KHN Morning Briefing

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Political Cartoon: 'Cover Your Bases?'

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

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IT'S A TRANSIENT THING

Loneliness in old
Age isn't a permanent
State. It can be eased.

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Summaries Of The News:

Health Law

Democratic Attorneys General Seek Role In ACA Subsidy Case: 'Lives Are At Stake'

The subsidies that are paid to insurance companies under the Affordable Care Act have been a threatened negotiation tool by President Donald Trump and have long been targeted by congressional Republicans. But not paying them would wreak havoc on the marketplaces, insurers and Democrats say.

Reuters: Democratic Attorneys General Seek To Intervene In Obamacare Case
More than a dozen Democratic attorneys general on Thursday sought to intervene to defend a key part of the Obamacare healthcare law - subsidy payments to insurance companies - which is under threat in a court case. The 16 attorneys general, led by California Attorney General Xavier Becerra and New York Attorney General Eric Schneiderman, filed a motion to intervene in the case pending in the U.S. Court of Appeals for the District of Columbia Circuit. (Levin, Hurley and Abutaleb, 5/18)

Morning Consult: States Seek To Join Appeal Of House Obamacare Lawsuit
The 15 states argue that the executive branch is not adequately defending its authority to make the CSR payments and does not represent their interests. They also said that if the appeals court agrees with the previous ruling that the Obama administration unconstitutionally paid the subsidies, states and their residents would be harmed and there would be significantly higher costs for health care. (McIntire, 5/18)

The Wall Street Journal: Democratic Attorneys General Seek To Preserve Affordable Care Act Subsidies
The group, led by California Attorney General Xavier Becerra and New York Attorney General Eric Schneiderman, filed a motion to intervene in a House Republican lawsuit over the payments. GOP lawmakers have asserted that the payments to insurers are illegal because Congress never appropriated the funding. ... “Millions of families across the country—including hundreds of thousands right here in New York—rely on these subsidies for their basic health care,” Mr. Schneiderman said in a statement about the motion, which was filed in the pending case in the U.S. Court of Appeals for the District of Columbia. (Armour, 5/18)

The Hill: Dem AGs Look To Protect ObamaCare Payments In Court
At issue are ObamaCare payments known as cost-sharing reductions (CSRs), which reimburse insurers for giving discounted deductibles to low-income enrollees under the ACA. House Republicans sued over the payments, arguing they are being made unconstitutionally without an appropriation. (Sullivan, 5/18)

CQ HealthBeat: Democratic Attorneys General Ask To Intervene In Obamacare Case
Insurance companies have called the payments "critical" to the health insurance offered under the law and the continued success of the struggling insurance markets. Some have already withdrawn. At least one company, Molina, has said it would immediately exit the insurance marketplaces if it is not paid the subsidies. If Molina follows through, that would leave more than half a million people without health insurance. Uncertainty over the payments is also driving up the rates companies have requested for plans they'll sell for 2018. (Mershon, 5/18)

Sacramento Bee: California Takes Legal Action To Prevent Obamacare Cuts 
California led a move Thursday to block one path Republicans in Washington might take to kill critical health care subsidies that go to millions of people using Obamacare. California Attorney General Xavier Becerra, joined by attorneys general from 14 other states and the District of Columbia, on Thursday filed a motion to intervene in a pending federal lawsuit filed in 2014 by the Republican-controlled House that sought to unravel a key part of Obamacare – cost sharing subsidies that reduce premiums and copays for low- and middle-income people. (Hart, 5/18)

Boston Globe: 15 States Sue In Bid To Preserve Key Aspect Of Federal Health Law
Attorney General Maura Healey has joined 15 other attorneys general in a bid to preserve a crucial component of the Affordable Care Act — the subsidies that help people cover their copays and deductibles. In a suit filed Thursday, the attorneys general are asking for a role in ongoing litigation over those subsidies, known as cost-sharing reductions. (Freyer, 5/19)

The Star Tribune: State Says $100 Million In MinnesotaCare Funding Is At Risk
Minnesota Attorney General Lori Swanson wants to intervene in a federal dispute over “cost-sharing reductions,” a form of subsidy under the federal Affordable Care Act that the state says is providing more than $100 million per year in funding for the MinnesotaCare health insurance program. Republicans in the U.S. House filed a lawsuit in 2014 to block funding for the cost-sharing reduction (CSR) payments, which in most states help individual consumers lower their out-of-pocket costs with private insurance coverage under the federal health law. (Snowbeck, 5/18)

'There Are No Hands On The Wheel': Insurers Heap Blame On Administration For Next Year's Rate Hikes

The finger-pointing toward the Trump administration undermines GOP arguments that the marketplaces are collapsing under their own weight. Meanwhile, Republicans are seizing on the increases to drum up support for their repeal-and-replace push.

Los Angeles Times: Health Insurers Plan Big Obamacare Rate Hikes — And They Blame Trump
Health insurers across the country are making plans to dramatically raise Obamacare premiums or exit marketplaces amid growing exasperation with the Trump administration’s erratic management, inconsistent guidance and seeming lack of understanding of basic healthcare issues. At the same time, state insurance regulators — both Democrat and Republican — have increasingly concluded they cannot count on the Trump administration to help them ensure that consumers will have access to a health plan next year. (Levey, 5/18)

The Wall Street Journal: Republicans Lock Onto Insurance Troubles In Push To Topple Health Law
Republicans are seizing on early signs of premium increases and diminishing insurer participation on next year’s insurance exchanges as proof the Affordable Care Act is floundering and must be overturned, pitting them against Democrats who say the GOP repeal effort itself is to blame. The finger-pointing is taking on new urgency as Republican lawmakers cite the ACA’s problems to drum up support for their legislation to topple the law, often called Obamacare. A bill passed the House earlier this month, and the Senate is now trying to craft its own version. (Armour, Wilde Mathews and Radnofsky, 5/18)

And in other news —

Politico Pro: Covered California To Hold 3-Month Open Enrollment Period 
Word that Obamacare is failing apparently hasn’t reached California. Covered California is preparing for a three-month open enrollment period this fall, and the exchange is operating solidly in the black. Covered California’s open enrollment period for 2018 coverage will run from Nov. 15 to Jan. 31, 2018 — the same as last year — despite the federal government’s plans to shorten HealthCare.gov's enrollment period to six weeks, Peter Lee, the exchange’s executive director, said at Thursday’s Covered California board meeting. (Colliver, 5/18)

Not Satisfied With What They're Seeing In Congress, Governors Start Drafting Own Health Plan

Governors will have more influence over the final legislation to repeal and replace the Affordable Care Act, because they're the ones who will be implementing the vision in their states. Meanwhile, lobbying groups are hoping they'll have better luck in the Senate than they did the House.

Reuters: U.S. Governors Work Senate As New Power Brokers In Obamacare Repeal
A group of about a dozen Republican governors is pushing for its own set of national healthcare reforms, flexing its considerable muscle in the national debate over the future of Obamacare as the U.S. Senate begins writing its bill. Led by Governor John Kasich of Ohio, the governors are using a nine-page proposal they crafted in February as the platform to shape what they think a critical portion of an Obamacare replacement law should look like, according to a half dozen people who helped write the plan. (Aubtaleb, 5/17)

The Hill: Lobby Groups To Watch In Senate Healthcare Fight 
Lobbying groups opposed to the House’s healthcare reform bill are pinning their hopes on the Senate for big changes. Industry groups felt largely cut out of the House’s drafting and passage of the American Health Care Act and now are clamoring for action to fix what they view as serious defects in the legislation.  (Roubein, 5/18)

And in other news on the American Health Care Act —

The Hill: Abortion Poses Hurdle For Senate Healthcare Bill 
Abortion has emerged as a potential stumbling block for Senate Republicans as they seek to craft an ObamaCare repeal-and-replace bill that can garner 51 votes. Senators are fretting that a provision in the House healthcare bill that bars financial assistance from being used to buy plans covering abortion will be stripped out under the Senate’s rules of reconciliation. Republicans hope to use that special budgetary procedure to bypass a Democratic filibuster. (Roubein, 5/19)

The CT Mirror: Senate Considers Stripping States Like CT Of Abortion Coverage Option
As Senate Republicans meet behind closed doors this week to craft their bill to replace the Affordable Care Act, one of the most contentious issues is how it will affect the abortion coverage millions of American women now have as part of their health insurance policies. The American Health Care Act, approved by the U.S. House earlier this month, bars anyone receiving a federal subsidy from buying a policy that includes abortion coverage. (Radelat, 5/18)

CQ HealthBeat: GOP Senators Discuss Health Tax Credits Ahead Of CBO Score
Senate Republicans on Thursday wrestled with questions of how to factor in consumers’ ages and income in devising a new set of federal subsidies for medical insurance, which would replace those created by Democrats’ 2010 health care law. Sen. Lamar Alexander of Tennessee, underscoring just how preliminary the meetings have been, suggested the Senate might split its massive rewrite of the health care law into two parts, the first of which would focus on stabilizing the market in 2018 and 2019. A scaled-back bill would be far easier to get through the Senate and perhaps could attract bipartisan support, but would represent a retrenchment in Republicans’ efforts to overhaul President Barack Obama’s health care law. (Young and Mershon, 5/18)

The Washington Post Fact Checker: Nancy Pelosi’s Claim That ‘Seven Million Veterans Will Lose Their Tax Credit’ Under The GOP Health Bill
While listing a series of criticisms of the House Republican bill to overhaul the Affordable Care Act, Pelosi described it as “Robin Hood in reverse” that hurts those in need, such as veterans. In its earlier iteration, the American Health Care Act (AHCA) contained a provision protecting tax credits for veterans, regardless of whether or not they were enrolled in the Department of Veterans Affairs health-care system. The version of the bill that was passed in May omitted this provision, meaning some veterans may no longer have access to subsidized private insurance. But Pelosi glossed over the nuances of this issue in her claim, so we dug into it. (Lee, 5/18)

After All That Turmoil, House May Have To Vote On Health Plan Again

In an "abundance of caution," House leaders are refraining from sending the legislation to the Senate until the CBO score comes back.

Bloomberg: House May Need To Vote Again On GOP Obamacare Repeal Bill
House Republicans barely managed to pass their Obamacare repeal bill earlier this month, and they now face the possibility of having to vote again on their controversial health measure. House Speaker Paul Ryan hasn’t yet sent the bill to the Senate because there’s a chance that parts of it may need to be redone, depending on how the Congressional Budget Office estimates its effects. House leaders want to make sure the bill conforms with Senate rules for reconciliation, a mechanism that allows Senate Republicans to pass the bill with a simple majority. (House, 5/18)

House Repeal Plan Would Cut $43B From Medicaid Coverage Of Kids, Analysis Finds

“Over time, per capita caps could significantly reduce the amount of funding that goes towards Medicaid coverage for children,” says Dan Mendelson, president of Avalere, the consulting firm that conducted the study. Meanwhile, in the Senate, Republican moderates float ideas in order to retain Medicaid expansion that could have other consequences for states.

The Hill: Study: House ObamaCare Repeal Bill Cuts $43B In Medicaid Funds For Children 
The House GOP’s ObamaCare replacement bill would result in a cut of $43 billion over 10 years in funding for Medicaid coverage of children, according to a new study. The study from the consulting firm Avalere finds that the cuts to coverage for non-disabled children would come as a result of a new cap on Medicaid payments that the bill would impose, known as a per capita cap. (Sullivan, 5/18)

Miami Herald: Medicaid Spending Caps In Republican Proposal Would Cut Coverage For Florida Children
Low-income children in Florida gained Medicaid coverage under the Affordable Care Act despite the state’s refusal to expand eligibility for the public health insurance program, according to a study published Wednesday by the non-partisan Urban Institute, a health policy think tank. But those gains may end if the American Health Care Act — the Republican-sponsored bill to repeal and replace the health law known as Obamacare — creates spending caps for Medicaid, according to the consulting firm Avalere Health in a separate report this week. (Chang, 5/18)

And in Medicaid news from the states —

The Associated Press: Medicaid Recipients Say They Need Health Care To Work
Medicaid recipients in Maine told state regulators Wednesday they shouldn't be forced to work to continue getting their health care benefits as the Republican governor has proposed. The health care bill recently approved by U.S. House Republicans would let states require certain Medicaid enrollees to work — an unprecedented change to the half-century-old health care program for low-income people run by states. The Senate is considering the bill. (Villaneuve, 5/17)

Texas Tribune: Texas Senate Budget Writers Approve Bill To Plug Funding Holes From 2015 
Texas Senate budget writers on Thursday approved a supplemental budget to pay for leftover expenses that aren’t covered in the state's current two-year budget, mostly for health and human services programs. The Senate Finance Committee unanimously voted to spend about $800 million in state funds — which comes with a matching $1.6 billion from the federal government — to cover a shortfall in Medicaid, the public health insurance program for the poor and disabled. (Walters, 5/18)

California Healthline: California To Pay About $1.3 Billion For Medicaid Expansion In First Year Of State Contributions
California will contribute about $1.3 billion to its Medi-Cal expansion this year, a new expenditure that will further strain an already burdened health care budget. This year marks the first time states that expanded Medicaid under the Affordable Care Act will have to pitch in to help fund their expansion of the program. Their share of the overall price tag compared with federal contributions is small — 5 percent of the cost to cover newly eligible enrollees — but that still equates to real money in the Golden State. (Bazar, 5/18)

KCUR: Remaining 'Medicaid 23' Defendants Receive Probation For Missouri Capitol Protest 
Six clergymen who were found guilty of trespassing in the Missouri Senate gallery after they protested Missouri’s failure to expand Medicaid were sentenced today to one year of unsupervised probation. The six, including well-known Kansas City clergymen Sam Mann, Wallace Hartzfield Sr. and Vernon P. Howard Jr., were part of the so-called Medicaid 23, who were charged with trespassing and obstructing government operations after leading a group of about 300 protestors in the Senate gallery three years ago. The 23, some of them septuagenarians, urged lawmakers to expand Medicaid benefits to 300,000 low-income Missourians. (Margolies, 5/18)

Administration News

Democrats Tell Trump To Get A Science Adviser So He's Not Vulnerable To Fake News

Lawmakers on the House Science Committee are urging the president to fill the empty position to head the White House Office of Science and Technology Policy.

Stat: Science Committee Dems To Trump: Stop With The Fake News And Get A Science Adviser
Several Democrats on the House Science Committee are scolding President Trump for his belief in fake news stories, tying that belief to the lack of scientific leadership in the White House Office of Science and Technology Policy. ... The group of seven Democrats was led by Representative Don Beyer of Virginia, one of two members of Congress to attend the March for Science in Washington last month and an outspoken voice against the Trump administration’s climate policies. Representatives Bill Foster of Illinois and Jerry McNerney of California, who hold PhDs in physics and mathematics, respectively, also signed the letter. (Facher, 5/18)

In other news —

The Associated Press: President's 2018 Budget To Include Paid Family Leave
President Donald Trump's 2018 budget proposal will require states to provide paid family leave programs, a senior budget official said Thursday. The official said the budget — set to be released Tuesday — will include a plan to provide six weeks of paid leave to new mothers, fathers and adoptive parents. A departure from Republican orthodoxy, the proposal expands on a campaign pledge to provide paid maternity leave, which Trump adopted at the urging of his daughter Ivanka. (Lucey, 5/18)

The Hill: Dems Ask To Meet With Ivanka Trump On Women's Healthcare Issues
Female Democratic lawmakers are asking to meet with Ivanka Trump this month to talk about women's health issues, such as access to contraception and maternity care. Trump, who works on women's issues in her father's administration, has been silent during the passage of the American Health Care Act (AHCA), which President Trump supports, the lawmakers said in a letter Thursday. (Hellmann, 5/18)

Medicare

Senate Committee Passes Bipartisan Bill To Revamp Medicare Coverage Of Chronic Care

The bill would give people greater access to telehealth services, promote care coordination between providers and expand value-based payment models.

Morning Consult: Senate Panel Approves Bill Revamping Medicare For Chronically Ill Patients
The Senate Finance Committee on Thursday unanimously advanced legislation aimed at improving care for people with chronic illnesses, part of a bipartisan effort that has advanced even as Republicans and Democrats fight over the future of the Affordable Care Act. The bill, which is backed by the American Heart Association and dozens of other industry groups, would revamp how Medicare works for patients who have chronic medical conditions. Specifically, the bill is aimed at reducing costs associated with chronic illness by giving people greater access to telehealth services, promoting care coordination between providers and expanding value-based payment models. (Reid, 5/18)

Modern Healthcare: House Lawmakers Push Back At MedPAC's Proposed Medicare Reforms
House lawmakers pushed back Thursday on the Medicare Payment Advisory Commission's calls to cut Medicare reimbursements to some kinds of providers, saying organizations in their districts tell them they could not survive with the proposed cuts. MedPAC executive director Mark Miller's prepared testimony for a House Ways and Means subcommittee Thursday said the federal government could have saved $11 billion by now if it had heeded the commissions repeated proposals to cut or freeze payments to skilled nursing facilities, inpatient rehabilitation centers, long-term care hospitals and home health agencies. In many sectors, MedPAC says profits off of Medicare patients are excessive. (Lee, 5/18)

Marketplace

UnitedHealth To Shutter Experiment Of No-Cost-Sharing Plans For Primary And Behavioral Care

Modern Healthcare reports that Harken Health, a UnitedHealth subsidiary, will close in Chicago and Atlanta. In more news on the insurer, KHN reports that UnitedHealth faces allegations that it overcharged the federal government by more than $1 billion through its Medicare Advantage plans.

Modern Healthcare: UnitedHealth Pulls Plug On Plan Testing No-Charge Primary Care
UnitedHealth Group is shutting down its health plan experiment featuring staff providers offering unlimited primary and behavioral care at no charge. Harken Health, a UnitedHealth subsidiary, reportedly is closing in Chicago and Atlanta after launching at the beginning of 2016. It will continue to cover and provide care for individual-market enrollees through the end of 2017, and will serve employer group members through the end of its contracts. (Meyer, 5/15)

Kaiser Health News: UnitedHealth Doctored Medicare Records, Overbilled U.S. By $1 Billion, Feds Claim
The Justice Department on Tuesday accused giant insurer UnitedHealth Group of overcharging the federal government by more than $1 billion through its Medicare Advantage plans. In a 79-page lawsuit filed in Los Angeles, the Justice Department alleged that the insurer made patients appear sicker than they were in order to collect higher Medicare payments than it deserved. The government said it had “conservatively estimated” that the company “knowingly and improperly avoided repaying Medicare” for more than a billion dollars over the course of the decade-long scheme. (Schulte, 5/17)

Quality

Despite Factors That Should Put It Ahead Of Game, U.S. Health Ranking Is 'An Embarrassment'

A new study finds that access to cutting-edge medical technology and well-trained doctors don't necessarily correlate to good health for a country.

The Washington Post: ‘An Embarrassment’: U.S. Health Care Far From The Top In Global Study
Americans grumble all the time about the quality of our health-care system, but when we're dealing with serious issues, such as injuries from an auto accident or cancer, we often count our blessings that we live in a wealthy country that has well-trained doctors with access to the latest medical technology. Yet those factors don't always correlate with staying alive. That's the distressing finding from a global study of what researchers call “amenable mortality,” or deaths that theoretically could have been avoided by timely and effective medical care. (Cha, 5/18)

Bloomberg: Americans Die When They Have To Work At Being Healthy 
The newly created Healthcare Access and Quality Index shows how well countries use their healthcare systems to stop preventable deaths. The inaugural version of the index finds huge disparities both between countries, and within them. Access to quality healthcare, the study shows definitively, is often the difference between life or death. For Americans, the results aren’t heartening. ... Not all diseases kill Americans with equal power, however. Despite recent skepticism about the efficacy of vaccines, diseases that they prevent — like tetanus and measles — kill significantly fewer Americans than those that require ongoing prevention and care, like hypertension and diabetes (both of which kill far fewer people in Andorra). (Shanker, 5/19)

Women’s Health

After Losing $2M In Funds Under New Measure, Planned Parenthood To Close 4 Clinics In Iowa

Iowa's Republican-led legislature agreed in its recent budget to discontinue a federal Medicaid program and replace it with a state one that bars funding to organizations that provide abortions or maintain facilities where abortions are carried out.

Reuters: Planned Parenthood To Close Four Iowa Clinics After Cuts
Planned Parenthood said on Thursday it would shutter four of its 12 clinics in Iowa as a result of a measure backed by Republican Governor Terry Branstad that blocks public money for family planning services to abortion providers. Health centers in Burlington, Keokuk and Sioux City will close on June 30 and one in Quad Cities soon after as a result of losing $2 million in funds under the new measure, said Susan Allen, a spokeswoman for Planned Parenthood of the Heartland. (Kenning, 5/18)

Des Moines Register: Planned Parenthood To Close Four Iowa Clinics After Legislative Defunding
Health centers will be closed in Bettendorf, Burlington, Keokuk and Sioux City that have served more than 14,600 individual patients in the past three years, said Susana de Baca, president and chief executive officer of Planned Parenthood of the Heartland. Eight health centers will remain open elsewhere in Iowa. De Baca said the impact will be devastating for Planned Parenthood's patients who have received family planning care in those four communities. It will be hardest on people who already face barriers to access health care, especially people of color, young people, poor people and rural residents, she said. (Petroski, 5/18)

Iowa Public Radio: Planned Parenthood Closing Four Iowa Clinics
"We agonized for months about which centers might stay open or what might have to close," says Planned Parenthood of the Heartland President Suzanna de Baca. "A team of senior staff and board looked at many, many factors including mission considerations" (Boden, 5/18)

Meanwhile, in Missouri —

KCUR: Judge Says No To Missouri’s Request To Stay Order Blocking Abortion Restrictions 
A federal judge has denied Missouri’s request to stay his order blocking two statewide abortion restrictions, making clear he takes a dim view of the state’s arguments. In a three-page ruling on Wednesday, U.S. District Judge Howard Sachs rejected out of hand Missouri’s claim that the restrictions protect abortion patients’ health. ... Sachs said that women seeking abortions in central and southwest Missouri currently have three options: They can go to a distant clinic; they can attempt to self-abort or seek an abortion from a non-professional; or they can submit to an unwanted birth. (Morgolies, 5/18)

Public Health And Education

Blood Tests May Have 'Significantly' Underestimated Lead Levels, FDA Warns

The tests the agency are warning about, though, are not used as often as less invasive screenings, so it should not affect most people, according to officials. However, pregnant women and children should be retested, they say.

The Washington Post: Blood Tests Significantly Underestimated Lead Levels, FDA And CDC Warn
Federal officials are warning that some blood tests may have “significantly” underestimated lead levels, and they are urging the retesting of some children, as well as pregnant and breast-feeding women. The Food and Drug Administration and the Centers for Disease Control and Prevention said the tests in question were made by Magellan Diagnostics, a Massachusetts-based testing company whose products are used in laboratories and doctors' offices throughout the country. The problem may go as far back as 2014, the agency said. The warning applies only to tests in which blood samples are taken from a vein, not the more common, less invasive tests in which fingers or heels are pricked for a blood sample. (McGinley, 5/17)

The Wall Street Journal: FDA Warns On Magellan Diagnostics Lead Blood Tests
Dr. Patrick Breysse of the CDC estimated that fewer than 1% of lead tests performed on residents of Flint, Mich., were of the venous variety in question. In that city the water system was tainted with lead in a widely publicized case that led to criminal charges against city and state officials and an $87 million payout from the state to replace lead pipes. (Burton, 5/17)

NPR: Common Lead Test Can Give False Results, FDA Warns
The majority of lead tests are not conducted with that kind of blood sample, but rather blood from a heel or finger prick, says Dr. Jeffrey Shuren, director of the FDA's Center for Devices and Radiological Health. "We have no evidence that Magellan's tests, when used with blood obtained from a finger or heel stick, are impacted," says Shuren. "We believe most people will not be affected by this issue." (Greenfieldboyce, 5/17)

What Goes Awry In The Brain To Lead To Alzheimer's? Scientists Still Aren't Quite Sure

The Los Angeles Times' series looks at dementia, Alzheimer's and aging.

Los Angeles Times: When The Memory Flickers Out
Facts, faces, experiences: Our brain’s capacity to learn new things, store the memories and summon them up on demand is a marvel. Yet we take it all for granted until the skills start to crumble in those we love, or in ourselves. What goes awry in the brain to make this happen? (Dance, 5/18)

Los Angeles Times: Why Exercise Is The Best Medicine For Your Brain
Given time, any brain can succumb to dementia — memories fade, thoughts scatter, basic abilities wither on the vine. Brains don’t come with lifetime guarantees, but there is one major step you can take to protect yourself from Alzheimer’s or other causes of mental decline: exercise your body. Nothing protects the brain quite like regular exercise, says Jennifer Heisz, a cognitive neuroscientist at McMaster University in Ontario, Canada. Not crossword puzzles, not supplements, not prescription medications. Exercise seems to beat them all, reducing the risk of Alzheimer’s disease or cognitive decline by about 35% to 45%, according to the latest evidence. (Woolston, 5/18)

Los Angeles Times: Eight Things You Can Do Now That Might Reduce Your Odds Of Dementia Later
It’s a safe bet that you’d like to avoid getting Alzheimer’s. But you probably haven’t done the one thing that could make you five times more likely to reach the age of 85 without getting the disease and 7.5 times more likely to have suffered no memory loss or other major cognitive decline. Don’t kick yourself. The only way you could have achieved this spectacular risk reduction was to be born with a genetic variant that’s been found in fewer than 0.5% of people studied. (Ravn, 5/18)

On Heels Of Opioid Crisis, Officials See Early Warning Signs That Meth Will Be Next Epidemic

Officials say a methamphetamine crisis could reach even further than the current opioid epidemic. In related news, senators introduce a bill to modify rules about Medicaid money and substance abuse treatment centers, Aetna is sending letters to dentists and oral surgeons who are "superprescribers," and more out of the states.

Stateline: A New Meth Surge Gathers Momentum
The opioid epidemic has killed tens of thousands over the last two years and driven major reforms in state and local law enforcement and public health policies for people with addiction. But another deadly but popular drug, methamphetamine, also has been surging in many parts of the country. And federal officials say that, based on what they learned as opioids swept the U.S., methamphetamine is likely to spread even further. (Vestal, 5/18)

Modern Healthcare: New Senate Bill Aims To Boost Medicaid Addiction Treatment Access 
A bipartisan group of senators on Wednesday introduced a bill that would allow more substance abuse treatment center to receive Medicaid payments. The legislation would enable treatment facilities with up to 40 beds to be reimbursed by Medicaid for 60 consecutive days of inpatient services. If passed, the bill would modify the Medicaid Institutions for Mental Disease law, which currently only allows Medicaid coverage for facilities with less than 16 beds. (Castellucci, 5/18)

Modern Healthcare: Aetna Targets Dentist 'Superprescribers' In Latest Opioid Initiative 
After a root canal or wisdom tooth removal, it's not unusual for a patient to walk away from the dentist's chair with a prescription for Vicodin or Percocet, even though ibuprofen would easily relieve the pain. Dentists are among the highest prescribers of highly-addictive prescription opioids—a driving factor in the worsening opioid epidemic. National health insurer Aetna hopes to keep these opioids out of medicine cabinets and off the street by encouraging dentists and oral maxillofacial surgeons that prescribe abnormally large amounts of opioids to change their behavior. (Livingston, 5/18)

The Philadelphia Inquirer: Aging, Addiction Advocates Worried About Consolidation Plan
Advocates for the elderly and for drug and alcohol programs on Thursday raised alarms that the voices of their constituents will be lost in Gov. Wolf’s proposed consolidation of the state departments of health, human services, aging, and drug and alcohol programs — especially as the state grapples with what experts call the worst addiction epidemic ever. Speaking at a joint Pennsylvania Senate hearing in Northeast Philadelphia, Michael Harle, chief executive of Gaudenzia Inc., a nonprofit addiction-treatment provider, described a decades-long process, starting in the early 1970s, to get a state department devoted to drug and alcohol addiction with a direct line to the governor. (Brubaker, 5/18)

New Hampshire Public Radio: With No Oversight, How Sober Is 'Sober Living' In New Hampshire? 
When recovering from an opioid addiction, one important step is finding safe, drug-free housing.There are a lot of places in New Hampshire that call themselves 'sober living.' But with no state oversight there’s no real way to check how sober these houses actually are...With the demand for this type of housing so high, places like this have been running under the radar – some maybe not for the right reasons. If you do the math, with an average rent of $150 a week and 12 people in a house, that comes out to $7,200 a month or more than  $86,000 a year. So the profit is definitely there. (Sutherland, 5/18)

Health News Florida: State Officials Begin Divvying Up Federal Opioid Grant Funding 
State officials will use the federal dollars to fund six new positions working with child protective services, drugs to counteract overdoses and prevention outreach programs. Nearly $4 million will go the Florida Alcohol and Drug Abuse Association to purchase a drug called Vivitrol that helps people in recovery stay clean by blocking the effects of opioids. (5/18)

Arizona Republic: AG: Tucson Podiatrist Pleads Guilty To Forging Prescriptions For Painkillers
A Tucson podiatrist has pleaded guilty to forging narcotics prescriptions for painkillers that he was addicted to, the Arizona Attorney General's Office said. In June 2016, Dr. Loren Wessel made a purchase of more than 5,000 oxycodone tablets, officials said. Shortly after, the veterinary-supply company that issued Wessel the drugs contacted the U.S. Drug Enforcement Administration in Phoenix. (Destin, 5/18)

Flushing Fallopian Tubes With Poppyseed Oil May Help Infertile Women Conceive

A small study shows a "clear" difference between oil-based and water-based solutions. In other public health news: breast cancer survival rates, pelvic exams, cancer treatments, internet addiction and gun safety.

Stat: Can Poppyseed Oil Help Infertile Couples Conceive?
Here’s something you don’t see in the New England Journal of Medicine every day: Flushing fallopian tubes with a poppyseed oil-based solution may help a woman to conceive — and one of the key researchers of the paper thinks he’s likely living proof of the technique’s efficacy. For decades, doctors have noticed that some couples who had previously been struggling to conceive became pregnant shortly after an imaging study of the woman’s uterus and fallopian tubes. Now, a randomized study strongly suggests a particular chemical used in that procedure may be to thank. (Sheridan, 5/18)

The Washington Post: Women With Advanced Breast Cancer Are Surviving Longer, Study Says
The number of women living with advanced breast cancer is rising substantially in the United States, reflecting improved survival among all ages, according to a study published Thursday. The study found that between 1992 and 1994, and 2005 and 2012, the five-year survival rate among women under age 50 initially diagnosed with advanced disease doubled from 18 percent to 36 percent. The median survival time for that group increased from 22.3 months to almost 39 months. For women ages 50 to 64, the survival time grew from a little more than 19 months to almost 30 months. (McGinley, 5/18)

NPR: Women Skip Pelvic Exams When Told They Have Little Health Benefit
This is a story about conflicting medical advice. One group of doctors, represented by the American College of Obstetricians and Gynecologists, recommends yearly pelvic exams for all women 21 years of age and older, whether they have symptoms of disease or not. But the American College of Physicians, representing doctors of internal medicine, says that potential harms of the exam outweigh benefits and recommends against performing pelvic examinations unless a woman is pregnant or has symptoms of disease such as bleeding, pain or signs of infection. (Neighmond, 5/18)

KCUR: MU Researcher Explores Cancer Treatments Inspired By Traditional Indian Medicine 
In some ways, the consultation isn’t that different from a regular doctor’s checkup. [Sarah] Kucera asks about the patient’s health history, diet and exercise regimen while typing notes on a laptop. But there are differences. The Ayurvedic remedies that Kucera prescribes are mostly plant-based – things like herbs and oils which are thought to be beneficial to various parts of the body. Ayurveda isn’t typically used to treat critical illness or injury. Kucera explains that it focuses more on prevention and wellness. (Smith, 5/18)

NPR: Is Internet Addiction A Thing?
When her youngest daughter, Naomi, was in middle school, Ellen watched the teen disappear behind a screen. Her once bubbly daughter went from hanging out with a few close friends after school to isolating herself in her room for hours at a time. (NPR has agreed to use only the pair's middle names, to protect the teen's medical privacy.) "She started just lying there, not moving and just being on the phone," says Ellen. "I was at a loss about what to do." (McClurg, 5/18)

Los Angeles Times: When States Have Strong Guns Laws, They Also Have Fewer Fatal Police Shootings
Fatal shootings of civilians by police officers are less common in states with stricter gun laws than they are in states that take a more relaxed approach to regulating the sale, storage and use of firearms, new research says. A study published Thursday in the American Journal of Public Health has found that fatal police shootings were about half as common in states whose gun laws place them in the top 25% of stringency than they were in states where such restrictions ranked in the bottom 25%. (Healy, 5/18)

State Watch

State Highlights: Tenn. Hospital Launches GoFundMe Page To Stay Open; 'Medicare For All' Rallies To Be Held Across Iowa

Media outlets report on news from Tennessee, Iowa, New Hampshire, California, Washington, Arizona, Indiana, Florida, Ohio and Oregon.

Stat: In Rural Tennessee, A Hospital Turns To Crowdfunding To Stay Afloat
In the southeast corner of Tennessee, one rural hospital has fallen into such dire financial straits it suspended inpatient services earlier this month. Now, the new CEO of the Copper Basin Medical Center has launched a GoFundMe campaign to save the hospital...The campaign seeks to raise just $100,000. That’s just a fraction of its debt — and it’s nothing in the world of online crowdfunding; the team behind an extra-heavy blanket marketed as a treatment for anxiety recently raised more than $3.5 million. (Blau, 5/18)

New Hampshire Public Radio: N.H. Health Department Likely To See $33 Million In Shortfall Dollars 
The New Hampshire House overwhelmingly OK’d a proposal Thursday to allocate $33 million to the state’s Department of Health and Human Services to make up for a budget shortfall. House Finance Chair Neal Kurk urged lawmakers to approve this measure, saying if the department doesn’t immediately get the money, it can’t pay its upcoming bills. Kurk says the shortfall is not the department’s fault, but rather that of state budget writers. He says earlier state budget writers were working with the wrong numbers. (Sutherland, 5/18)

Los Angeles Times: Area School Districts See Gains In Vaccination Rates
Area school districts made gains in the rates of vaccinated students because of a change in state law that eliminated personal exemptions as a reason not to immunize children, according to an Orange County Grand Jury report released earlier this week. “Each district planned well in advance of the change and acted early and successfully in their efforts,” said the report, which listed year-by-year vaccination rates for 24 school districts in the county dating to the 2013-14 school year. (Alderton, 5/18)

Seattle Times: Qliance Closes After 10-Year Effort At New Approach To Basic Medical Care 
Qliance Medical Management, a Seattle-based chain of clinics that provided basic medical treatment on a monthly membership basis, closed Monday after a decade of providing low-cost and insurance-free primary care. Qliance, considered a pioneer of that medical model, told patients in an email that limited services will still be available for the next 30 days. The closure will affect 13,000 members between primary-care and emergency-care services. Qliance’s physicians will independently continue to provide primary care for now in a program serving Seattle firefighters. (Carlson, 5/17)

Modern Healthcare: Physician-Led Group Offers To Buy CHS' 8 Fort Wayne Hospitals
A leveraged-buyout group led by physicians in Fort Wayne has made an offer to buy Community Health Systems' eight Indiana hospitals branded as Lutheran Health Network, Fort Wayne City Councilman Dr. John Crawford said Thursday. Crawford, co-founder of Radiation Oncology Associates in Fort Wayne who is not a part of the buyout group, said his eight-physician practice has written a letter supporting the buyout. (Barkholz, 5/18)

Orlando Sentinel/Tampa Bay Tribune: Orlando Health Building Medical Complex, ER In Lake Mary 
Orlando Health is building a free-standing emergency department and medical pavilion in Lake Mary, the health system announced on Wednesday. “Our future vision for the healthcare site includes an acute care hospital, additional medical offices, a potential ambulatory surgery center and other health and wellness concepts,” said Karen Frenier, president of South Seminole Hospital in a news release. The $42-million complex, which is scheduled to open in late fall 2018 and break ground later this year, is about a mile away from Florida Hospital’s new 18,000-square-foot free-standing ER. (Miller, 5/18)

Columbus Dispatch: New Digital Technology Allows For Quicker, More Accurate Cancer Diagnoses
The new technology at the Arthur G. James Cancer Hospital at Ohio State University allows physicians to scan the sliver from a glass microscope slide and transform it into a digital image. That technological shift is a game changer for the pathologists who form diagnoses from biopsies, Parwani said. It means that these diagnoses are delivered faster and more accurately. (Viviano, 5/18)

The Oregonian: Hospital Patients Less Likely To Die If Seen By Younger Doctors, Surprising Study Finds 
Hospital specialists, or "hospitalists," age 40 and younger have better results -- lower 30-day readmission and mortality rates for their patients -- than those aged 60 and older, states a new study published in the British Medical Journal. The possible reason: Recent training makes a big difference. ... It concluded that "older physicians have decreased clinical knowledge, adhere less often to standards of appropriate treatment, and perform worse on process measures of quality with respect to diagnosis, screening and preventive care." (Perry, 5/18)

Columbus Dispatch: Former Nursing Home's Mission To Continue, Without The Building
No longer able to see its way to long-term financial stability, the board of the Isabelle Ridgway Care Center made the difficult decision a few years ago to sell the historic operation to a for-profit company. But Ridgway’s legacy and her mission — to bring comfort and care to elderly, impoverished African-Americans — are set to thrive anew. (Price, 5/19)

Kaiser Health News: California Bill Addresses Safety Concerns At Dialysis Clinics
Saying they are concerned about safety in California’s dialysis clinics, a coalition of nurses, technicians, patients and union representatives is backing legislation that would require more staffing and oversight. The bill, introduced by Sen. Ricardo Lara (D-Bell Gardens), would establish minimum staffing ratios, mandate a longer transition time between appointments and require annual inspections of the state’s 562 licensed dialysis clinics. (Gorman, 5/19)

Weekend Reading

Longer Looks: A Grandmother's Abortion; Exploding Obamacare; And Doctors In China

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

The New Yorker: My Grandmother’s Desperate Choice
Some friends and I had got into a long after-school discussion about abortion, prompted by the gruesome posters that a protester had staked in front of the Planned Parenthood in our Vermont town. I had already begun reading my mother’s Ms. magazines cover to cover, but this was the first time I’d encountered a pro-life position. When I hopped into my mom’s car after school, I was buzzing with new ideas. I had almost finished repeating one friend’s pro-life argument when I saw the look on Mom’s face. That’s when she told me: the “household accident” that had killed her mother had, in fact, been a self-induced abortion. (Kate Daloz, 5/14)

Vox: What Does It Look Like When Obamacare Explodes? This Interactive Graphic Explains.
The biggest risk when health insurance plans quit Obamacare is that some areas could end up with no plans at all. This would mean that, while the law was still technically standing, people there would not have access to the program. They’d have no place to use the financial help the government provides to buy coverage on Healthcare.gov. (Sarah Kliff and Sarah Frostenson, 5/15)

The Economist: Shod, But Still Shoddy: China Needs Many More Primary-Care Doctors
Queues at Chinese hospitals are legendary. The acutely sick jostle with the elderly and frail even before gates open, desperate for a coveted appointment to see a doctor. Scalpers hawk waiting tickets to those rich or desperate enough to jump the line. The ordeal that patients often endure is partly the result of a shortage of staff and medical facilities. But it is also due to a bigger problem. Many people who seek medical help in China bypass general practitioners and go straight to hospital-based specialists. In a country once famed for its readily accessible “barefoot doctors”, primary care is in tatters. (5/11)

Wired: The WannaCry Ransomware Hackers Made Some Major Mistakes
The WannaCry Ransomware Attack has quickly become the worst digital disaster to strike the internet in years, crippling transportation and hospitals globally. But it increasingly appears that this is not the work of hacker masterminds. Instead, cybersecurity investigators see in the recent meltdown a sloppy cybercriminal scheme, one that reveals amateur mistakes at practically every turn. (Andy Greenberg, 5/15)

The Atlantic: Does Depression Contribute To Opioid Abuse?
It can sometimes seem strange how so much of the country got hooked on opioids within just a few years. Deaths from prescription drugs like oxycodone, hydrocodone, and methadone have more than quadrupled since 1999, according to the CDC. But pain doesn’t seem to be the only culprit: About one-third of Americans have chronic pain, but not all of them take prescription painkillers for it. Of those who do take prescription opioids, not all become addicted. (Olga Khazan, 5/15)

Health Policy Research

Research Roundup: Medicaid Wellness Programs; Preexisting Conditions; Changes In Subsidies

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

Health Affairs: Iowa’s Medicaid Expansion Promoted Healthy Behaviors But Was Challenging To Implement And Attracted Few Participants
As part of Iowa’s Medicaid expansion, the Healthy Behaviors Program was designed to provide members with incentives to complete specified healthy activities in return for waiving monthly premiums. We used claims data and interviews to document the first year (2014) of the program’s implementation. Healthy activities completion rates did not exceed 17 percent. Interviews with members and clinic managers revealed low levels of awareness of the program’s existence, deficits in knowledge about how the program works, and a variety of barriers to activity completion. ... The results suggest that efforts by federal and state governments to reform Medicaid by shifting responsibility onto program members for healthy behaviors are unlikely to succeed. (Askelson et al., 5/2)

JAMA: Trends And Patterns Of Geographic Variation In Cardiovascular Mortality Among US Counties, 1980-2014
In this study of small area estimation models applied to death records from the National Center for Health Statistics, the difference between county-level mortality rates declined substantially over the past 35 years for both ischemic heart disease and stroke; however, large differences remained in 2014. The largest concentration of counties with high cardiovascular disease mortality extended from southeastern Oklahoma along the Mississippi River Valley to eastern Kentucky, and several cardiovascular disease conditions were clustered substantially outside the South, including atrial fibrillation (Northwest), aortic aneurysm (Midwest), and endocarditis (Mountain West and Alaska). (Roth et al., 5/16)

The New England Journal of Medicine: Aerobic Or Resistance Exercise, Or Both, In Dieting Obese Older Adults
In this clinical trial involving 160 obese older adults, we evaluated the effectiveness of several exercise modes in reversing frailty and preventing reduction in muscle and bone mass induced by weight loss. Participants were randomly assigned to a weight-management program plus one of three exercise programs — aerobic training, resistance training, or combined aerobic and resistance training — or to a control group (no weight-management or exercise program). ... Of the methods tested, weight loss plus combined aerobic and resistance exercise was the most effective in improving functional status of obese older adults. (Villareal et al., 5/18)

JAMA Internal Medicine: Perceived Discrimination Experienced By Physician Mothers And Desired Workplace Changes
In a large cross-sectional survey of physician mothers, we found that perceived discrimination is common, affecting 4 of 5 respondents, including about two-thirds of the respondents who reported discrimination based on gender and more than a third who reported maternal discrimination. The overlap of groups reporting gender and maternal discrimination was less than half, suggesting that they are somewhat different phenomena. (Adesoye et al., 5/8)

International Journal of Health Services: Availability Of Outpatient Mental Health Care By Pediatricians And Child Psychiatrists In Five U.S. Cities
The authors sought to assess the availability of outpatient mental health care through pediatrician and child psychiatrist offices in the United States and to characterize differences in appointment availability by location, provider type, and insurance across five cities. To do so, the authors posed as parents of a 12-year-old child with depression, gave a predetermined insurance type, and asked to make the first available appointment with the specified provider. They called the offices of 601 individual pediatricians and 312 child psychiatrists located in five U.S. cities and listed as in-network by Blue Cross Blue Shield, one of the largest private insurers in the United States. Appointments were obtained with 40% of the pediatricians and 17% of the child psychiatrists. The mean wait time for psychiatry appointments was 30 days longer than for pediatric appointments. (Cama et al., 5/9)

The Kaiser Family Foundation: Gaps in Coverage Among People With Pre-Existing Conditions
The American Health Care Act (AHCA), which has passed the House of Representatives, contains a controversial provision that would allow states to waive community rating in the individual insurance market. In this brief we estimate the number of people with pre-existing conditions who might be affected by such a policy. ... Using the most recent National Health Interview Survey (NHIS), we estimate that 27.4 million non-elderly adults nationally had a gap in coverage of at least several months in 2015. This includes 6.3 million people (or 23% of everyone with at least a several-month gap) who have a pre-existing condition that would have led to a denial of insurance in the pre-ACA individual market and would lead to a substantial premium surcharge under AHCA community rating waiver. (Levitt et al., 5/17)

Urban Institute: Premium Tax Credits Tied To Age Versus Income And Available Premiums: Differences By Age, Income, And Geography
This paper compares tax credits offered through the Affordable Care Act (ACA) with those in the American Health Care Act (AHCA). They examined the premium levels in 10 cities, five of which have relatively low premiums and five of which have relatively high premiums. The authors find that younger people typically receive larger insurance premium tax credits under the AHCA, while older adults typically receive larger premium tax credits under the ACA. The analysis also shows that lower-income older adults currently receive higher tax credits under the ACA than they would under the AHCA regardless of where they live. (Holahan, Blumberg and Wengle, 5/17)

Editorials And Opinions

Perspectives On Health Debate: GOP Disregard Of ACA Maintenance; Miss USA's Health Stand

Even as other issues are overtaking the air waves, some opinion writers keep an eye on the health debate.

The New York Times: Trumpcare Is Already Hurting Trump Country
The mere threat that Obamacare will be dismantled or radically changed — either by Congress or by President Trump himself — has persuaded several big insurance companies to stop selling policies or significantly raise premiums. The practical effect is that some lower-income and middle-class families may have no good options for insurance and will have to spend more on health care. (5/19)

Los Angeles Times: Miss USA Spoke For Many Americans When She Said Healthcare Isn't A Right
[W]e probably shouldn’t be surprised that the person who has most clearly articulated America’s core philosophical belief when it comes to healthcare is our newly crowned Miss USA, Kara McCullough. She was asked at this week’s celebration of swimsuits, evening gowns and womanhood whether she thought “affordable healthcare for all U.S. citizens is a right or a privilege.” "I'm definitely going to say it's a privilege," the 25-year-old answered without hesitation. ... Miss USA initially was voicing a position common to many Americans, mostly conservatives — a stance that has prevented the United States from joining all other developed countries in providing its citizens with universal coverage. (David Lazarus, 5/19)

Medscape: Is Medicaid Only For Those Who 'Deserve' It?
I am irritated today. Why? Because we keep getting proposals from Washington that suggest that people ought to work if they want to be eligible for Medicaid. What bothers me about this is that it is a reversion to 19th-century thinking, that the people who deserve healthcare are only those who earn it. This was the attitude when Charles Dickens wrote Oliver Twist, which was a bit biographical in that his own dad was hauled off to debtor's prison when the author was a child. He bemoaned the idea that only the "deserving" poor should get our aid. (Art Caplan, 5/18)

The New York Times: The Best Replacement For Obamacare Is Medicaid
In defending their efforts to repeal the Affordable Care Act, Republican leaders in Congress argue that the insurance marketplaces created by the law are failing. They aren’t completely wrong. Trouble began with faulty websites during the rollout in 2013. Since then, enrollment continues to be below expectations. Obamacare plans often have higher premiums and out-of-pocket expenses than expected. Some markets, mainly in rural areas, may not attract a single insurer in 2018. And insurers that stay are likely to impose double-digit premium increases. (Michael S. Sparer, 5/18)

Louisville (Ky.) Courier-Journal: A Country Of The Well, A Country Of The Sick
I am alarmed at many of the ideas underlying the House Republican health care plan and the administration’s proposed budget. Each seems to be driven by an idea that there is an “us” (rich, healthy, young) and a “them” (poor, sick, old). The winners and the losers, each residing in their unchanging, indisputable categories. This cold-blooded social Darwinism is poised to deprive millions of health care, while millions more will find insurance prices prohibitive and go without basic health care, or the astronomical cost of insurance and health care will bankrupt them. According to the logic of this health care plan, it is their own fault for having pre-existing conditions, or being old, or poor. (Sara T. Baker, 5/18)

Morning Consult: Despite What You’ve Read, Many Small Businesses Support Obamacare
Now, the latest round of stories on the Republican attempt to repeal and replace the Affordable Care Act give the impression that America’s small businesses will be glad to see the ACA go if and when Congress manages to repeal it. While most small business owners agree there are portions of the ACA that can and should be improved, polling shows that a majority of small businesses actually prefer the current law over the GOP replacement plan, and that key provisions of the ACA are helping entrepreneurs succeed. (John Arensmeyer, 5/19)

Viewpoints: Opening For Medicare Long-Term Care?; Texas Seeks Planned Parenthood Money

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

Forbes: Congress May Open The Door To Some Medicare Long-Term Care
Congress is taking a small, but important, step towards expanding Medicare to include some long-term supports and services. ... the biggest changes would apply to the care provided by managed care programs. One would expand the use of those special needs plans, which are explicitly aimed at people with chronic conditions and high medical needs. Some of these programs already provide supports and services as part of their benefit packages but they remain relatively small. The other would give Medicare Advantage plans important new flexibility to offer social supports and other non-medical services to their members. (Howard Gleckman, 5/17)

Los Angeles Times: Texas Wants To Use Federal Money To Attack Planned Parenthood — And Might Get It
Five years ago, Texas voluntarily gave up $30 million a year in federal funding for women’s health programs, just so it could exclude Planned Parenthood from the roster of approved providers. Instead, the state established its own so-called Healthy Texas Women program in which it could set its own rules. Now, staggering under the cost of the program and hopeful that the Trump administration will see things its way, Texas is applying for a restoration of the federal subsidy under the same terms. Signals from the White House and the Department of Health and Human Services suggest the state might succeed. If so, some other states may follow, and the cause of women’s reproductive health will suffer a major blow. (Michael Hiltzik, 5/18)

Des Moines Register: Health Has No Religion; Health Care Shouldn't Have One Either
A policy with wide-ranging consequences for patients of Mercy Medical Center was made public recently through a Facebook post on a page for mothers. It came from a woman who was denied a tubal ligation after having a cesarean section because Mercy is a Catholic hospital. In verifying that prohibition, I discovered other religious-based restrictions at Mercy and 547 other Catholic hospitals across the U.S. How are these institutions fulfilling their legal and professional obligations to their patients and the taxpayers who subsidize them with billions of dollars? (Rekha Basu, 5/18)

Next Avenue: Aging at Home Will Be Harder With Medicaid Cuts
Proposed cuts to Medicaid under the American Health Care Act passed by the House recently could change life for (Ti) Randall and many others. Medicaid is not only an insurance program for low-income people. It’s a lifeline for older adults like Randall who need supportive services to stay at home. At-home services are a lifeline for Medicaid as well, which would otherwise be paying for more expensive care in an institutional setting. (Beth Baker, 5/17)

Stat: Doctors Must Be Honest About Their Own Biases When Treating People In Pain
Many doctors enter medicine to prevent and treat suffering. Yet it seems that as we advance in our training, the more bothersome and frustrating evaluations of pain become. We want to make people feel better, but we don’t always know why or how much someone is hurting. And there are consequences of both prescribing too much or too little pain relief. So we turn to this language to minimize the pain we don’t understand or can’t fix. Unfortunately, this tends to occur more often with patients of color. (Katherine Brooks, 5/17)

Stat: Why Taking Drugs To Treat Addiction Doesn't Mean You're 'Still Addicted'
My patient was lucky: He didn’t die because of a widely held, and completely inaccurate, definition of addiction — one that was recently supported by remarks from Health and Human Services Secretary Tom Price, who disparaged medication use as merely “substituting one opioid for another.” But until politicians, the media, and the public catch up with addiction science, we will not be able to stop the epidemic of overdose deaths. (Sarah E. Wakeman and Maia Szalavitz, 5/18)

JAMA: Primary Care Of Patients With Chronic Pain
Primary care physicians have the responsibility for the care of patients with chronic pain, often in follow-up to an episode of acute pain treated in an urgent care center, emergency department, or specialty clinic setting. The lack of a full understanding of how chronic pain differs from acute pain can lead to all pain being treated as acute pain, often with opioids. The current widespread use of opioids is essentially a case-finding system that identifies the roughly one-sixth of the adult population particularly susceptible to opioid misuse, sometimes leading to escalating doses, a shift to illegal nonprescription opioids, addiction, and unintentional overdose. (Jill Schneiderhan, Daniel Clauw and Thomas L. Schwenk, 5/18)

Des Moines Register: Iowa Should Allow Needle Exchange Programs
The Iowa Department of Public Health in February released its first report on hepatitis C infections in this state. The number of Iowans diagnosed with the liver-damaging virus that can lead to death has increased nearly three-fold, from 754 cases in 2000 to 2,235 cases in 2015. The number of infected Iowans aged 18 to 30 has quadrupled in recent years. ... preventing the spread of the virus is so important, and Iowa is not doing all it can. Unlike several other states, we do not have a needle exchange program, which is an important part of infection prevention. (5/18)

The (Eugene, Ore.) Register-Guard: Oregon’s Medicaid Mess
"Troubling” doesn’t begin to describe the current situation at the Oregon Health Authority, which, state auditors have discovered, has been doling out hundreds of millions of dollars to tens of thousands of Medicaid recipients who may or may not be eligible for the benefits. ... About three years ago, Oregon got permission from federal regulators to temporarily quit verifying that each OHP patient still qualified for Medicaid. At the time, the state was in the throes of extricating itself from Cover Oregon, which failed spectacularly in setting up an online program to enroll people in health care. Somehow, the state never got around to resuming these routine eligibility checks. (5/19)

Morning Consult: Turning Up The Volume On Over-The-Counter Hearing Aids
Hearing aids currently cost around $5,000 per pair. Fitting and tuning are not covered by Medicare or most private insurance plans. Unable to afford these out-of-pocket costs, nearly 80 percent of Americans with hearing loss choose to suffer on their own. ... It shouldn’t be this way. The technology exists to deliver relief to these patients and the families that love them. But government has to act to ensure that those who stand to gain the most from that innovation are able to access it. The Over-the-Counter Hearing Aid Act of 2017 would be a needed update to federal policy. (Rep. Joe Kennedy III (R-Mass.) and Rep. Marsha Blackburn (R-Tenn.), 5/18)

The Kansas City Star: Vital Diabetes Device Denied By Medicare
I’m angry because people like me are being denied an essential medical treatment by Medicare, the federal program that’s supposed to be supporting seniors, not forcing them to abandon an essential medical device. The device I use is called Omnipod. It’s a wireless insulin delivery pump. ... A few months before turning 65, I was told that unlike almost all private insurers in this country, Medicare wouldn’t pay for Omnipod. And I was even more confused to learn that this was the only FDA-approved insulin pump not covered by Medicare. (Susan Vietti, 5/18)