evans, 6/15)

Texas Tribune: Texas Gov. Greg Abbott Signs "Sandra Bland Act" Into Law 
Texas Gov. Greg Abbott on Thursday signed into law a measure that seeks to address the circumstances that led to the death of Sandra Bland, a black woman found dead in a county jail days after being arrested during a routine traffic stop. The Sandra Bland Act mandates county jails divert people with mental health and substance abuse issues toward treatment, makes it easier for defendants to receive a personal bond if they have a mental illness or intellectual disability, and requires that independent law enforcement agencies investigate jail deaths. (Silver, 6/15)

Austin American-Statesman: Sandra Bland Act Signed Into Law To Address Mental Health Of Prisoners
Gov. Greg Abbott has signed into law the Sandra Bland Act which, among several provisions, requires more training for jailers on mental health issues of prisoners... County jails also will have to provide prisoners with access to mental health professionals, in person or through electronic means, and a medical professional would have to review “as soon as possible” any prescription medication that a prisoner was taking when placed in custody. (Chang, 6/15)

KCUR: Closed-Door Negotiations Produce Abortion Bill No Missouri Legislator Is Happy With 
Republican lawmakers pushed an abortion bill through the Missouri Senate this week, but were unable to secure many of the provisions they wanted. Democrats are happy with a watered-down bill, but unhappy with having to deal with another attempt to further restrict access to abortion and that it came during a special legislative session. The Senate sent the House a scaled-back bill early Thursday morning after Republican and Democratic negotiators spent roughly 14 hours behind closed doors hammering out a compromise version that could get through the upper chamber without being blocked by a filibuster. (Griffin, 6/16)

State Highlights: Minn. Nurses Union Helps Pay Patients' Medical Debts; Head Of Colo.'s State Mental Hospital Resigns

Media outlets report on health-related news from Minnesota, Colorado, Georgia, Texas, Massachusetts, New Jersey and California.

The Star Tribune: Minnesota Nurses Raise Money To Pay Off Medical Debts Of 1,800 Patients
Roughly 1,800 patients will see $2.6 million in medical debts disappear because of charitable payments by the Minnesota Nurses Association, the union that represents hospital nurses throughout the state. The union announced on Thursday that it would pay off the patients’ debts in conjunction with the anniversary of a strike by its nurses against five Allina Health hospitals in the Twin Cities. (Olson, 6/15)

Denver Post: Head Of Colorado State Mental Hospital Resigns As Hospital Is Placed On “Termination Track” 
The head of Colorado’s state mental institution has resigned in the midst of a staffing shortage that resulted in federal regulators determining the Pueblo hospital poses an “immediate and serious threat to the health and safety” of its 449 patients. Officials at the Colorado Department of Human Services, which oversees the hospital, would not say whether the resignation of Superintendent Ron Hale is related to the hospital’s numerous deficiencies, described in two recent federal reviews. He will stay until July 9, to “ensure a smooth transition,” state officials said. (Brown, 6/15)

Georgia Health News: State Agency To Monitor Blue Cross Rule On ER Use
Blue Cross recently told policyholders that starting in July, it will stop covering ER visits it considers to have been unnecessary. The health insurer, Georgia’s largest, said it’s pursuing the move, involving its coverage of individual policies, due to the costs of routine primary care being administered in an ER setting. (Miller, 6/15)

Houston Chronicle: Six Pregnant Women In Harris County Test Positive For Zika 
Six pregnant women in Harris County have tested positive for Zika, the first cases of the mosquito-borne disease to be reported locally in 2017. All of the women have since delivered their babies, but it is not yet known if any of the children were born with the birth defects that can be caused by the virus, said a spokesman for Legacy Community Health, a southeast Texas network of clinics where the women were initially tested. (Ackerman, 6/15)

Boston Globe: These Startups Want To Save You A Trip To The Drugstore 
Since the company was founded in 2013, it has raised about $118 million in funding, built a highly automated pharmacy in Manchester, N.H., and grown to more than 500 employees. Along with another Boston startup, ZappRx, it hopes to eliminate the familiar headache of driving to the drugstore and standing in line, only to find that someone forgot to do something, and the crinkly white bag isn’t there waiting for you. (Kirsner, 6/16)

The Philadelphia Inquirer: Troubled Mount Laurel Nursing Home Closing Next Month
Mount Laurel Center for Rehabilitation & Healthcare, a South Jersey nursing home that has been on a list of the nation’s most troubled facilities for 19 months without showing improvement, said it has lost its Medicare and Medicaid certifications and will close next month...Patient transfers are expected to be completed by July 16, when Medicare and Medicaid payments will stop for patients admitted before Friday. No federal payments will be made for patients admitted after Friday. (Brubaker, 6/15)

Austin American-Statesman: Austin City Council Places Julie Oliver On Central Health Board
The council voted to approve the appointment of Julie Oliver in a 6-5 vote after a closed session discussion. Council Members Ora Houston, Jimmy Flannigan, Ann Kitchen, Delia Garza, Kathie Tovo and Ellen Troxclair voted for the appointment. Her appointment had raised some eyebrows due to her position as division controller at St. David’s HealthCare, a competitor of Seton Healthcare Family, which partners with Central Health, Travis County’s hospital district. (Goldenstein, 6/15)

San Francisco Chronicle: Most Bay Area Beaches Are Free From Harmful Bacteria, Report Says 
The bathing-suit-and-bikini set can splash around happily knowing they are unlikely to get sick frolicking in the water at Bay Area beaches, all but one of which are free of harmful bacteria and pollution, according to a statewide beach report card released Thursday. But the one that didn’t make the grade — Marina Lagoon, in the Lakeshore Park area of San Mateo County — is pretty icky, getting an F for water quality and a No. 4 spot on the environmental group Heal the Bay’s Top 10 Beach Bummer list for California. (Fimrite, 6/25)

Health Policy Research

Research Roundup: Medicaid Flexibility, Drug Price Transparency and Hospital Quality

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

JAMA Forum: State Flexibility For Medicaid: How Much?
President Trump’s budget proposal and the recent House health legislation included substantial reductions in Medicaid. Understandably, those cuts have focused attention on the potential effect on coverage for lower-income individuals. But there’s another important and related conversation that needs attention: how much flexibility should states have in redesigning the federal-state Medicaid program? (Butler, 6/14)

Brookings: Would Price Transparency For Generic Drugs Lower Costs For Payers And Patients?
In “Would price transparency for generic drugs lower costs for payers and patients?“, the authors provide background information on generic prescription drug pricing and outline a proposed policy to generate information on actual average prices paid by retail pharmacies to acquire generic drugs. The proposed policy would make actual average generic drug price information selectively available to third-party payers and would analyze the likely effects of limited price disclosure on competition and efficiency. The authors estimate additional information would cut health spending $4 billion for every $1 reduction in the average reimbursement to retail and mail-order pharmacies for a generic prescription. (Lieberman and Ginsburg, 7/14)

NEJM: Changes in Hospital Quality Associated with Hospital Value-Based Purchasing
Starting in fiscal year 2013, the Hospital Value-Based Purchasing program introduced quality performance based adjustments of up to 1% to Medicare reimbursements for acute care hospitals. The authors evaluated whether quality improved more in acute care hospitals that were exposed to HVBP than in control hospitals. The authors found HVBP was not associated with improvements in measures of clinical process or patient experience and was not associated with significant reductions in two of three mortality measures. (Ryan, Krinsky, Maurer and Dimick, 6/15)

The Kaiser Family Foundation: The Effects Of Premiums And Cost Sharing On Low-Income Populations: Updated Review Of Research Findings
This brief reviews research from 65 papers published between 2000 and March 2017 on the effects of premiums and cost sharing on low-income populations in Medicaid and CHIP. ... Together, the research finds: Premiums serve as a barrier to obtaining and maintaining Medicaid and CHIP coverage among low-income individuals. ... Even relatively small levels of cost sharing in the range of $1 to $5 are associated with reduced use of care, including necessary services. ... State savings from premiums and cost sharing in Medicaid and CHIP are limited. (Artiga, Ubri and Zur, 6/1)

Urban Institute: The Evidence On Recent Health Care Spending Growth And The Impact Of The Affordable Care Act 
National health expenditures have been growing in recent years at about the rate of increase in gross domestic product (GDP) plus 1 percent, following decades of growth at GDP plus 2.5 percent. In this brief the authors discuss a number of reasons for the slowdown, including contributions made by the ACA. The authors also discuss reasons for the growth in marketplace premiums, finding that states with rapid growth rates typically have little insurer or provider competition. Large numbers of states have seen relatively modest premium increases. Finally, the authors conclude with evidence on Medicaid spending growth, arguing that enrollment increases have played a major role, with growth in spending per enrollee below that of other payers. This largely reflects the cost containment efforts of states. (Holahan et. al, 5/24)

Editorials And Opinions

Perspectives: Medicaid Costs And Cuts; Should Doctors March On Washington?

Opinion writers examine a variety of issues related to health system reform and current efforts to repeal and replace the Affordable Care Act.

The New England Journal Of Medicine: Controlling The Cost Of Medicaid
The federal–state Medicaid program is facing the possibility of the largest and most consequential changes to its funding since its inception in 1965. The American Health Care Act (AHCA), H.R. 1628, as adopted by the House of Representatives on May 4, would replace the current federal matching program for Medicaid with a per capita cap on federal funds. This cap would limit the growth of these funds to the growth rate of the medical care component of the Consumer Price Index, with an additional 1% growth allowed for older adult and disabled Medicaid enrollees. The Congressional Budget Office has projected that this policy would result in federal funding reductions of more than $800 billion over the next 10 years, equivalent to a 26% reduction in federal support by 2026. These large reductions represent an unprecedented shift of financial risk to the states. Missing from the debate has been consideration of policies that could improve the value of the Medicaid program, controlling Medicaid spending without diminishing coverage or quality. (K. John McConnell and Michael E. Chernew, 6/14)

Richmond Times-Dispatch: The GOP Is Stealthily Shredding Health And Financial Protections For Ordinary Americans 
While the media fixates on Trump, Republicans are rushing through legislation that will deprive millions of Americans of health insurance coverage and open the way for another Wall Street wilding... Millions of Americans — particularly older workers, the aged and the mothers and children who depend on Medicaid, the disabled and the vulnerable — are about to be stripped of health-care coverage. (Katrina Vanden Heuvel, 6/15)

The Charlotte Observer: House Health Care Plan Would Hurt N.C. More Than Most
Medicaid has been around for decades. It doesn’t grab headlines like the Affordable Care Act. It can be boring. It’s also terribly important for children’s health. And healthy children are key to our state’s future prosperity. Thanks to the hard work of many, 96 percent of all N.C. children have health insurance. A little under half of those insured are covered by Medicaid – the workhorse of health coverage. (W. Scott St. Clair, 6/15)

The New York Times: Time For A Doctors’ March On Washington
Recently, a patient with end-stage kidney disease told me that his insurance company stopped covering one of his essential medications. It took me hours of phone calls to reinstate this lifesaving treatment. Another patient — frail and elderly — was on the verge of having to move to a nursing home. An intensive blitz to coordinate visiting nurse services, physical therapy, Meals on Wheels and home hospice allowed her to stay in her home. Advocating for patients is as much a part of medical care as the medical care itself. (Danielle Ofri, 6/16)

The Washington Post: Trump Says The House Health-Care Bill Is ‘Mean.’ He’s Wrong.
Anyone who thinks real compassion is found in a federal government program hasn’t spent much time at the post office. That’s the central insight motivating the inclusion of the state waiver from the Obamacare program in the House-passed American Health Care Act. And it’s the reason President Trump was wrong to call the bill “mean.” Almost everyone is frustrated with the process of repealing and replacing Obamacare that has played out this year. Conservatives are most justified in their frustration. After consistently being told the Republican Party was unified in the objective of repealing Obamacare lock, stock and barrel, we’ve had our worst suspicions confirmed about the cynicism of so many in Washington. (Michael Needham, 6/15)

The Washington Post: Why Mitch McConnell’s Secrecy Gambit On His Health-Care Bill Could Backfire
Right now, the Republican leadership in the Senate is undertaking an unprecedented effort to write and pass a bill to remake the entire American health-care system in secret, with not a single hearing or committee markup and with its details kept hidden even from many Republican senators. This plan was devised by Senate Majority Leader Mitch McConnell (Ky.), who is widely respected for his strategic acumen even by Democrats who believe he has a bottomless void where his soul ought to be. But is it possible that McConnell’s plan will backfire? (Paul Waldman, 6/15)

The Wall Street Journal: Don’t Blame Trump When ObamaCare Rates Jump
Insurers must submit applications by next Wednesday to sell plans through, and these will give us some of the first indicators of how high ObamaCare costs will skyrocket in 2018. ObamaCare supporters can’t wait to blame the coming premium increases on the “uncertainty” caused by President Trump. But insurers faced the same uncertainty last year under President Obama. (Chris Jacobs, 6/15)

Richmond Times-Dispatch: Right To Health Care Is Wrong Argument
Is there a right to health care? As much as people argue about it, it’s not a very good question — not, at least, in our society, in which nearly everyone agrees that all people must have access to some basic level of health care. Because of that consensus, conservatives who deny a right to health care don’t really mean it, and liberals who affirm it can’t use it to clinch the case for their favored policies. (Ramesh Ponnuru, 6/15)

Viewpoints: Waiting For The Doctor; Preventing A Mental Health Crisis

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

Sacramento Bee: Treat Mental Illness Before Crisis Occurs
Psychotic episodes are a defining factor in diagnosing schizophrenia and schizoaffective disorder, and often accompany the onset of mood disorders such as depression and bipolar disorder... Every year in the United States, 100,000 young adults – sons and daughters – experience their first psychotic break. (Darrell Steinberg and Cameron Carter, 6/15)

Los Angeles Times: How Trump Has Made The Department Of Health And Human Services A Center Of False Science On Contraception
Contraception policy may not be the biggest target of the anti-science right wing — climate change and evolution probably rank higher — but it’s the field in which scientific disinformation has the most immediate consequences for public health. So it’s especially disturbing that President Trump and Health and Human Services Secretary Tom Price have stocked the corridors of health policy with purveyors of conclusively debunked claptrap about contraception, abortion, pregnancy and women’s reproductive health generally. (Michael Hiltzik, 6/15)

The New York Times: A New Kind Of Jail For The Opioid Age
Not long ago, I visited a Narcotics Anonymous meeting where men with tattoos and short-cropped hair sat in a circle and talked out their errors. One had lived under an overpass, pimping his girlfriend’s daughter for cash to buy heroin. As the thought brought him to tears, his neighbor patted his shoulder. Others owned to stealing from grandparents, to losing jobs and children. Soon, most in the room — men with years of street addiction behind them – were wiping their eyes. (Sam Quinones, 6/16)

Real Clear Health: Stricter Regulations Are Not The Answer To Lower Smoking Rates
Regulations on the tobacco industry are nothing new to Americans. As early as the 1950s, the U.S. government has made efforts to regulate the industry, from public service announcements to advertising regulations such as the Federal Cigarette Labeling and Advertising Act in 1965. It wasn’t until 2010 when the Family Smoking Prevention and Tobacco Control Act was enacted into law that the Food and Drug Administration gained the power to regulate the tobacco industry. (Lindsay Marchello, 6/17)