KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Kaiser Health News Original Stories

Tax Day Is Zero Hour For Health Insurance, Too

People who don’t have insurance coverage or get federal assistance to pay their insurance premiums need to take a little extra care when completing their tax forms. (Julie Rovner, 4/17)

Political Cartoon: 'Hands Off?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Hands Off?'" by Dan Piraro.

Here's today's health policy haiku:

THE FUTURE OF THE HEALTH LAW’S COST-SHARING SUBSIDIES?

Will he, or won’t he?
Trump leaves everyone guessing
On key subsidies.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Summaries Of The News:

Health Law

Friction In Republican Party Over Health Care Sparks Into Flames At Town Halls

Lawmakers on recess take heat from their constituents for the Republicans' botched attempts to pass a health care bill.

The Wall Street Journal: Congress Feels Squeeze From Sputtering Health Law Overhaul
After nearly two hours of fielding mostly health-care questions from hundreds of rowdy constituents at a full auditorium here this week, Republican Rep. Mike Coffman threw up his arms in frustration. “Those of you on the extreme left will never be satisfied,” he told the group of about 500 people assembled at a town hall here at the University of Colorado Anschutz Medical Campus. The crowd erupted in boos. (Andrews and Peterson, 4/14)

The Washington Post: Two Republican Lawmakers Face Anger, From Their Own Voters, On Health Care
Inside a government building here, far-right Rep. Ted Yoho (R-Fla.) scolded his party’s leaders for rolling out an “ill-advised” health-care bill and blamed House Speaker Paul D. Ryan for the ensuing debacle. The next evening on a college campus nestled in the Rocky Mountains, moderate Rep. Mike Coffman (R-Colo.) held the House Freedom Caucus — to which Yoho belongs — culpable for the legislation’s defeat. (Sullivan and Snell, 4/15)

The Associated Press: Even In Hometown, Constituents Rip Into Republican Lawmaker
Republican congressman Greg Walden found a hostile audience when he hosted a town hall in his Oregon home town last week. Roughly 800 people turned out to confront the 10-term congressman on issues like health care, immigration, the environment and Syria. Walden is a magnet for questions about health care because he is a lead author of the stalled House Republican health care bill. (Fram, 4/17)

The Washington Post Fact Checker: Do Members Of Congress Pay For 100 Percent Of Their Health Insurance?
The Fact Checker has been receiving lots of fact-check suggestions from readers who attended district town halls, in response to our new initiative to fact-check what members of Congress tell constituents during the April recess. Not surprisingly, some of the most heated exchanges at many of the town halls involved health care and the failed GOP replacement bill for the Affordable Care Act, or Obamacare. (Lee, 4/17)

Meanwhile, President Donald Trump's rejuvenated health care push is throwing a wrench in congressional plans —

The Wall Street Journal: Trump’s Renewed Focus On Health Bill Vexes GOP Tax Overhaul Strategy
President Donald Trump’s revived enthusiasm for tackling health-care legislation before tax policy has highlighted the complicated interplay between Republicans’ health-care overhaul and their planned tax bill. Mr. Trump signaled last week that one of the reasons he has reprioritized health care is that he was relying on savings from the health bill to bolster the tax plan. (Rubin, 4/16)

Many Alaskans Find Health Law Is Like Trying To Fit A Square Peg Into A Round Hole

Due to its sheer size, sparse population and harsh environment, Alaska faces unique circumstances that aren't really accommodated by the health law. In other news on the Affordable Care Act, new data details the rise in people covered, a CEO of a major hospital system in Chicago talks about the changes he has seen, NPR looks at pre-existing conditions and more stories.

The Associated Press: In Alaska, Anxiety Grows As Debate Over Health Care Rages
Going without health insurance is a risk. Going without it in Alaska can be a gamble of a much higher order, for this is a place unlike anywhere else in the U.S., a land of pitiless cold, vast expanses and dangerous, back-breaking work such as pulling fishing nets from the water or hauling animal carcasses out of the woods. And yet many people on the Last Frontier do not carry insurance. For them, the Affordable Care Act just isn't working. (Bohrer and D'Oro, 4/15)

WBUR: Maps Show A Dramatic Rise In Health Insurance Coverage Under ACA 
New data from the U.S. Census Bureau present the most detailed picture yet of the dramatic rise in the number of people covered by health insurance since the Affordable Care Act went into effect. County-level data going back to 2010, when the law was signed, show a patchwork of people living without health insurance that ticked down slowly for the first three years under the ACA. But once the online insurance exchanges opened at the end of 2013 and Medicaid expanded, the population living without coverage dropped noticeably. (Hurt, Elosua and Hersher, 4/14)

The Associated Press: Insider Q&A: Public Health System CEO Sweats Out ACA Debate
Cook County Health & Hospitals System, which handles more than 1 million patient visits in the Chicago area every year, has seen a significant financial boost from the Affordable Care Act. The federal law — whose future is up in the air — expanded the Medicaid program for the poor, giving most of the system's patients coverage for the first time in its 180-year history. (Murphy, 4/16)

NPR: 'Pre-Existing Conditions' Reveal A Health Care Conundrum
For most of his life, Carl Goulden had near perfect health. He and his wife, Wanda, say that changed 10 years ago. Carl remembers feeling, "a lot of pain in the back, tired, fatigue, yellow eyes — a lot of jaundice." Wanda, chimes in: "Yellow eyes, gray-like skin." His liver wasn't working, she explains. "It wasn't filtering." Carl was diagnosed with hepatitis B. Now 65 and on Medicare, he had a flower shop in Littlestown, Pa., back then, so had been buying health insurance for his family on the market for small businesses and the self-employed. (Gordon, 4/15)

Kaiser Health News: Tax Day Is Zero Hour For Health Insurance, Too
Your federal income taxes are due April 18 and, likely for several million people, so is a fine for failing to get health insurance. Despite a lengthy debate, Congress has not yet acted on a bill to repeal portions of the Affordable Care Act. That means the law and almost all of its regulations remain in force, for now. (Rovner, 4/17)

Detroit Free Press: 5.4% Of Tax Returns Fined For No Health Insurance
What do Bliss Township, Carp Lake Township, Detroit, Dodgeville and Wawatam Township have in common?  ZIP codes in these communities had the highest percentage of tax returns that paid the individual-mandate penalty for not having health insurance during the 2014 tax year.  A total of 209,320, or 4.5%, of individual tax returns filed in Michigan during the 2015 calendar year included a payment for not having health care coverage. Nationwide, 5.4% of returns paid the fine. Texas had the highest rate of returns with the fine — 8.9%, or more than 1 million returns, according to the latest Internal Revenue Service data. (Tanner, 4/14)

What Trump's Market Stabilization Rule Means For Consumers

The Associated Press looks at how people buying off the exchanges will be affected by the administration's steps to stabilize the marketplace. Meanwhile, the insurance industry is worried the moves will reduce enrollment and therefore sales.

The Associated Press: How Trump Insurance Changes Could Affect Coverage Next Year
A much tighter sign-up deadline and coverage delays will be waiting for some health insurance customers now that President Donald Trump's administration has finished a plan designed to stabilize shaky insurance markets. Shoppers will have a shorter time period to choose a 2018 plan and a harder time enrolling outside that window if they lose a job or have some other special circumstance that affects their coverage. (Murphy, 4/14)

Modern Healthcare: Market Stabilization Rule Could Collapse The ACA Exchanges 
Insurers are reeling from regulatory changes to the individual insurance market that they say will lower revenue and does nothing to address their biggest financial concerns. A final rule released Thursday was supposed to help stabilize the marketplace created by the Affordable Care Act in lieu of any resolution to repeal and replace the healthcare reform law. But the insurance industry immediately reacted with fear, saying the moves would reduce enrollment and therefore sales. The result could leave hospitals on the hook for more uncompensated care. (Dickson, 4/14)

Politico Pro: Feds Relax Oversight Of Provider Networks
The Trump administration's first major Obamacare regulation was largely intended to tighten insurance enrollment standards, but it also defers more authority to states to review insurers' provider networks. HHS is dropping its oversight in states that have the authority to review network adequacy. In states lacking that authority, HHS will rely on accreditation from insurers that their provider networks are sufficient. (Pradhan, 4/14)

GOP Plan Targets 'Frivolous' Malpractice Suits As Way To Reduce Health Spending

Democrats, however, say limiting patients' ability to litigate removes rights from those harmed by horrific medical mistakes.

In other news —

Detroit News: Health Overhaul Includes Crackdown On Lottery Winners
Republican efforts in Congress to replace the Affordable Care Act include a Michigan-inspired policy that would let states across the nation remove from Medicaid rolls individuals who win big in the lottery. Rep. Fred Upton, R-St. Joseph, has sponsored a bill — included in the House Republican health care overhaul plan — that he says, over a decade, could save the government hundreds of millions of dollars in payments for Medicaid, the health care program for low-income Americans. But one budget expert says the change could end up being a hassle for states. (Burke, 4/17)

When Reality And Political Philosophy Collide: A Look At Indiana's Medicaid Expansion

As the state's expansion model gains national attention, Politico investigates how both sides turned out to be wrong with their predictions. Outlets report on Medicaid news out of Ohio, Kansas and Missouri as well.

Politico: Pence’s Medicaid Experiment Confounds Expectations On The Left And Right
When former Indiana Gov. Mike Pence embraced Obamacare’s Medicaid expansion with conservative twists — such as requiring enrollees to contribute to their care — critics lamented poor people would be locked out while backers cheered the program’s focus on personal responsibility. Neither side’s expectations were quite borne out. (Pradhan, 4/15)

Cincinnati Enquirer: How Medicaid Expansion Saved One Ohioan
Cotterill, 28, and more than 700,000 Ohioans benefited from the Medicaid expansion in the Buckeye State to get health insurance. Yet uncertainty clouds the ACA’s future, even after the Trump administration’s first effort to repeal the law crashed. (Saker, 4/16)

Wichita (Kan.) Eagle: Medicaid Expansion May Come Up Again When Legislative Session Resumes
Democrats are preparing for another run at Medicaid expansion when lawmakers return, hoping they can offer changes to conservatives to gain their support. But opponents vow to fight, saying there are no modifications that would win them over. The Legislature will reconvene May 1. Supporters of expansion mounted an unsuccessful effort earlier this month to override Gov. Sam Brownback’s veto of a bill that would have increased eligibility for the program. (Shorman, 4/16)

Administration News

Lawmakers Strike Deal To Reauthorize FDA User Fee Agreements

The agreement extends the agency's authority to collect fees from drug and medical device manufacturers. Without the fees, 5,000 Food and Drug Administration employees could be laid off and drug reviews would be prolonged.

Modern Healthcare: Lawmakers Reach Bipartisan Deal To Extend FDA User Fees 
Legislators reached a tentative deal Friday to reauthorize the FDA's authority to collect user fees, extending funding to maintain and streamline the agency's product approval process. The bipartisan leaders of the Senate's and U.S. House of Representatives' health committees released a draft of the bipartisan Food and Drug Administration Reauthorization Act Friday. The act would reauthorize the FDA's four user fee agreements that renew the FDA's authority to collect user fees from the makers of prescription brand drugs, medical devices, generic drugs and biosimilars, and several crucial programs at the FDA. The fees would incrementally increase year over year. (Kacik, 4/14)

Morning Consult: Senior Republicans, Democrats Reach Deal On FDA User Fee Reauthorization
Top Republicans and Democrats in Congress have reached a preliminary deal to extend funding for several programs that are crucial to the approval of new drugs and medical devices in the United States. The deal announced Friday would reauthorize four user fee agreements that drug and medical device makers and the Food and Drug Administration depend upon to get products approved. (Reid, 4/14)

Public Health And Education

Many Desperate To Find Alternative To Opioids, But Pain Is A Pain To Research

As the opioid crisis rages on, there's a rush to figure out ways to treat pain that doesn't involve traditional painkillers. But that's pretty hard. In other news, addiction experts are disappointed by the lack of forward movement from the president.

The Associated Press: Overcoming Opioids: The Quest For Less Addictive Drugs
Tummy tucks really hurt. Doctors carve from hip to hip, slicing off skin, tightening muscles, tugging at innards. Patients often need strong painkillers for days or even weeks, but Mary Hernandez went home on just over-the-counter ibuprofen. The reason may be the yellowish goo smeared on her 18-inch wound as she lay on the operating table. The Houston woman was helping test a novel medicine aimed at avoiding opioids, potent pain relievers fueling an epidemic of overuse and addiction. (Marchione, 4/17)

Boston Globe: More Study? Addiction Experts Disappointed With Trump’s Lack Of Action On Opioid Crisis 
Drug addiction experts battling soaring overdose rates worry President Trump has not lived up to repeated campaign pledges to curb opioid abuse, favoring a tough-on-crime approach rather than the treatment programs he promised. While the White House heralds a new opioid addiction study commission, advocates said they wanted action — not further study. The epidemic, largely triggered by legal prescription drugs, is already clearly defined, they say, and remains by most accounts out of control. (Herndon, 4/16)

Outlets report on news about the epidemic out of the states as well —

The Associated Press: West Virginia Law Authorizes Opioid Antidotes At Schools
Schools in West Virginia will be able to give drugs to students who overdose on opioids without having to first contact parents under a new law approved this week. The measure passed unanimously by the state Legislature and signed Tuesday by Gov. Jim Justice comes as West Virginia recorded 844 overdose deaths last year, more than 700 involving at least one opioid such as heroin, fentanyl or prescription painkillers. (4/14)

The Baltimore Sun: Drug-Related Deaths Overburden Maryland Medical Examiner's Office 
The opioid epidemic that has claimed so many lives in Maryland is overwhelming the state medical examiner's office. The agency has exceeded national caseload standards — the number of autopsies a single pathologist should perform in a year — in each of the past four years. The office now risks losing its accreditation. The office can continue to operate without accreditation. But the association warns that performing too many autopsies can jeopardize quality and undermine confidence in the results. The situation has troubling implications for the criminal justice and public health systems. Prosecutors rely on autopsy findings and medical examiners' testimony to bolster their cases, and public health officials use data from the agency to direct resources. (Cohn, 4/15)

The Star Tribune: In Battle Against Opioids, Minnesota Leaders Promote Wider Use Of Naloxone 
Minnesota has placed pharmacies at the front line of the opioid epidemic, with laws allowing them to distribute naloxone, the overdose antidote drug, without a prescription and efforts to make them collection points for unused prescription opioids to prevent their misuse. Now state health and pharmacy leaders want to make sure that pharmacies take up the cause — and that people use these convenient locations to obtain the “rescue drug” for themselves or for friends or loved ones abusing opioids. (Olson, 4/14)

Getting To Delivery Room A Harrowing Journey For Some Amid Rural Hospital Crisis

Because of financial strain, many rural hospitals are shutting down their labor and delivery services. Women in those areas are then faced with long drives to get to a safe place to deliver their babies. In other public health news: infectious diseases, strokes, young blood, genetic testing, fertility treatments, trauma care and more.

Stat: A Crisis In Rural Health Care Puts Mothers-To-Be On A Risky Road
Financial pressures, insurance problems, and doctor shortages forced more than 200 hospitals to close their birthing units between 2004 and 2014, according to the University of Minnesota’s Rural Health Research Center. That’s left millions women of reproductive age facing longer drives to deliver babies — who sometimes arrive en route. The long drives, understandably, increase anxiety. They also make mothers and babies less safe; studies show these distances bring with them increased rates of complications and infant deaths, as well as longer stays in neonatal intensive care units. (Ross, 4/17)

Stat: Former CDC Head: Outbreaks ‘Tremendous Threats To Business’
The world has faced a string of infectious disease threats in the past dozen or so years, with SARS, bird flu, swine flu, MERS, and Ebola wreaking havoc. Yet despite the abundance of evidence that microbes pose major threats, both to human health and economies, global preparedness is not where it needs to be, Dr. Julie Gerberding warned this week. Gerberding was a former director of the Centers for Disease Control and Prevention — a post she held during the 2003 SARS outbreak. She is now Merck’s executive vice-president for strategic communications, global health policy and population health. (Branswell, 4/14)

The Washington Post: Giving Young Blood To Older Animals Raises Tantalizing Possibilities For People
Dracula may have been onto something. It wasn’t just blood, but the blood of youth that was the secret to staying alive for centuries. The rejuvenating effect of young blood has been demonstrated in strange, draculoid experiments first done 150 years ago. Two genetically compatible animals, one young and one old, are sewn together. With their circulatory systems connected, the old animal gains access not only to the younger animal’s blood but also to the detoxifying and metabolizing function of its organs. The state is known as heterochronic parabiosis. (Brown, 4/14)

Los Angeles Times: What The New, FDA-Approved 23andMe Genetic Health Risk Reports Can, And Can't, Tell You
Genetic testing firm 23andMe got approval from the Food and Drug Administration last week to sell reports that show customers whether they have an increased genetic risk of developing certain diseases and conditions. The go-ahead is the first time the federal agency has approved such direct-to-consumer genetic tests and comes about three years after the FDA warned Mountain View, Calif.-based 23andMe to stop marketing its health reports because they lacked agency authorization. (Masunaga, 4/14)

Tampa Bay Times: Here's Why Two Doctors Who Treated Pulse Victims Oppose A Plan For More Trauma Centers
But many trauma doctors, including some who treated the Pulse shooting victims, say that's a bad idea. They say caps on the number of trauma centers ensure each is filled with highly trained specialists, in densely populated areas where they get plenty of practice treating everything from bullet wounds to car crash injuries. Critical lawmakers say Republicans are trying to fix something that already works. (Auslen, 4/17)

Dallas Morning News: Are Heartburn Medicines Linked To A Serious Gut Infection?
The pills you take to control heartburn and suppress stomach acid may be linked to increased risk of a serious gut infection. A study published late last month in JAMA Internal Medicine reports that people who take commonly used prescription and over-the-counter indigestion medicines such as Prilosec and Zantac are at risk of repeat infection with the bacteria Clostridium difficile. (Yasmin, 4/15)

State Watch

State Highlights: Judge Delays N.H. Malpractice Insurance Payouts; Ga. Fails To Offer Protections To Personal Care Home Residents

Outlets report on news from New Hampshire, Georgia, Kansas, Texas, Florida, Missouri, Minnesota, Virginia, California, Illinois and Oregon.

NH Times Union: This Time, Insurance Payout Is $50 Million
Merrimack County Superior Court Judge Richard McNamara recently put the brakes on releasing $50 million in surpluses from the New Hampshire Medical Malpractice Joint Underwriting Association to 6,200 policyholders — even though all parties to this case were on board. That’s because nothing about this state-run group supplying malpractice insurance to doctors, hospitals and other health care providers for the past 40 years has been done quickly or without debate. In 2009, at the height of peak earnings and its position in the marketplace, the JUA’s surplus attracted the attention of former Gov. John Lynch. (Landrigan, 4/16)

The Augusta Chronicle: Personal Care Home Owners Or Employees Rarely Face Criminal Charges 
An investigation by The Augusta Chronicle found many examples just in Augusta where personal care home residents were left alone, went without food and medicine, and at least in one case was left in his own waste, locked inside a dark room. Georgia has criminal laws designed to protect at risk-adults – such as exploitation of an elderly or disabled adult, aggravated cruelty to an elderly adult, and abuse and neglect of an elderly or disabled person. Approximately 82 people are in prison serving time for these crimes. (Hodson, 4/15)

KCUR: Law Allowing States To Deny Planned Parenthood Funding Won’t Have Immediate Effect Locally 
The law signed on Thursday by President Trump allowing states to cut off family-planning funding to Planned Parenthood won’t have an immediate effect on the organization’s affiliates in Missouri and Kansas. That’s because Kansas barred Planned Parenthood from receiving Title X family planning funds several years ago – a move later upheld by a federal appeals court. And Title X funds continue to flow to Planned Parenthood’s affiliates in Missouri because the Missouri Family Health Council, not the state, is the recipient of the funds. The council in turn makes the funds available to Planned Parenthood. (Margolies, 4/14)

Politico Pro: Court Victories Don’t Restore Abortion Access In Texas 
The Supreme Court last June threw out restrictive Texas laws that had forced many clinics to close, leaving large regions of a vast state with no abortion providers at all. By and large, the clinics have not mustered the resources to reopen in a politically hostile, regulation-heavy environment. (Rayasam, 4/17)

Pioneer Press: Hennepin County Measles Outbreak Now Includes 8 Children 
A Hennepin County outbreak of childhood measles now includes eight cases, after five more cases were confirmed by the Minnesota Department of Health. The department said Friday that all eight cases are unvaccinated children between the ages of 1 and 4. Investigators are trying to trace the infections and protect others who may have been exposed. Seven of the confirmed cases are Somali-American children, and all but one have common contact. Six of the children were hospitalized. (4/14)

The Star Tribune: Five New Cases Of Measles Confirmed In Hennepin County 
Minnesota health officials have confirmed five new cases of measles in young children in Hennepin County, bringing the total number of cases in the outbreak to eight. All eight are unvaccinated children ranging in age from 1 to 4, the Minnesota Department of Health said in a Friday night news release. (Zamora, 4/15)

Richmond Times-Dispatch: Mental Health System Has Improved Since Tech, But Has A Long Way To Go, Experts Say 
Snook and several others agree that Virginia has been fairly adept at responding to crises — but they say lawmakers haven’t been as successful at addressing the mental health system’s underlying problems. Decades ago, Virginia shut down many of its state-run mental hospitals in response to a growing national trend but didn’t lay the groundwork for community-based care that would keep residents with mental illness from spiraling out of control. (Kleiner, 4/14)

Health News Florida: An Unknown Future For Military Caregivers Of Post-9/11 Veterans 
For the last decade, Patti Katter has managed her husband’s medical appointments, medications and rehabilitation. ... She learned to care for herself and found a job with a non-profit, Hope for the Warriors. She now works from home helping other military caregivers navigate the system. And she is a fellow with the Elizabeth Dole Foundation that advocates for military and veteran caregivers. (O'Brien, 4/14)

California Healthline: California Lawmakers Mull Improvements To Troubled Dental Program
California lawmakers are considering several bills to improve and expand access to Denti-Cal, the state’s troubled dental program for low-income people — including ones that would draw from the state’s new tobacco tax to boost dentists’ pay. Assembly Bill 753, introduced by Assemblywoman Anna Caballero (D-Salinas), would direct money from the state’s new tobacco tax to broaden access to Denti-Cal, which for years has been faulted in state and federal reports. The bill will be heard in the Assembly Committee on Health on Tuesday. (Ibarra, 4/17)

WBUR: California Tries Again To Move On Universal Health Care 
Many Californians are rallying around the idea of a single-payer health system, similar to those in Canada and parts of Europe. Efforts to establish universal health care in California have failed in the past. But with Republican leaders in Washington planning to repeal and replace the Affordable Care Act, voters are eager to try again. (Feibel, 4/14)

Chicago Tribune: Feds Subpoena Baxter Employee Over National Shortage Of IV Solutions 
The federal government has subpoenaed a Baxter International employee as part of a criminal investigation related to a nationwide shortage of intravenous saline solution, the Deerfield-based company revealed Friday. The subpoena asks for documents about the pricing, sale, manufacture and shortage of intravenous solutions, including saline solution, which is used in IVs to hydrate patients, and other injectable medications. It also seeks Baxter's communications with competitors over the issue, according to a regulatory filing. (Schencker, 4/14)

San Francisco Chronicle: Hawaii Accused Of Downplaying Parasite That Struck SF Couple 
Health officials in tourist-friendly Hawaii are defending themselves from criticism that they have for years downplayed the severity of a rare, brain-invading parasite that has infected dozens on the islands, including a San Francisco couple stricken by the disease on a recent honeymoon. A cluster of rat lungworm cases in Maui caught widespread attention last week when Eliza Lape of San Francisco and her husband, UC Berkeley journalism professor Ben Manilla, revealed they had become severely ill in January after they eloped on the island. (Lyons, 4/14)

Georgia Health News: Georgia Aims To Avoid Snags As It Launches Program For Public Benefits 
Georgia is rolling out an expensive eligibility determination system for Medicaid, food stamps and other public benefits, with officials hoping to avoid the massive problems with a similar set-up in Rhode Island, operated by the same vendor. The new computer system, delivered by Deloitte Consulting, has a price tag of $380 million, with all but $33 million paid for by the federal government under the Affordable Care Act. The rest comes from state money. (Miller, 4/14)

Editorials And Opinions

Perspectives On Health Law Debate: Will Trump Break The System? Praise For Freedom Caucus

Opinion writers look at the simmering questions about what Republicans should do about health care.

The Washington Post: Does Trump Want To Be The President Who Broke Health Care?
"Obamacare is dead next month if it doesn’t get that money,” President Trump told the Wall Street Journal on Wednesday in a barely veiled threat to defund a crucial part of the Affordable Care Act. The president delivered this threat even though he has no viable replacement plan. Senate Minority Leader Charles E. Schumer (D-N.Y.), the president said, “should be calling me and begging me to help him save Obamacare.” No. Mr. Trump should be working to preserve the Affordable Care Act, which is delivering health insurance to millions of Americans. (4/16)

San Antonio Press Express: Blame The Freedom Caucus? No, Thank It
So why did the so-called Freedom Caucus object to this legislation? Well, simply, the caucus is for individual freedom and liberty. ... The brave members of this small body probably saved the Republican Party from a tremendous amount of embarrassment by helping stop legislation that did little to nothing toward lowering health care costs. (Alan Preston, 4/15)

The Washington Post: Trump Is Now Destroying A Healthy Health-Care System
President Trump this week threatened not to pay $7 billion to insurers in annual subsidies for giving discounted coverage to low-income Americans. If he follows through, it ends Obamacare as we know it. But even if he’s bluffing, the threat itself is outright sabotage and goes a long way toward dismantling the Affordable Care Act. (Dana Milbank, 4/14)

The Wichita Eagle: Still Hope For Medicaid Expansion?
Good for health care advocates for not giving up on Medicaid expansion this legislative session – though it likely is a long shot.Large bipartisan majorities in the House and Senate approved Medicaid expansion last month. But the House fell three votes short of overriding Gov. Sam Brownback’s veto of the bill. That seemed to doom expansion this session. But advocates are still holding out hope, the Kansas News Service reported. (4/14)

Arizona Republic: Can David Schweikert Fix What's Wrong With Obamacare?
There should be two goals for the replacement of Obamacare. First, create a robust and sustainable individual health insurance market as an alternative to employer-provided insurance. Second, create a safety net to subsidize the health care of the poor and the seriously or chronically sick. To do that requires understanding why the individual health insurance market created by Obamacare is imploding. (Robert Robb, 4/14)

Arizona Republic: Why Health-Care Reform Will Never Make Us Happy
Republicans failed to repeal the Affordable Care Act, but the fight over what the program should look like is not going away. We will never all agree about what a health-care policy should accomplish. But if we consider four things that we seem to all want from health insurance and two that many simply fail to understand, our discussion will at least be more informed. (Michael O'Neil, 4/15)

Seattle Times: All Americans Deserve Quality Health Care
Last year, I returned to the U.S. after living in Australia, which has a single-payer health-care system. The myths conservatives and self-interest groups spin about such systems is wrong. The quality of health professionals is on a par with the United States: appointments scheduled easily, care provided quickly, with a high degree of competence and costing substantially less. I never had to wait, and the system worked efficiently compared to our excessive administration and higher costs due to profit motives, and the complexity of our system with too many providers, insurers and payment companies. A single payer system, along with optional private insurance, is a cost effective, less complex way to provide health care. (Christopher J. Wachholz, 4/14)

Viewpoints: The Need For More Patient Safety Measures; The FDA And Pizza

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

The New York Times: Real Malpractice Reform: Investing In Patient Safety
Congressional Republicans have recently revived efforts to overhaul malpractice laws, including capping certain kinds of suits at $250,000. A perennial argument of supporters of such measures is that many claims are frivolous, clogging the court system and driving up health care costs for everyone. But does the evidence support this? (Aaron E. Carroll, 4/17)

The Wall Street Journal: The FDA’s Pizza Minders
The Food and Drug Administration can’t possibly fulfill all of the responsibilities it claims to have, and here’s one way the Trump Administration can set better priorities: Direct the agency to end its effort to inform Americans that pizza contains calories. (4/16)

Stat: Balancing Hope And Realism Can Be A Challenge For Doctors
Conveying the right balance of hope and realism is largely learned through experience during medical training. Young doctors patch together a framework for navigating discussions that hinge on uncertainty, often pilfering mentors’ phrases and techniques. Most of all we learn from our own missteps, and from those of our colleagues. I know that many patients prefer to hear realistic interpretations of their illness, and that these discussions are increasingly important as providers lean toward shared decision-making, which has been linked to greater patient satisfaction. Still, it’s sometimes a challenge to truthfully discuss a serious medical issue while leaving the door open to the hope that is so vital for patients and families. (Allison Bond, 4/14)

Stat: Gaps In Care For Babies With Zika Highlight A Deeper Problem In Medicine
A new report from the Centers for Disease Control and Prevention highlights the damage that the Zika virus can do to unborn babies. It also shows that US doctors poorly follow evidence-based guidelines. According to the CDC, among pregnant women who tested positive for Zika, 1 in 10 had babies with microcephaly or another birth defect. That was the number that grabbed headlines. But there were two other numbers that worried me: Just 65 percent of babies born to mothers who tested positive for Zika were themselves tested for it, and only 25 percent received brain scans — despite recommendations that 100 percent of such babies be tested. (Amesh A. Adalja, 4/14)

Morning Consult: Ensure Medicare Access To Blood And Marrow Transplants For Seniors With Cancer
Last year, the Centers for Medicare and Medicaid Services enacted a significant policy change improving access to blood and marrow transplants for Medicare patients diagnosed with life-threatening blood cancers. The change came in the form of a Medicare rule on how outpatient blood and marrow transplants are reimbursed by the federal health care program beginning on Jan. 1, 2017. While this move a step in the right direction, this rule does not address the vast majority of transplants (97 percent) that are performed in the inpatient setting. Sadly, Medicare continues to provide inadequate reimbursement to hospitals performing inpatient transplants and this limitation threatens to limit access to seniors needing this lifesaving therapy. (Krishna Komanduri, 4/17)

Boston Globe: We Should Be Expanding Scientific Research Spending
A large majority of Americans agree that we should increase the money we spend on research. If we can’t come together as a country and make this happen — if we can’t, at the very least, double the tiny fraction of our federal budget that we invest in basic research — then what kind of future do we believe in? ... Alzheimer’s disease offers the perfect example of how foolish it is to shortchange investments in research. (Sen. Elizabeth Warren (D-Mass.), 4/15)

The New York Times: You Draw It: Just How Bad Is The Drug Overdose Epidemic?
How does the surge in drug overdoses compare with other causes of death in the U.S.? ... Since 1990, the number of Americans who have died every year from drug overdoses has increased by more than 500 percent. In 2015, more Americans died from drug overdoses than from car accidents and gun homicides combined. It’s the worst drug overdose epidemic in American history (Josh Katz, 4/14)

The Washington Post: 10 Years After The Virginia Tech Massacre, Virginia Still Falls Short On Mental Health Care
It is hard to believe that it has been 10 years since the horrific day at Virginia Tech when 32 students and faculty were killed and many others were injured by a young student with untreated mental illness. Ten years since countless lives and families were altered forever, including my own. ... Although progress has been good, Virginia sits in the bottom half of states in overall ranking for mental health care per person. Virginia still needs funding to establish consistent and comprehensive services in all communities; to expand intervention, treatment and transition programs for young adults, especially for those experiencing the first signs of mental illness; to attract and retain mental-health providers in the face of a critical workforce shortage; and to establish strict quality and performance outcomes to meet the needs of families and communities in our commonwealth. (Elizabeth Hilscher, 4/14)

Des Moines Register: When Iowa's Mental Health Crisis Lands Next Door
[W]hat we didn’t know, what most people don’t know or see that goes on behind closed doors when someone is mentally ill, were what relatives recounted later: Chase’s multiple suicide attempts. We didn’t see the countless appointments with doctors, psychiatrists and counselors, the rounds of various medications to find just the right cocktail and the battles to get Chase to take them. We didn’t see the self-harm, the many trips to the hospital when Chase was in crisis, only to be sent home days or hours later when there were no beds available, or Charla’s early retirement from her job as a Des Moines Public Schools teacher so she could better monitor and care for her son. And we didn’t see all the tears they likely shed, the arguments and moments of despair that no doubt occurred in their household in trying to deal with their sick son the best they could. (Kali VanBaale, 4/14)

Milwaukee Journal Sentinel: Why We Need Equal Access To Clean Water In Wisconsin
This week, the Senate passed SB 76, a bill that substantially unravels oversight of high-capacity wells in the state. It’s a bald-faced giveaway to large-scale farming and feedlot operations, mostly, with almost no consideration for how pulling millions of gallons of water a day out of the ground affects surrounding communities. The bill allows for drilling wells that pump large amounts of water without review by state regulators, so long as the new wells replace existing, permitted wells. (Emily Mills, 4/14)

Los Angeles Times: California's Vaccination Rates Are Up. Let's Keep It That Way
The controversial 2015 law doing away with an exemption that had allowed public school students to skip vaccinations based on their “personal beliefs” appears to have worked. California state officials reported this week that 95.6% of kindergartners are fully vaccinated. That’s the highest rate recorded at least since 1998, when a now-debunked study purported to show a link between vaccinations and autism. (4/14)