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SENATORS GET AN EARFUL ON PROPPING UP INSURANCE MARKETS

They’re complex fixes 
With high political stakes.
How to move forward?

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Summaries Of The News:

Health Law

Chairman Tells Governors: Funding Insurer Subsidies Is Easy Part, What Else Do You Want?

The governors, both Republicans and Democrats, weighed in on their thoughts about how to stabilize the marketplace at a hearing in front of the Senate Health, Education, Labor and Pensions Committee. But when they brought up reinsurance, Chairman Lamar Alexander shot them down.

The New York Times: Governors Rally Around Health Law Fixes As White House Pushes Repeal
Governors from both political parties told Congress on Thursday that they supported immediate action on modest, bipartisan steps to repair the Affordable Care Act without repealing it, even as the Trump administration continued to encourage efforts to dismantle the law. Testifying at a hearing of the Senate health committee, governors from Colorado, Massachusetts, Montana, Tennessee and Utah endorsed proposals to stabilize health insurance markets by providing federal money for continued payment of subsidies to insurance companies to offset the cost of discounts provided to low-income people. (Pear, 9/7)

The Washington Post: Five Governors, Friends And Foes Of The ACA, Urge Congress To Bolster Its Markets For 2018
From Massachusetts to Utah, the governors agreed that guaranteeing payments to ACA insurers to help defray certain coverage expenses for consumers ranks as the most urgent step Congress should take. The cost-sharing-reduction subsidies, which reimburse insurers for discounts they must give roughly 7 million lower-income customers for health plans’ out-of-pocket costs, will total as much as $10 billion next year. (Eilperin and Goldstein, 9/7)

The Associated Press: Governors Back Bipartisan Senate Bid To Control Health Costs
The support from the governors seemed to further isolate Trump on the issue. But with partisan feelings heightened by the failed Republican effort to dismantle former President Barack Obama's health law, the prospects for even a modest effort to shore up the Affordable Care Act are uncertain. Health panel chairman Lamar Alexander, R-Tenn., said in a brief interview it was "a good bet" the narrow measure would be limited to extending the payments to insurers and making it easier for states to get exemptions to some of the statute's requirements. (Fram, 9/7)

The Wall Street Journal: Plan To Fund Health Insurer Payments Coalesces
Senate Health Committee Chairman Lamar Alexander (R., Tenn.) said he hoped to reach an agreement with Democrats by the end of next week on the insurer payments, which offset subsidies they provide low-income consumers. At a hearing Thursday, Mr. Alexander suggested he would be willing to authorize the subsidy payments for multiple years, as Democrats are demanding, in exchange for “structural changes” to the ACA, also called Obamacare. (Hackman, 9/7)

NPR: Senate Asks Governors For Advice In How To Fix Health Insurance
Funding CSR's is the easy part, Alexander said. He was looking for tweaks that will appease conservative Republicans who for years have told their constituents that Obamacare is a failure. They would be hard-pressed to appropriate money to fund it without some substantive changes. Alexander presented the dilemma to the governors as an opportunity to ask for specific changes they'd like to see happen fast. "This train may move through the station, and this is the chance to change those things," he said near the end of the hearing. "And so if you want to tell us exactly what those are, and we got it by the middle of next week, we could use it and it would help us get a result." (Kodjak, 9/7)

Modern Healthcare: Momentum Builds For Bipartisan Compromise On ACA Fixes
The governors' requests for renewed federal reinsurance funding drew less support. Although the governors said their states cannot raise money quickly enough to provide reinsurance to offset high-cost patients' care, Alexander said that would have to wait for a longer-term solution. "Creating a brand new reinsurance pool in the next 10 days is just not going to happen," he said. "There isn't any way to do that." (Lee, 9/7)

Kaiser Health News: 5 Governors Press Congress For Fast Bucks To Secure Obamacare Market In 2018
But a clearly frustrated Alexander said at the end of Thursday’s hearing that he couldn’t pass that kind of bill. “To get a Republican president, House and Senate to vote for just more money isn’t going to happen in the next two or three weeks,” he said. That, however, did not convince the governors, who said this money was essential in stabilizing the markets. “One of our great challenges is to get more people participating in the system; a reinsurance pool is one of the best ways to do that,” said Gov. John Hickenlooper, a Democrat from Colorado. (Rovner and Bluth, 9/7)

Boston Globe: Baker Seeks Special Mass. Fund To Stabilize Health Insurance Rates
Governor Charlie Baker, appearing before US senators Thursday, said his administration is working to establish a fund to help stabilize Massachusetts health insurance rates in case President Trump ends the federal subsidies that many insurers and consumers rely on. The Baker administration’s plan to create the fund needs approval from federal officials. (McCluskey, 9/7)

WBUR: Baker And Warren On Same Page At Health Care Hearing
Democratic U.S. Sen. Elizabeth Warren does not agree with President Donald Trump on much, if anything. Republican Gov. Charlie Baker is no fan of the president's either. So there they were Thursday, an unlikely duo, joining forces during a Senate hearing on Capitol Hill to tag team the White House in an effort to undermine Trump's threats to sabotage Obamacare. (Murphy, 9/7)

Kaiser Health News: Lawmakers Debate How Much Wiggle Room To Give States In Health Care
One of the few things that Republicans and Democrats broadly agree on is that states should have some flexibility to experiment with different ways to pay for and deliver health care. But they disagree — strongly — on how much. In fact, Republicans don’t agree with one another on this, and that dissent helped sink efforts this summer to “repeal and replace” the Affordable Care Act. Bridging these divides will help determine the success of a bipartisan effort in the Senate this month to help shore up the individual health insurance market. (Rovner, 9/7)

Bloomberg: Wyden Backs Obamacare State Flexibility, With Protections 
Ron Wyden, a key Democratic senator on health-care matters, said he’s on board with giving states more flexibility in how they run Obamacare -- so long as they don’t use the new freedom to weaken the health law’s protections. Republicans are proposing more flexibility in the use of so-called 1332 waivers that would give states more say in how the program is run, as part of potential compromise legislation to stabilize the law’s markets. Governors have also asked for more flexibility. (Tracer and Edney, 9/7)

Most Republicans Throwing Cold Water On Last-Ditch Plan To Gut Health Law

Despite support from President Donald Trump, the bill by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) isn't getting a warm welcome from colleagues on the Hill.

Politico: Senate GOP Accepting Defeat On Obamacare Repeal
Senate Republicans are throwing cold water on the idea of holding another Obamacare repeal vote before their opportunity to gut the law on a party-line vote expires at the end of this month. Though President Donald Trump and some Senate Republicans are pushing a plan being devised by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) to block grant federal health care funding to the states and keep much of Obamacare's taxes, the idea of passing the measure by month's end appears almost impossible, according to senators and aides. (Everett, 9/7)

Bloomberg: GOP Senators To Try Again With Alternate Obamacare Replacement 
Republican Senators Bill Cassidy and Lindsey Graham said Thursday they will introduce a revised version of their proposal to replace Obamacare, with the goal of getting a vote by the end of this month. Majority Leader Mitch McConnell has promised a vote in September if the senators can line up 50 of their colleagues to back the measure, Cassidy said in an interview, adding that President Donald Trump is supportive of the plan. (Litvan and Dennis, 9/7)

Marketplace

New York Opts To Extend Health Law Enrollment Period Despite Shorter Federal Deadline

"Our goal is to ensure that consumers have adequate time to shop for and enroll in the health plan that is best for their family,” Donna Frescatore, executive director of New York State of Health, says. In other news, Covered California announces premium increases for its small-business exchange.

The Hill: New York Extends ObamaCare Enrollment Deadline
New York will extend its open enrollment period for ObamaCare plans, citing concerns about an earlier deadline set by the federal government. New York's open enrollment will now begin on Nov. 1 and end on Jan. 31, officials said on Thursday. The Trump administration cut this year's open enrollment in half for states that use the federal marketplace. It will end for those states on Dec. 15. (Hellmann, 9/7)

Capitol Hill Watch

As Left-Wing Chases 'Medicare For All' Dream, This Senator Is Taking More Pragmatic Approach

Sen. Chris Murphy (D-Conn.) is giving Democratic lawmakers who don't want to attach themselves to Sen. Bernie Sanders' plan an alternative that gets them a step closer to universal health care coverage.

Politico: Chris Murphy’s Stealthy Single-Payer Pitch
While Bernie Sanders readies a single-payer health care bill that the GOP is itching to attack, one of his Democratic colleagues is proposing a step toward that goal that could give cover to the party’s vulnerable incumbents. Sen. Chris Murphy, a potential presidential contender, is working on legislation expected this fall that would let individuals and businesses buy into Medicare as part of Obamacare’s exchanges. As Sanders and other potential challengers to President Donald Trump flock to “Medicare for all,” embracing a top liberal priority before 2020, Murphy is taking a conspicuously more pragmatic approach designed to get Democrats closer to that lofty but potentially unobtainable goal. (Schor, 9/7)

The Hill: Warren Co-Sponsoring Sanders's 'Medicare For All Bill' 
Sen. Elizabeth Warren (D-Mass.) said Thursday she is co-sponsoring Sen. Bernie Sanders's (I-Vt.) "Medicare for All bill," the latest Democrat to back a signature Sanders campaign issue. "I believe it’s time to take a step back and ask: what is the best way to deliver high quality, low cost health care to all Americans?"  Warren, often considered a potential presidential candidate in 2020, said in a statement Thursday. (Savransky, 9/7)

Lawmakers Agree CHIP Needs To Be Funded, But Do Little To Work Through Partisan Differences

Delays from any partisan bickering could force many states, which soon will exhaust their federal allotments, to start winding down the popular Children's Health Insurance Program over the next few weeks or months.

Modern Healthcare: CHIP Funding Deadline Looms As Senators Signal Bipartisan Support
Republican and Democratic senators agreed Thursday that they need to extend funding for Children's Health Insurance Program, which covers 8.4 million low- and moderate-income children. But there was little or no discussion during the Senate Finance Committee hearing on how to resolve thorny disagreements about details of the program or how long to extend federal funding, which ends Sept. 30. (Meyer, 9/7)

CQ: Senate Finance Kicks Off Children's Health Care Debate
CHIP has traditionally found bipartisan support from both sides of the aisle. The program was spearheaded by the late Sen. Ted Kennedy, D-Mass., and Senate Finance Chairman Orrin G. Hatch, R-Utah, 20 years ago. During the Obama administration's most recent renewal, Congress updated the program five months before the September 2015 deadline. However, partisan fights this year over a comprehensive health care overhaul (HR 1628) delayed action and led to the cancellation of the committee’s originally scheduled May hearing. (Raman, 9/7)

And in other congressional news --

Stat: NIH Budget Increased By $2 Billion Under Senate Plan
Senate appropriators on Thursday approved a plan that would increase spending for the National Institutes of Health by $2 billion and maintain nearly $300 million in grants for family planning programs that a House committee had sought to eliminate. The plan would also fund the Substance Abuse and Mental Health Services Administration by $387 million more than the amount recommended by President Trump’s budget blueprint. (Facher, 9/7)

Modern Healthcare: Health Centers Urge Congress To Act To Avoid Mass Closures
Brian Toomey is worried about uninsured patients that come to his community health centers in North Carolina. The majority of the federal funds that help keep the center on track will disappear at the end of the month baring congressional action. But between the fallout from Hurricane Harvey, the need to increase the debt ceiling and pressing calls to draft a new law to protect undocumented children, Toomey who is CEO of Piedmont Health Services, is worried that cries for help from health centers will fall through the cracks. (Dickson, 9/7)

In Mostly Symbolic Gesture, Senate Panel Votes To Overturn Trump's Mexico City Policy

The rule prevents federal family planning assistance from going to foreign nongovernmental organizations that promote or provide abortions. But it's unlikely the measure will make it into the final funding bill.

Politico: Senate Appropriators Rebuke Trump On Abortion Policy
Senate appropriators on Thursday dealt a twofold rebuke to the Trump administration on abortion policy, though it is almost certain the changes won't become law. The Senate Appropriations Committee approved a fiscal 2018 foreign relations funding bill containing language that would undo a Trump administration prohibition on funding for nongovernment organizations that perform or promote abortion. (Haberkorn, 9/7)

Stat: Senate Panel Votes To Reverse Mexico City Policy, Signaling Support For Global Family-Planning Assistance
In a move likely to prove only symbolic, the Senate Appropriations Committee voted on Thursday to overturn the Mexico City Policy, which President Trump announced in January he would reinstate and which the State Department formalized in May. The policy, put in place by Republican presidents and nullified by Democratic ones for three decades, prevents federal family planning assistance from reaching foreign nongovernmental organizations that promote or provide abortions. The policy as announced by the State Department in the spring went a step further by prohibiting any global health assistance from going to these foreign NGOs. (Facher and Swetlitz, 9/7)

Pharmaceuticals

FDA Blasts EpiPen Maker For Not Investigating Complaints About Life-Threatening Device Flaws

The FDA cites troubling incidents where the failure to properly investigate and take action over defective products had led to patient deaths.

Stat: FDA: Lapses By EpiPen Maker Tied To ‘Serious’ Problems, Patient Deaths
Throughout last year, Meridian Medical Technologies received hundreds of complaints that the EpiPen device, which is used to combat serious allergic reactions, failed to operate during life-threatening emergencies. Yet the Pfizer manufacturing unit not only failed to thoroughly investigate the problem, but did not initially remove potentially defective products. The lapses were detailed in an extraordinarily disturbing Sept. 5 warning letter the Food and Drug Administration sent to the Pfizer unit and described the findings of an inspection last March. (Silverman, 9/7)

In other pharmaceutical news —

Stat: Alnylam Gene-Silencing Drug Studies In Hemophilia Suspended Following Patient Death
The death of a hemophilia patient due to a blood clot has forced Alnylam Pharmaceuticals (ALNY) to temporarily suspend studies of its gene-silencing drug fitusarin, the company said Thursday. The new safety setback comes at a particularly bad time for the Cambridge, Mass.-based biotech company, developers of drugs based on a technology known as RNA interference, or RNAi. In the next days to weeks, Alnylam is expecting to receive and announce results from its first phase 3 clinical trial for a different drug called patisiran in a rare nerve condition. (Feuerstein, 9/7)

Stat: It's Not Just One Suspect Vaccine Trial: Most New Drugs Are Tested Overseas
The clinical trial for a herpes vaccine flouted just about every norm in the book: American patients were flown in to the Caribbean island of St. Kitts for experimental injections. Local authorities didn’t give permission. Nor did the Food and Drug Administration. Nor did a safety panel. That’s why the trial — run by a startup which has since received funding from billionaire investor Peter Thiel — prompted widespread alarm and censure when it was reported last week by Kaiser Health News. (Robbins, 9/8)

The Associated Press: Prosecutors Want Shkreli’s Bail Revoked Over Clinton Posting
Federal prosecutors on Thursday filed a court motion asking a judge to revoke Martin Shkreli’s bail and throw him in jail because of recent threats the so-called “Pharma Bro” allegedly made against Hillary Clinton. “Since his conviction on August 4, 2017, Shkreli has engaged in an escalating pattern of threats and harassment that warrant his detention pending sentencing,” prosecutors wrote in their motion. (McElroy, 9/7)

Kaiser Health News: Meningitis B Vaccine’s High Price Tag Poses A Health Care Conundrum
Four years ago, when meningitis B, an extremely rare but potentially lethal form of the infection, sickened a small number of college students at Princeton and the University of California-Santa Barbara, there was no vaccine against the disease sold in the U.S. Despite its availability abroad, it had never been licensed in the country due to its limited marketability. Scientific evidence supporting an absolute need to immunize against meningitis B still falls short. The risk of contracting it is smaller than that of being involved in a car crash. (Luthra, 9/8)

San Francisco Chronicle: Startup That Makes Personalized Cancer Treatments Gets $93 Million In Funding
Gritstone Oncology, the 2-year-old Emeryville startup that develops immunotherapy treatments for cancer, has received $93 million in new financing, the company announced Thursday. The privately held company is one of several Bay Area startups making inroads in applying artificial intelligence to drug discovery, a fast-growing segment of the health technology field that has attracted hundreds of millions of dollars from investors over the last few years. (Ho, 9/7)

Eli Lilly, Facing Stiff Competition On Diabetes Products, Will Cut 3,500 Jobs

The company says the move will save about $500 million annually that it will use partly to support new drug development.

The Wall Street Journal: Eli Lilly To Cut 8% Of Jobs, Invest More On New Drugs
The drug industry has eliminated tens of thousands of jobs over the past decade. In a sign that the bleeding is far from over, Eli Lilly & Co. announced plans on Thursday to cut roughly 8% of its global workforce. Indianapolis-based Lilly cited a number of issues that are plaguing many drugmakers, including the need to lower costs and raise investment in new drugs ahead of patent expirations that are expected to erode sales of older products. The company said it would eliminate about 3,500 positions globally, including 2,000 in the U.S. (Loftus, 9/7)

Stat: Lilly Will Cut 3,500 Jobs, Or 8 Percent Of Its Global Workforce, To Revamp
Although specifics were not disclosed, the drug maker indicated that about half of the projected savings would be used to support clinical development of new drugs and finding additional uses for existing medicines, as well as underwriting product launches. ... The move comes as Lilly attempts to reorient itself. Although revenue rose 6 percent last year and net income climbed 13.6 percent, the company faces challenges on several fronts. Although sales of its new Trulicity diabetes drug are rising, Lilly faces stiff competition in the overall diabetes market, which is engendering new scrutiny from federal and state lawmakers concerned about drug pricing. (Silverman, 9/7)

Bloomberg: Drugmaker Eli Lilly Will Cut 3,500 Jobs
Faced with expiring patents on a number of its medicines, Lilly has been focused on diabetes drugs, which account for three of its 10 top-selling products. Its biggest seller is insulin. But intense competition from a flurry of new treatments in that market has helped drive down prices and profits. ... Lilly has cut thousands of jobs in recent years amid a slide in sales caused by generic rivals. It’s been hurt by research failures, as well. Last year, it eliminated 500 positions following the failure of an experimental Alzheimer’s disease drug. (Hopkins, 9/7)

Medicare

Medicare Weighs Opening Website To Include Consumers' Comments On Doctors

Medical groups oppose the move because it could unfairly damage a doctor's reputation. In other Medicare news, beneficiaries are warned about protecting the new cards coming out next year, and federal officials relax some rules for people in Texas affected by Hurricane Harvey.

Bloomberg/BNA: Medicare: The New Angie's List?
Should an official Medicare Website let beneficiaries air their opinions of doctors and other health care professionals? The Medicare agency says there’s clamor for this. Patient and caregivers “regularly ask for more information from patients like them in their own words,” the Centers for Medicare and Medicaid (CMS) said in a proposed rule. They regularly request that the Medicare agency include narrative reviews of clinicians and groups on the Website, the agency said. The Website in question is called Physician Compare. ... The CMS said it’s considering adding results from five open-ended questions about beneficiaries’ experiences with medical professionals. (Yochelson, 9/5)

Detroit Free Press: Seniors Warned About Medicare Scams Before New Cards Arrive In 2018
New Medicare cards — the ones that won't make it easy for ID thieves to steal your Social Security number — will find their way into wallets next year. But we're already hearing warnings about scams that are bubbling up before the big changeover. The design for the new Medicare card is expected to be revealed in September. And TV ads have already begun talking about the new cards and featuring the tagline "Guard Your Card." (Tompor, 9/7)

Dallas Morning News: Medicare Making It Easier For Harvey Victims To Get Access To Medical Supplies
Texans enrolled in Medicare that had medical supplies that were lost or damaged due to Hurricane Harvey will have access to an altered set of rules for a short time. Medicare will pay to replace products like home oxygen equipment, breathing devices, diabetes testing supplies, artificial limbs, canes and wheelchairs, the federal agency that oversees the program said in an announcement Thursday. Rules that require patients to see a physician face-to-face and obtain documents showing new medical necessity are also being waived. (Rice, 9/7)

Public Health And Education

New Mexico Joins Growing Cadre Of States Suing Drugmakers Over Opioid Crisis

However, while many states are focusing on pharmaceutical companies alone, New Mexico is also going after distributors. Media outlets report on news about the epidemic out of Arizona, Florida and Ohio, as well.

The Wall Street Journal: New Mexico Sues Drugmakers, Distributors Over Opioid Crisis
New Mexico sued several major pharmaceutical companies and wholesale drug distributors on Thursday, arguing the corporations are partly to blame for rampant opioid addiction rates in the state. The lawsuit, filed in state court in Santa Fe County, follows the lead of half a dozen other states that have also sued over the opioid crisis. All claim pharmaceutical companies played down the addictive risk of the painkillers in their marketing to the public and doctors, causing them to be widely prescribed for chronic pain and fueling addiction. (Randazzo, 9/7)

Arizona Republic: Gov. Doug Ducey's Opioid Plan Seeks To Limit Initial Pain-Pill Fills
Arizona would limit all initial opioid prescriptions to five days for new patients under sweeping guidelines recommended Wednesday by Gov. Doug Ducey's administration. Dr. Cara Christ, director of the ADHS, said that the state recommended the five-day limit for initial opioid fills after reviewing other states' restrictions and Centers for Disease Control and Prevention research. (Alltucker, 9/6)

Orlando Sentinel: Florida Medical Schools Developing Common Curriculum For Pain And Opioid Rx
Florida’s nine medical schools have formed a collaborative group to educate the next generation of doctors on opioid prescription and pain management. The Pain Management Working Group, which includes the state’s six public and three private medical schools, is developing a common curriculum to train the state’s more than 3,000 medical students, in hopes of graduating young doctors who can play a role in curbing the opioid epidemic. (Miller, 9/7)

The Plain Dealer: How State And Local Officials Report, Classify Overdose Deaths Lead To Conflicting Tallies
The number of deaths due to drug overdose continue to climb in Ohio, but exactly how many people are dying, and how many of these deaths are due to the escalating opioid epidemic, can be a little unclear. There are often variations in local, state and national numbers for causes of death because the reports come from multiple sources -- in Ohio, from 88 county coroners and medical examiner's offices, said Chris Kippes, Director of Epidemiology, Surveillance, and Informatics at the Cuyahoga County Board of Health. (9/8)

As Doctors Continue To Work Later In Life, Some Hospitals Are Screening For Age-Related Decline

Some doctors say it's age discrimination while other acknowledge it's a safety issue for patients. In other public health news: fats and carbs, acid reflux, squid ink and the dentist, sex education programs and the children who lived through 9/11.

The Philadelphia Inquirer/Philly.com: More Doctors Are Practicing Past Age 70. Is That Safe For Patients?
As more doctors choose to work past the traditional retirement age, health systems are navigating a complex set of issues that revolve around what may sometimes be  competing interests: keeping valued “late-career” employees happy and keeping patients safe.  Most older doctors do good work and many choose to do less challenging work as a concession to age,  experts said. But systems are testing how best to screen for the few who are slipping and don’t know it.  This region’s two largest health systems — Penn Medicine and Jefferson Health — are embarking on screening programs. (Burling, 9/8)

The New York Times: New Study Favors Fat Over Carbs
High carbohydrate intake is associated with a higher risk of mortality, and high fat intake with a lower risk, researchers report. An international team of scientists studied diet and mortality in 135,335 people between 35 and 70 years old in 18 countries, following them for an average of more than seven years. Diet information depended on self-reports, and the scientists controlled for factors including age, sex, smoking, physical activity and body mass index. The study is in The Lancet. (Bakalar, 9/8)

The New York Times: Treating Reflux With Diet
A small study has found that a plant-based diet is just as effective as proton pump inhibitors in treating laryngopharyngeal reflux, or LPR. LPR is a disease in which stomach acid comes up into the throat to the level of the laryngopharynx. It is not the same as gastro-esophageal reflux, or GERD, which involves a backflow of stomach acid into the lower esophagus. (Bakalar, 9/7)

Stat: Could Squid Ink Replace Painful Dental Probes For Gum Disease?
It’s one of the worst parts of a dental checkup — painful probing with sharp instruments to look for signs of gum disease. The time-consuming and sometimes bloody process keeps patients fearful, hygienists frustrated, and dentists worried they might be missing important symptoms. Now a nanoengineer in San Diego says he’s got a possible solution. It involves imaging gums after patients swish around a mouthful of squid ink. (McFarling, 9/7)

Reveal: Teens, Say No To Sex, Trump Officials Say. But That Advice Doesn’t Work
Over the last decade alone, teen births have dropped by more than half. But now, health experts worry that the Trump administration will reverse these improvements by promoting abstinence-only programs, cutting off funding for research to prevent teen pregnancy and appointing officials who oppose federal support for birth control. (Kay, 9/7)

Fox News: Kids Who Lived Through 9/11 Face Future Health Risks, Research Finds
It’s been almost 16 years since the September 11 terrorist attacks, and the damage is still being done. Children who lived in lower Manhattan and were exposed to the toxic cloud of debris from the terrorist attacks are already showing increased risk of future heart disease, according to a new analysis published in the journal Environment International. (9/7)

State Watch

State Highlights: Cleveland Pre-K, Kindergarten Kids To Be Screened For Lead Poisoning; Iowa's Federal Grant For Teen Pregnancy Prevention Slashed

Media outlets report on news from Ohio, Iowa, Tennessee, Pennsylvania, California, Oregon, Louisiana, Maryland and Virginia.

The Plain Dealer: Cleveland Pre-K And Kindergarten Students To Be Screened For Lead Poisoning By CWRU Nursing Students
Student nurses from Case Western Reserve University will soon start testing preschool and kindergarten-aged Cleveland school students for lead poisoning as part of a pilot program to bolster the dismal screening rates for the dangerous toxin. Startlingly few children -- only about a third-- who are at risk for lead poisoning in the Cleveland area are screened for lead, according to a 2015 analysis for The Plain Dealer by Ohio State University's Kirwan Institute for the Study of Race and Ethnicity. (Dissell and Zeltner, 9/7)

Des Moines Register: Feds Cut $966,000 Annual Grant For Iowa Teen-Pregnancy Prevention
A program aimed at preventing teen pregnancy in western Iowa is in jeopardy because of a Trump administration decision to curtail federal money for such efforts. Like most of the country, Iowa has seen teen pregnancies become much rarer in recent years. In 2008, 33 of every 1,000 Iowa women ages 15 through 19 gave birth. By 2015, that rate had plummeted to less than 19 per 1,000. (Leys, 9/7)

Nashville Tennessean: Memphis VA Hospital Among 4 Under Tight Watch From Agency Officials
A veteran with diabetes and poor circulation checked into the Memphis VA Medical Center for a scan and possible repair of blood vessels in his right leg last year, but what he left with was a piece of plastic packaging that VA providers had mistakenly embedded in an artery. Doctors didn’t discover the 10 inches of tubing — used by manufacturers to protect catheters during shipping and handling — until the veteran had to have the leg amputated three weeks later. (Lowary and Slack, 9/7)

The Philadelphia Inquirer/Philly.com: Gov. Wolf Visits Philly's Planned Parenthood To Offer Support
Gov. Wolf, an advocate of Planned Parenthood, visited Philadelphia’s Elizabeth Blackwell Health Center  on Thursday to show his support for the work of the agency and its volunteers — and to send a not-so-subtle message to those who would disagree. “I think what you are doing is more important than ever before, and the need is great,” said Wolf, the state’s top Democrat, to a gathering of Planned Parenthood staff and volunteers after touring the Locust Street center. (Giordano, 9/7)

The Associated Press: Judge Opens Door For Lawsuit Over Girl Declared Brain Dead
A California judge ruled that a teen girl who was declared brain dead more than three years ago after a tonsillectomy may technically still be alive, allowing a malpractice lawsuit against the hospital to move forward and possibly setting up the family to have her care paid for if they succeed. Alameda County Judge Stephen Pulido ruled Tuesday that it’s up to a jury to determine whether Jahi McMath is alive, which would increase the damages jurors could award if they determine doctors at Children’s Hospital in Oakland botched a routine operation to remove the girl’s tonsils. (Elias, 9/7)

Atlanta Journal-Constitution: Gwinnett Urine Lab Implicated In Bribery Scandal
A federal indictment filed in Tennessee claims a Gwinnett County urinalysis lab paid bribes and filed fraudulent Medicare and Medicaid reimbursement requests. The indictment filed in East Tennessee stems from an alleged network of “pill mills” in and around Knoxville that federal prosecutors say dispensed opioid pain medication to people who didn’t need it and stuck taxpayers with the bill for mandatory urine tests. (Joyner, 9/7)

KQED: Families Fight Closure Of Nursing Unit In San Francisco
Sub-acute nursing units treat patients with complex medical needs, such as tracheostomies, sometimes for months or even years. The patients don’t need as much care as a regular “acute” hospital patient, but do need a level of skilled nursing care that is difficult to provide at home. Richard, for example, has congestive heart failure and diabetes. St. Luke’s is the last hospital in San Francisco with a sub-acute unit, and parent company Sutter Health has plans to close it by the end of the year. (Klivans, 9/7)

The Oregonian: As Portland Air Improves, Rogue Valley Residents Lament Frustrating Conditions 
Portland's air quality dramatically improved Thursday thanks to westerly winds sweeping into the metro area, but those in Southern Oregonian are still feeling the burn, and not in a good way. Rogue Valley residents have spent the better part of the past month trying to stay indoors - shuffling from house to work and from work to grocery store -- to avoid the unhealthy and often hazardous air blanketing the valley. Prolonged exposure to the stagnant smoky haze is a recipe for headaches, burning eyes and scratchy throats, and potentially dangerous for those with heart or respiratory issues like asthma. Small children and the elderly could also be more adversely affected. (Theen, 9/7)

New Orleans Times-Picayune: New Orleans East Doctor Pleads Guilty To Running Pain Clinics As 'Pill Mills' 
A New Orleans doctor pleaded guilty Thursday (Sept. 7) to federal accusations that he ran a pair of New Orleans East clinics as "pill mills," illegally prescribing millions of dosages of oxycodone, fentanyl and other addictive drugs to patients--and to undercover government sources posing as patients, court records show. Dr. Frederick Floyd, 58, faces a mandatory term of 10 years in prison should the federal court accept his plea agreement on charges of illegally dispensing drugs and money laundering, according to the office of Acting U.S. Attorney Duane A. Evans. He also faces a fine of up to $1.25 million and at least three years of supervised release following any prison time. (McKnight, 9/8)

Nashville Tennessean: Candidates For Tennessee Governor Split On Medical Marijuana
As Tennessee lawmakers begin discussions about possibly allowing medical marijuana in Tennessee, the top-tier candidates seeking to replace Gov. Bill Haslam have vastly different opinions. While legalizing medical marijuana in Tennessee has been brought up in the legislature several times in recent years, House Speaker Beth Harwell, who announced her run for governor in July, made headlines when she said she was open to the idea. (Ebert, 9/7)

Health Policy Research

Research Roundup: Hospital Antitrust Concerns; ACA Narrowed Racial Disparities in Health Care

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

Health Affairs: Corporate Investors Increased Common Ownership In Hospitals And The Postacute Care And Hospice Sectors
The sharing of investors across firms is a new antitrust focus because of its potential negative effects on competition. ... [Researchers] used data from the Provider Enrollment, Chain, and Ownership System of the Centers for Medicare and Medicaid Services ... the percentage of acute care hospitals having common investor ties to the postacute or hospice sectors increased from 24.6 percent in 2005 to 48.9 percent in 2015. (Fowler et al., 9/1)

Commonwealth Fund: Affordable Care Act Narrowed Gaps In Access To Health Care Between Whites, And Blacks And Hispanics
To assess the effect of the ACA’s major coverage expansions on disparities in access to care among adults, [researchers conducted an analysis] of nationally representative data from the American Community Survey and the Behavioral Risk Factor Surveillance System. After the implementation of the ACA’s coverage expansions, minority populations experienced historic gains in their ability to access health care when needed. (Riley, Radley and McCarthy, 8/24)

Pediatrics: Characteristics Of Children Enrolled In Medicaid With High-Frequency Emergency Department Use
Among Medicaid-insured children with high-frequency ED use in 1 year, [researchers] sought to describe the characteristics of children who sustain high-frequency ED use over the following 2 years. ... One in 6 Medicaid-insured children with high ED use in a single year experienced sustained high levels of ED use over the next 2 years. Adolescents and individuals with multiple chronic conditions were most likely to have sustained high rates of ED use. Targeted interventions may be indicated to help reduce ED use among children at high risk. (Peltz et al., 9/1)

Annals of Internal Medicine: Proposed U.S. Funding Cuts Threaten Progress On Antimicrobial Resistance
The Centers for Disease Control and Prevention (CDC) estimates that at least 2 million persons in the United States acquire antibiotic-resistant infections each year, resulting in at least 23 000 deaths. ... In the past 2 years, national and global leaders have united against this threat. ... However, budget cuts of a historic magnitude proposed by the Trump administration now threaten to undo this progress. (Boucher, Murray and Powderly, 9/5)

Editorials And Opinions

Viewpoints: Evidence, Spending And How The U.S. Health System Ranks; The GOP's 'Efficiency Paradox'

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

The New England Journal Of Medicine: From Last To First — Could The U.S. Health Care System Become The Best In The World?
Many Americans believe that the United States has the best health care system in the world, but surprisingly little evidence supports that belief. On the contrary, since 2004, reports from the Commonwealth Fund have consistently ranked the performance of the U.S. health care system last among high-income countries, despite the fact that we spend far more on health care than these other countries .... These reports — based on recent Commonwealth Fund surveys of primary care doctors and the general population, as well as data on health outcomes gathered by international organizations — reveal several reasons why, despite offering some of the most specialized, technically advanced treatments in the world, U.S. health care fails to achieve the level of performance of the health care systems of other high-income countries. An understanding of these reasons may point the way to essential improvements. (Eric C. Schneider and David Squires, 9/7)

RealClear Health: The Efficiency Paradox: Republican Orthodoxy And Health Care Reform
Republican efforts at health care reform have been and will continue to be, undermined by the same fundamental reality: the basic economic concept of efficiency. Republican rhetoric on health care reform centers on a core conservative orthodoxy: that efficient markets, free of government interference or regulation, invariably solve societal ills. Simply put, Health and Human Services Secretary Tom Price and many other proponents of the Republicans’ approach to health care argue that an unfettered free market structure will lead to lower premiums, engender greater access to care, lower overall health care costs, and--through competition--lead to both better coverage and better health care outcomes. (Dennis R. Bullock, 9/8)

The New England Journal Of Medicine: The HITECH Era And The Path Forward
The [Health Information Technology for Economic and Clinical Health (HITECH) Act] spurred rapid progress toward digitizing the health care delivery system, which has experienced a dramatic transformation as a result of concerted efforts by both public and private sectors. We believe we’re at an inflection point in terms of the capability to share research results, clinical guidelines, and patient data seamlessly and securely. The federal government’s actions to date have set the stage for an expanding role for health information technology (IT) in improved care delivery. (Vindell Washington, Karen DeSalvo, Farzad Mostashari and David Blumenthal, 9/7)

The New England Journal Of Medicine: The HITECH Era In Retrospect
At a high level, the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 accomplished something miraculous: the vast majority of U.S. hospitals and physicians are now active users of electronic health record (EHR) systems. No other sector of the U.S. economy of similar size (one sixth of the gross domestic product) and complexity (more than 5000 hospitals and more than 500,000 physicians) has undergone such rapid computerization. Along the way, however, we lost the hearts and minds of clinicians. We overwhelmed them with confusing layers of regulations. We tried to drive cultural change with legislation. We expected interoperability without first building the enabling tools. In a sense, we gave clinicians suboptimal cars, didn’t build roads, and then blamed them for not driving. (John D. Halamka and Micky Tripathi, 9/7)

Stat: My Medical Training Didn't Prepare Me To Be An Ambassador To Nightmares
Escorting those left behind, parent or spouse or sibling or friend, into a world that most of us can’t even imagine without shivering might be the toughest task in emergency medicine. I’d rather not be an ambassador to nightmares. But when I don’t have a choice, I try to do it with compassion and care. That requires a degree of openness and vulnerability, and that means my fears and emotional reactions will enter into the process. There’s no hiding behind a white coat. Through the years it hasn’t become easier. And I hope it never does. (Jay Baruch, 9/7)

Stat: Why Can't More American Women Access Medications For Preterm Birth?
There are two medications that prevent preterm birth, the most common cause of perinatal death in the U.S. One costs 16 cents a week, one $285. Poor black women aren’t getting either. ... The medical community can do better to reduce this racial disparity, but doing so requires focused interventions directed toward those women most likely to benefit. (Jodi Frances Abbott, 9/7)

Lexington Herald Leader: When Money And Politics Dictate Public-Health Policy, People Die
It seems like I wake up every morning to news that someone in Lexington has been shot. Recent killings have included pregnant women and toddlers. This epidemic of gun violence has got to stop. I’m talking about all the gun violence: the mass murderers who shoot up elementary schools, the toddlers who accidentally shoot their siblings, the teenagers who take their own lives with their parents’ guns — all of it. (Shelly Roberts Bendall, 9/7)

The Mercury News: Californians Deserve Transparency In Prescription Drug Pricing
Californians now pay more for their prescription drugs than they do for their doctors. The state spent a whopping $4 billion on drugs in 2015, and pharmaceutical companies are pushing another 12 percent increase in 2017. The Legislature has to pass state Sen. Ed Hernandez’ SB 17 and force drug makers to provide information about how they price their products. (9/7)

The Des Moines Register: Reynolds, Branstad Have Inflicted Lasting Damage On Iowans
Your policies have decimated our state budget, degraded our environment, injured Medicaid beneficiaries, victimized disabled and mentally ill Iowans, assaulted education and the Regents Institutions, privatized government functions that were better and more economically handled internally, gutted the state's workforce, failed to protect children, shuttered valuable state institutions, caused lawsuits against the state costing millions of taxpayer dollars, and the list goes on. (Dean Lerner, 9/6)

Los Angeles Times: If Teenagers Get More Sleep, California Could Gain Billions
Sleep deprivation among teenagers should be regarded as a public health epidemic. Only about 60% of teenagers get the eight to 10 hours of sleep a night recommended by sleep scientists and pediatricians. A major reason teens aren’t getting enough sleep isn’t hormones, their busy social lives, too much homework or too much screen time. It’s actually a matter of public policy. (Wendy M. Troxel and Marco Hafner, 9/7)