KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Political Cartoon: 'Time Warp?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Time Warp?'" by Darrin Bell.

Here's today's health policy haiku:

LANDMINES AND THE LEGISLATIVE CALENDAR

It may be August
But September is looming
and could be brutal.

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Summaries Of The News:

Administration News

Trump Administration Grants Insurers 3 Extra Weeks To Calculate 2018 Rate Requests

The Centers for Medicare & Medicaid Services announced late last week that the deadline would be extended as insurance companies face uncertainty resulting from President Donald Trump's threat to cut off some subsidies paid to them on behalf of low-income people. The uncertainty has disrupted planning by insurance companies and led some to either leave or contemplate leaving the Obamacare marketplaces.

The New York Times: Health Insurers Get More Time To Calculate Increases For 2018
The Trump administration is giving health insurance companies more time to calculate price increases for 2018 because of uncertainty caused by the president’s threat to cut off crucial subsidies paid to insurers on behalf of millions of low-income people. Federal health officials said the deadline for insurers to file their rate requests would be extended by nearly three weeks, to Sept. 5. (Pear, 8/13)

The Hill: ObamaCare Deadline For Insurers Delayed By Three Weeks
The Trump administration is giving insurers more time to file their 2018 rate requests for ObamaCare plans. The Centers for Medicare and Medicaid Services said Thursday it would extend the deadline by three weeks, to Sept. 5, with a final deadline of Sept. 20. (Hellmann, 8/11)

Concord Monitor: Health Insurance Companies Get More Time To Set 2018 Rates
Insurance companies struggling with uncertainty about the national health-care program have an extra three weeks to figure out how much to charge next year. The federal government said Friday it was extended its rate-filing deadline from Aug. 16 to Sept. 5 for insurance companies offering 2018 plans on state exchanges, including the exchange in New Hampshire. (Brooks, 8/11)

The Hill: High Anxiety For Insurers On ObamaCare Deadline
Insurers are grappling with a serious predicament in finalizing how much their health plans will cost, even after a three-week extension from the Trump administration. The new Sept. 5 deadline gives carriers more time to tweak their premiums for HealthCare.gov in a year where uncertainty surrounding the law has reached a new high. (Roubein, 8/13)

Capitol Hill Watch

With 'Brutal' September Looming, Trump Braces For 'Thorny Issues' On Capitol Hill

With a number of must-pass legislative items on the agenda, there are also few working days on the congressional calendar -- and a possibility that GOP lawmakers may make another attempt at an Obamacare repeal. All the while, news outlets examine how President Donald Trump's Twitter and verbal attacks on Senate Majority Leader Mitch McConnell could further complicate the days ahead. Meanwhile, during the August recess, Republicans faced a lot of health care questions at town hall meetings. And Democrats use the GOP's failed repeal-and-replace measures to formulate their talking points and political strategies. Abortion politics, though, continue to complicate their message.

Politico: Trump Aides Predicting 'Brutal' September
Senior officials have described the coming month as "brutal," “bad” or “really tough” because of the confluence of complicated issues — but they also say it’s pivotal to getting the presidency back on course. Aides hope to have a better blueprint for how the president wants to proceed on a series of thorny issues — the nation’s debt ceiling, the 2018 federal budget, tax reform, infrastructure spending and perhaps another stab at repealing Obamacare — after a series of meetings in New York this week. (Dawsey, 8/13)

The Associated Press: Trump’s Verbal Shots Against McConnell Complicate His Agenda
Donald Trump’s attacks on Senate Majority Leader Mitch McConnell come at the worst possible time, if the president’s goal is actually to advance his agenda on health care, infrastructure and taxes that he’s goading his GOP ally to pass. ... McConnell’s allies say that Trump’s frustration over the failure on health care is shared by the majority leader. (Taylor, 8/12)

The Washington Post: At Raucous Town Halls, Republicans Have Faced Another Round Of Anger Over Health Care
The long August congressional recess, which Republicans had hoped would begin a conversation about tax reform and must-pass budget measures, has so far seen another round of angry town halls focused on President Trump and the stalled effort to repeal the Affordable Care Act. Over just one day, in three small towns along Georgia’s Atlantic coastline, Rep. Earl L. “Buddy” Carter (R-Ga.) spent more than four hours answering 74 questions, many of them heated. Just three focused on tax reform; nearly half were about health care. (Weigel, 8/11)

The Associated Press: Graham Says GOP In Trouble If Obama’s Health Care Law Stands
A GOP senator says all Republicans are in trouble politically if they’re unable to scrap former President Barack Obama’s health care law and replace it with a better one. Sen. Lindsey Graham of South Carolina says he doesn’t mind that President Donald Trump is upset with Republicans for failing to fulfill their seven-year-old pledge on a health overhaul. (8/13)

The Associated Press: Democrats Use Bus Tour To Criticize GOP Health Care Vote
Democrats used a bus emblazoned with the words “Drive for our Lives” to gin up opposition to vulnerable House Republicans who voted against “Obamacare” with the aim of upending the GOP’s majority in next year’s midterm elections. The vote to repeal and replace the Obama health care law looms large for 21 GOP lawmakers, including Iowa Reps. David Young and Rod Blum. They represent competitive congressional districts where Democrat Hillary Clinton won or came close in last year’s presidential election. (Beaumont, 8/12)

News outlets also examine how Medicaid has come through the most recent attempts to overhaul it -

The Associated Press: A Stronger Medicaid Emerges From GOP Health Overhaul Debate
Medicaid, a 1960s Great Society pillar long reviled by conservatives, seems to have emerged even stronger after the Republican failure to pass health overhaul legislation. The federal-state health insurance program for low-income Americans hasn’t achieved the status of Social Security and Medicare, considered practically untouchable by politicians, like an electrified “third rail.” But it has grown to cover about 1 in 5 U.S. residents, ranging from newborns to Alzheimer’s patients in nursing homes, and even young adults trying to shake addiction. ... Increased participation — and acceptance — means any new GOP attempt to address problems with the Affordable Care Act would be unlikely to achieve deep Medicaid cuts. (Alonso-Zaldivar, 8/14)

And the Trump administration is taking steps to roll back the health law's LGBT protections -

The Hill: Trump Expected To Roll Back LGBT Protections In ObamaCare
The Trump administration appears poised to roll back ObamaCare’s anti-discrimination protections for transgender patients, a move that has activist groups girding for a fight. A proposed rule from the Department of Health and Human Services is expected to be released in the coming weeks or months that opponents say would make it easier for doctors and hospitals to deny treatment to transgender patients and women who have had abortions. (Weixel, 8/12)

House GOP Lawmakers Contemplate Efforts To Stabilize Obamacare Insurance Markets

Reports indicate that Rep. Mark Meadows (R-N.C.) and Rep. Tom Arthur (R-N.J.) are considering legislation to fund payments to insurers known as cost-sharing subsidies in exchange for increased state flexibility in waiving health law coverage requirements. However, Democrats have a different view. They see must-pass legislation -- such as critical spending fights on tap for September -- as giving them leverage to secure those subsidies.

The Hill: Conservative Chairman In Talks About ObamaCare Stabilization Deal 
Reps. Mark Meadows (R-N.C.) and Tom MacArthur (R-N.J.) are in talks for a bill that would stabilize ObamaCare markets. The measure would fund key ObamaCare payments known as cost-sharing reductions, possibly in exchange for expanded flexibility favored by conservatives for states to waive ObamaCare regulations through broadening an existing provision known as 1332 waivers. (Sullivan, 8/11)

The Hill: Democrats See ObamaCare Leverage In Spending Fights 
House Democrats want to use the looming battle over government spending and raising the debt limit as leverage to shore up ObamaCare. The minority party believes Republicans will need their votes on the critical fiscal issues, and they think they can secure concessions on healthcare. (Lillis, 8/13)

Meanwhile, the House Freedom Caucus is signaling its hope to bring up another Obamacare repeal vote -

The Washington Post: House Conservatives Hope To Revive Obamacare Repeal Vote
Members of the conservative House Freedom Caucus want to seize control of the health-care debate by petitioning Republicans to hold a vote on a version of a repeal bill that passed the House in 2015. Conservatives say they believe a repeal measure can pass without a replacement, despite warnings from Ryan and other leaders that the votes aren’t there. The long-shot effort gained momentum last week with support from influential outside groups. (Snell, 8/13)

Collapse Of GOP Health Plan Leaves Insurers, Medical Devicemakers Facing Dreaded Taxes

Republicans were hoping to rescind the health law's levies on both health insurance plans and medical devices. But with action on their bill suspended for now, the industries are working to find other ways to stop the taxes.

Bloomberg: Health Insurers Struggle To Win Reprieve Of Obamacare Tax 
Health insurers won a victory in 2015 when a tax that was part of the Affordable Care Act was suspended. Now as they fight to repeal or delay the tax again before it comes back into effect, the odds don’t seem to be in their favor.  Insurers, businesses and conservative groups are scrambling for ways to at least delay the health-insurance tax, or HIT, following the collapse of health-care legislation in July. They seemed poised for victory just a few months ago, when the health-insurance fee, and most of the other levies enacted to help fund Obamacare, were targeted in repeal bills passed by House Republicans and considered by Senate Republicans. (Brody, 8/11)

The Associated Press: Health Care Divide Leaves Tax On Path To Reinstatement
The industry that makes medical devices from artificial hips to miniature pumps for IV drips is looking for a fallback plan to repeal a widely reviled sales tax that almost met its end in GOP health care legislation. The 2.3 percent excise, one of several taxes and fees in the Affordable Care Act that pay for expanded insurance coverage, has been the subject of ferocious lobbying by manufacturers seeking its permanent death. Yet for now it's on track to be reinstated on Jan. 1 after a two-year hiatus, leaving industry leaders worried it will hurt employment and stifle development of innovative, even lifesaving products. (Salsberg, 8/13)

Health Law

Markets In Flux: What's Happening On The Ground? What Are States Doing To Keep Obamacare Exchanges Working?

Even as state insurance commissioners attempt to "enter the breach," reports indicate that Ohio is bracing for increases as high as 48 percent if President Donald Trump opts to stop cost-sharing subsidies paid to insurers for coverage for low-income people and, in Virginia, Anthem announces it will stop selling plans in much of the state. News outlets also detail developments in Florida and Montana.

Politico: How The Trump Administration Is Spending Millions To Shore Up Obamacare
President Donald Trump has threatened to blow up Obamacare. But his own administration is separately dangling hundreds of millions of dollars before states to bail out their insurance markets. Alaska will get $323 million over the next five years to coax its lone Obamacare insurer to remain in the market and hold down premiums. At least four other states, including some that have vociferously opposed the Affordable Care Act, are seeking similar deals. ... The White House said Thursday it applauds the stabilization efforts even as Trump steps up the pressure on the Senate to resume efforts to try to pass legislation to repeal and replace Obamacare. (Pradhan, 8/13)

The Hill: States Enter The Breach To Protect ObamaCare
State officials are using every tool at their disposal to try to keep their insurance marketplaces stable in the face of uncertainty from the Trump administration over the future of ObamaCare. Insurance commissioners are working with providers, advocates and insurance companies to help keep the system running, but it’s an uphill climb. (Weixel, 8/13)

Cleveland Plain Dealer: Ohio Insurers Seek Up To 48 Percent Premium Hikes If Trump Yanks Federal Obamacare Subsidies
Ohio insurers in the Affordable Care Act market are filing new, substantially higher premium requests -- with average hikes as high as 48 percent -- in case President Donald Trump pulls the plug on federal money promised by President Obama. It is still possible their earlier rate requests for 2018, with increases of 20 percent or more, will hold. Those were already considered steep. (Koff, 8/12)

The Associated Press: Anthem To Stop Selling Individual Plans In Much Of Virginia
A third insurance company said Friday that it will stop offering individual health insurance plans under the Affordable Care Act next year in Virginia, citing in part the uncertainty in Washington as lawmakers debate the future of the health care law. Anthem Blue Cross Blue Shield said in a statement that the decision was based on the shrinking individual market and “continual changes and uncertainty” in the operation, rules and guidance of the law. (Finley, 8/11)

Tampa Bay Times: Tampa Obamacare Sign-Up Organizers Brace For Shortened Enrollment, Less Help
As Republicans in Congress and the White House have an on-again, off-again debate about repealing Obamacare, a couple of developments on the ground are expected to affect this winter's open enrollment period for coverage. For one thing, Tampa is one of 18 cities nationwide affected by a Trump administration decision not to renew contracts with two companies that helped people sign up for health insurance through the Affordable Care Act. (Danielson, 8/14)

The Associated Press: Montana’s Health Co-Op Remains Standing As Others Falter
The Montana Health Co-op resumes accepting new enrollees on Sunday after withdrawing from the state’s health insurance exchange last year amid worries about its financial health. Chief Executive Officer Jerry Dworak asserts that the co-op is in position to absorb all 64, 000 Montanans who buy policies from the state’s health insurance exchange. (Calvan, 8/12)

CBO To Release Analysis This Week On Effects Of Ending Cost-Sharing Reduction Subsidies

President Donald Trump repeatedly has vowed to cancel the payments that help low-income people pay for deductibles and copayments when they buy insurance on the health law marketplaces.

The Hill: CBO To Release Analysis Of Ending Key ObamaCare Insurer Payments 
The nonpartisan Congressional Budget Office (CBO) will release an analysis next week detailing the effects of ending key ObamaCare insurer payments. The CBO announced Friday the score would be released next week. President Trump has threatened to cancel the payments, known as cost-sharing reductions, which reimburse insurers for giving discounted deductibles and copays to low-income people. (Hellmann, 8/11)

Modern Healthcare: CBO​ To​ Weigh​ In​ On​ Cost-Sharing​ Reduction​ Payments 
A new healthcare must-read will hit everyone's summer list this week. That's when the Congressional Budget Office is set to release a report detailing what could happen to insurance markets if the federal government stops making cost-sharing reduction payments. The payments, part of the Affordable Care Act, reimburse insurers for limiting deductibles and copays to individual customers with incomes of less than $29,700, or 250% of the poverty level. Premiums for the plans those customers buy do not cover the cost of the generous benefits. (Lee, 8/12)

Pharmaceuticals

House Expected To Hold Hearings On 'Right-To-Try' Bill That Senator Tied To FDA Funding

The Senate quickly passed the bill that would allow dying patients access to experimental drugs after Sen. Ron Johnson (R-Wis.) had threatened to slow down consideration of a separate bill to renew the FDA’s fee-collection authority. In other drug industry news, the FDA is implementing new rules about hiring foreign scientists, industry tightens controls to keep out counterfeit drugs, cancer trials are low on patients and costs of old drugs rising quickly for Medicaid.

Roll Call: ‘Right To Try’ Bill Could Face Slower Action In House
A Senate-passed bill intended to help dying patients access experimental drugs will likely face lengthier deliberations in the House. While the Senate fast-tracked the bill on Aug. 3, the House will likely subject it to a hearing and markup before bringing it up to a vote, according to congressional aides and a lobbyist. (Siddons, 8/14)

Stat: FDA Puts New Restrictions On Hiring Of Foreign Scientists, Documents Show
The Food and Drug Administration is implementing a new hiring protocol that could make it significantly harder for foreign scientists to find jobs and research opportunities at the agency, according to interviews and newly obtained documents. The FDA recently began directing hiring managers not to extend any employment offers — including for fellowship and contractor positions — to any individual who has not lived in the U.S. for at least three of the five previous years, according to briefing materials shared with STAT that have been presented to some agency employees. (Mershon, 8/11)

The New York Times: A Cancer Conundrum: Too Many Drug Trials, Too Few Patients
With the arrival of two revolutionary treatment strategies, immunotherapy and personalized medicine, cancer researchers have found new hope — and a problem that is perhaps unprecedented in medical research. There are too many experimental cancer drugs in too many clinical trials, and not enough patients to test them on. The logjam is caused partly by companies hoping to rush profitable new cancer drugs to market, and partly by the nature of these therapies, which can be spectacularly effective but only in select patients. (Kolata, 8/12)

Kaiser Health News: Climbing Cost Of Decades-Old Drugs Threatens To Break Medicaid Bank
Skyrocketing price tags for new drugs to treat rare diseases have stoked outrage nationwide. But hundreds of old, commonly used drugs cost the Medicaid program billions of extra dollars in 2016 vs. 2015, a Kaiser Health News data analysis shows. ... Rising costs for 313 brand-name drugs lifted Medicaid’s spending by as much as $3.2 billion in 2016, the analysis shows. Nine of these brand-name drugs have been on the market since before 1970. In addition, the data reveal that Medicaid outlays for 67 generics and other non-branded drugs cost taxpayers an extra $258 million last year. (Lupkin, 8/14)

Veterans' Health Care

Trump Signs Bill That Adds $2 Billion To Program Giving Veterans Private Medical Care

In addition to the funding for the Veterans Choice Program, the emergency spending legislation provides $1.8 billion for core VA health programs, including 28 new VA medical facilities.

The Associated Press: Trump Signs Bill To Fund Veterans Medical Care Program
President Donald Trump has signed an emergency spending bill that will pump more than $2 billion into a program that allows veterans to receive private medical care at government expense. ... The bill, which addresses a budget shortfall at the Department of Veteran Affairs that threatened medical care for thousands of veterans, provides $2.1 billion to continue funding the Veterans Choice Program, which allows veterans to seek private care. (Lemire, 8/12)

CQ Roll Call: More Private Health Care For Veterans Eyed Despite Troubles
In one of its last acts before leaving for the August recess, Congress injected $2.1 billion into a private medical care access program for veterans that was on life support. Meanwhile, federal watchdogs are raising red flags about how some parts of the current program are functioning — and the Department of Veterans Affairs' handling of Veterans Choice Program funds is prompting questions among lawmakers about how it will be revamped or widened. The Veterans Choice Program was created (PL 113-146) as a temporary relief valve to help reduce a spike in demand for medical care that left VA health centers struggling nationwide. While the new funds are designed to keep the program running for another six months, it’s clear that authorizers don’t want Choice to disappear. (Mejdrich, 8/14)

Atlanta Journal-Constitution: VA Health Enrollment System In Disarray, Audit Finds
Poor oversight and mismanagement of the enrollment system resulted in delays to health care access for some veterans and likely denied access to others, according to a draft report that the VA’s Office of Inspector General wrote in May. The report highlights the depth of the problems in the VA’s enrollment process that is overseen by the Veterans Health Administration and its national Health Eligibility Center in Atlanta. (Schrade, 8/10)

Marketplace

Hospital Officials Question Whether Medicare Readmissions Penalties Have Run Their Course

The program, mandated by the health law, has been credited with helping bring down costly readmissions. But hospital and industry leaders say that has hit a standstill. Also in the news, a new report spotlights a slowing of the increases in health care prices, and WebMD's CFO talks about plans for the company.

Modern Healthcare: Private Payers Tamp Down Hospital Prices In June
Consumers are getting some relief on healthcare prices this summer. The increase in June was just 1.5% compared with the prior-year period at 1.9%, according to a new report by the Altarum Institute's Center for Sustainable Health Spending. Hospitals, whose privately insured patients paid just 1.8% more for services in June compared with the year before led the moderation. That's the smallest monthly increase in that category since Altarum started tracking the private-payer pricing data in June 2014. (Barkholz, 8/11)

The Wall Street Journal: WebMD Wants To Go Beyond Medical Information
According to [WebMD's] chief financial officer, Blake DeSimone, who was appointed to the position in September, WebMD is in the process of transforming its flagship site for consumers, WebMD.com, from a one-stop shop for information to a platform people can engage with and take action to improve their health. WebMD last month agreed to be acquired by private-equity firm KKR & Co. for $2.8 billion, after publicly putting itself in play early this year. (Stratton, 8/13)

Public Health And Education

Examining The Trump Administration's Opioid Emergency Declaration; What's Behind The Increasing Cost Of Treating Overdoses?

News outlets also examine efforts to meet the treatment needs of pregnant women as well as recent developments related to the opioid epidemic in Arizona, New Hampshire and Minnesota.

Stat: 4 Questions About Trump's Emergency Declaration On Opioids
President Trump threw the public for a loop again on Thursday when he announced his administration was moving to declare the opioid crisis a national emergency, just two days after administration officials said they weren’t going to take such a step. Emergency declarations can carry both symbolic weight and serious policy consequences. Here are four things STAT will be keeping an eye on. (Joseph, 8/11)

Stat: The Cost Of Treating Opioid Overdose Victims Is Skyrocketing
The cost of treating opioid overdose victims in hospital intensive care units jumped 58 percent in a seven-year span, according to a new study that concludes increasingly sick patients are placing a greater strain on an overmatched health care system. Between 2009 and 2015, the average cost of care per opioid admission increased from $58,500 to $92,400 in the 162 academic hospitals included in the study, which was led by Beth Israel Deaconess Medical Center in Boston. That rapid escalation far outpaced the overall medical inflation rate in the U.S., which was about 19 percent during the period covered by the study. (Ross, 8/11)

The Washington Post: Pregnant Women Addicted To Opioids Face Tough Choices, Fear Treatment Can Lead To Separation And Harm
As the nation’s opioid crisis has deepened, the number of drug treatment centers for pregnant women has grown. But experts and advocates say there aren’t enough services for pregnant women to meet the demand, and many don’t offer the drugs doctors would normally use to treat addiction because they are concerned about the effects they might have on a fetus. And some laws requiring that babies going through withdrawal be removed from their mother’s care can be a deterrent to seeking help, they said. (Ockerman, 8/13)

Arizona Republic: 200 Deaths In 60 Days: Ducey Extends Opioid Overdose Tracking Order
Arizona Gov. Doug Ducey this week extended an order requiring timely tracking of suspected opioid overdoses, a move that coincides with talk of declaring a state of national emergency. Ducey's initial June 13 order called for state health officials to collect opioid-related overdose information from first responders and health-care providers within 24 hours of a case, providing a nearly real-time picture of the issue. (Pohl, 8/11)

Public Health Roundup: Ordering STD Tests Online; Baseball Players And Brain Cancer

News outlets explore these and a range of other public health developments, including ongoing efforts to improve battle plans against vector-borne diseases such as Zika and Lyme; human-genome editing; end-of-life advice on Medicare's dime; and more.

NPR: You Can Order A Dozen STD Tests Online — But Should You?
Cases of chlamydia, gonorrhea and syphilis all hit record-high numbers in 2015. Tens of thousands contract HIV every year in the U.S., and oral cancers caused by human papillomavirus are increasing. So startups are popping up online to help serve what they see as unmet demand for STD testing. ... The question is whether those companies can survive — at least one left the market before its product even launched — and whether the services they offer get the right tests to the right people. (Haelle, 8/13)

The New York Times: The Brain Cancer That Keeps Killing Baseball Players
Since Darren Daulton succumbed to brain cancer on Aug. 6, heartfelt tributes have honored the way he led a raucous Phillies team to the World Series in 1993. And unanswered questions have surfaced about the way he died. Daulton and several prominent contemporaries in baseball — including at least three other Phillies who played at Veterans Stadium, the team’s home from 1971 to 2003 — have died of glioblastoma, according to news media accounts. It is considered the most aggressive and frequently diagnosed form of malignant brain tumor. Researchers who have examined the baseball cases for years say there is insufficient evidence to determine whether they represent anything more than coincidence. Possible cancer clusters are notoriously hard to prove. (Longman, 8/14)

WBUR: What We Can Learn From The French About Fighting Lyme Disease
There are some hopeful signs of support for our fight against Lyme disease: The U.S. federal government has recently committed $40 million to create four regional centers of excellence for vector-borne diseases — which include Lyme — as part of its efforts to control the Zika virus. But most of that money is expected to go toward fighting Zika, so it will likely do little to help fill the public health funding gaps that are leaving us far behind France in the fight against Lyme. (Scales, 8/11)

East Bay Times: Stanford: Scientist Searches For Answer To His Son’s Devastating Condition
As a renowned Stanford scientist, Ron Davis has a deep appreciation for the power of modern medicine. And yet an explanation for the disease afflicting his own beloved son eludes him. Son Whitney, 33, suffers from such severe Chronic Fatigue Syndrome that he is bedridden, unable to eat or speak. The handsome man was once a photographer and adventurer. He traveled through the United States, studied Buddhism in India and Nepal, lived in an Ecuadorian rainforest and ran a campaign office for former president Barack Obama. Now he’s returned home to Palo Alto for 24-hour care. (Krieger, 8/12)

Politico: The Doctor Will Analyze You Now
In part because of their Alaska Native heritage, which puts a high value on spiritual health, the leaders of Southcentral recognized decades ago that behavioral health is tightly linked with bodily health. So they became one of the early adopters of integrated care. They embedded treatment for mental and emotional ills in their primary care practices, and found that patient satisfaction rates skyrocketed and usage of medical care went down, saving millions of dollars while improving patient outcomes. In the nearly 30 years since Southcentral hired its first psychologist, pretty much every study has shown that integrating mental health care into medical care results in better patient outcomes and lower costs. (Silberner, 8/9)

Los Angeles Times: Americans Want A Say In Human Genome Editing, Survey Shows
Just last week, scientists reported a new first in the journal Nature: They edited heritable cells in human embryos to treat an inherited form of heart disease. The day after the research was published, a group of genetics experts published a statement calling for further debate before applications of the technology are taken any further in humans. According to a new survey of 1,600 adults published in the journal Science today, much of the American public shares this desire for engagement in decision-making. (Abed, 8/11)

The Washington Post: Babies With A Rare, Severe Form Of Epilepsy Depend On This Drug. The Maker Stopped Selling It.
The medicine has had a powerful effect. Seizures that once struck multiple times an hour now come once every five or six days. But the drug came with a deadline: At the end of June, GlaxoSmithKline, the British drug company that sells Potiga, pulled it off the market because of declining sales, forcing families to stockpile supplies or wean their children off a drug that dramatically improved their quality of life. The dilemma faced by parents whose children benefited from Potiga — and future families who potentially may never have access to the drug — highlights the limitations of drug companies’ business model. (Johnson, 8/11)

Kaiser Health News: End-Of-Life Advice: More Than 500,000 Chat On Medicare’s Dime
The 90-year-old woman in the San Diego-area nursing home was quite clear, said Dr. Karl Steinberg. She didn’t want aggressive measures to prolong her life. If her heart stopped, she didn’t want CPR. But when Steinberg, a palliative care physician, relayed those wishes to the woman’s daughter, the younger woman would have none of it. ... Steinberg used an increasingly popular tool to resolve the impasse last month. He brought mother and daughter together for an advance-care planning session, an end-of-life consultation that’s now being paid for by Medicare. In 2016, the first year health care providers were allowed to bill for the service, nearly 575,000 Medicare beneficiaries took part in the conversations, new federal data obtained by Kaiser Health News show. (Aleccia, 8/14)

State Watch

Rural Hospitals Still Face Continuing Difficulties

Even though the Capitol Hill repeal-and-replace debate -- and its proposed funding cuts -- has quieted, worries persist about the future capacity of these facilities to provide services. The Wall Street Journal, for instance, examines the dangers of childbirth in rural America.

The Wall Street Journal: Rural America’s Childbirth Crisis: The Fight to Save Whitney Brown
Since the start of the century, it has become more dangerous to have a baby in rural America. Pregnancy-related complications are rising across the U.S., and many require specialized care. For some women, the time and distance from hospitals with the resources and specialists to handle an obstetric emergency can be fatal. The rate at which women died of pregnancy-related complications was 64% higher in rural areas than in large U.S. cities in 2015. That is a switch from 2000, when the rate in the cities was higher, according to Centers for Disease Control and Prevention data analyzed by The Wall Street Journal. (McKay and Overberg, 8/11)

Texas Senate OKs Bill Restricting Insurance Coverage Of Abortion

Opponents say the measure, now headed for the governor's desk, is another attempt to stigmatize abortion.

Houston Chronicle: Abortion Insurance Coverage Bill Wins Initial Passage 
Texas women are on the verge of having to buy additional insurance to cover abortions if they want it under a bill that will likely land on the governor's desk early next week, dealing a win to conservative Republicans. The Senate passed the bill on a 20-10 vote Saturday evening, leaving it one perfunctory vote away from heading to Gov. Greg Abbott, who is expected to sign the legislation. It is one of 20 items he considered must-pass measures in the special session that ends Wednesday. (Wallace and Zelinski, 8/12)

The Associated Press: Texas Senate OKs Restricting Insurance Coverage For Abortion
The Republican-controlled Texas Senate backed a plan Saturday night to restrict insurance coverage for abortions, over the objections of opponents who expressed concern it could force some women to make heart-wrenching choices because no exceptions will be made in cases of rape and incest. The 20-10 party-line vote for preliminary approval requires women to purchase extra insurance to cover abortions except amid medical emergencies. (Weissert and Crary, 8/13)

Also in the news from Texas -

Texas Tribune: Texas House Votes To Extend Life Of Maternal Mortality Task Force
Legislation that would extend the life of a state task force studying Texas’ high maternal morbidity rates was tentatively approved by the Texas House late Sunday night. The task force, launched by the Legislature in 2013, found that between 2011 and 2012, 189 Texas mothers died less than a year after their pregnancies ended, mostly from heart disease, drug overdoses and high blood pressure. (Samuels, 8/13)

Illinois Halves Number Of Insurers In Overhaul Of Medicaid Managed Care Program

The more than 500,000 state residents who were in the six plans that are no longer participating will have to switch insurers. Also in Medicaid news, an Iowa woman ties changes in the program there to her husband's death, complaints about Mississippi's program and Maine prepares for a referendum on expanding the program.

Chicago Tribune: Illinois Names 6 Insurers To Take Part In Overhauled Medicaid Managed Care 
More than half a million Illinois residents on Medicaid are about to see major changes in their coverage as the state slashes in half the number of insurers in its Medicaid managed care program. The Illinois Department of Healthcare and Family Services announced Friday that it has selected six insurers to be part of Gov. Bruce Rauner's planned overhaul of the program, down from the 12 now participating. In Medicaid managed care, private insurers administer Medicaid benefits, whereas the state administers benefits in traditional Medicaid. (Schencker, 8/11)

Des Moines Register: A Medicaid Patient Lost The Care He'd Received For 20 Years. 3 Months Later, He Was Dead.
Thirty-two years ago, a vehicle accident left Todd Mouw a quadriplegic, unable to feed himself and needing a ventilator to breathe. Yet for decades he was able to live at home with the help of family, aided by medical staff who visited him daily to help provide 24-hour care. That care abruptly ended when a for-profit company that Iowa hired last year to manage the state's Medicaid program announced that some of the staffers who had attended to Mouw all those years weren't qualified, and it wouldn't pay for the cost. (Clayworth, 8/12)

The Associated Press: Complaints Challenge Mississippi Medicaid Decision
A nonprofit organization supported by hospitals and another health care provider have filed complaints over Mississippi Medicaid's decision to award a major managed care contract to other companies. Mississippi True, a newly formed nonprofit backed by 65 hospitals, and Amerigroup have gone to court asking for damages and seeking a court order to bar the state from finalizing the Medicaid contract, which they contend was awarded improperly. (8/12)

The Associated Press: Medicaid Referendum Has Each Side Accusing Other Of Misinformation
As congressional efforts to change former President Barack Obama’s health law sputter, a push to expand Medicaid in Maine has opponents raising questions about the source of future federal funding. Maine voters are set to consider a Nov. 7 ballot question to require the state to apply for a Medicaid expansion for adults under 65 with incomes at or below 138 percent of the federal poverty line. (8/12)

State Highlights: State Attorneys General Step Up Litigation On A Range of Health Issues; Fla. Lawsuit Targets Medicare 'Observation Status'

Media outlets report on news from Wisconsin, Florida, California, Georgia, Illinois, Texas, Pennsylvania, New Hampshire and Arizona.

The Associated Press: Democratic Attorneys Escalate Legal Fight Against Trump
[A]n emboldened coalition of Democratic state attorneys general has unleashed a torrent of lower-profile litigation they argue is necessary to protect public health, the environment and consumers from a Republican White House. State attorneys from Massachusetts to New York to California, often working together, have brought more than 40 legal actions against the Trump administration over the last seven months. The pace, which both parties describe as unprecedented, has produced an average of one lawsuit or legal motion every five days since Trump’s inauguration, not including many more letters, legal threats and formal comments to federal agencies. (Peoples, 8/13)

Naples (Fla.) Daily News: Lawsuit Aims To Give Medicare Seniors Rights On Hospital Stay
Connie Ragonesi spent seven days in a hospital bed in Florida with a fractured ankle, and it set in motion years of heartache. The 88-year-old was cared for under “observation status,” a Medicare policy that became a nightmare and contributed to her having to sell her home in Wellington, on the state’s east coast, according to her daughter, Carol Taylor. ... The Washington, D.C.-based Center for Medicare Advocacy, which focuses on seniors’ rights, was recently granted class action status in a lawsuit against the federal government regarding the policy. The issue is whether patients should have the right to appeal to Medicare when they are placed by a hospital on the outpatient-based observation designation, as opposed to admitted. (Freeman, 8/12)

Milwaukee Journal Sentinel: New State Law On Dental Hygienists Could Be A 'Game Changer' In Improving Access To Basic Care
The new law enables clinics — particularly those such as community health centers that provide care primarily to people with low incomes — to hire dental hygienists to provide basic preventive care, such as cleanings, fluoride varnishes, sealants and education on oral health. ...Access to dental care for adults and children covered by Medicaid programs, such as BadgerCare Plus, is a longstanding problem throughout Wisconsin. (Boulton, 8/12)

San Francisco Chronicle: California’s Assisted-Dying Loophole: Some Doctors Won’t Help Patients Die
Judy Dale died of cancer in her San Francisco home in September, in agony, after being denied the pain-relieving medication she might have received under the state’s aid-in-dying law that had taken effect three months earlier. A lawsuit by her children will determine whether UCSF Medical Center, where Dale first went for treatment, was responsible for her suffering by allegedly concealing its oncologists’ decision not to provide life-ending drugs to patients who ask for them. (Egelko, 8/12)

Atlanta Journal-Constitution: Some Georgia Retirees Will See Big Boost In Health Insurance Premiums
While Georgia’s state employees and teachers will see an average 3.7 percent hike in their health insurance premiums in 2018, the news is much worse for some retirees. About 46,000 retired teachers and state employees, and their dependents, currently get coverage from “premium” health insurance plans offered by Blue Cross Blue Shield and UnitedHealthcare through the State Health Benefit Plan. (Salzer, 8/11)

Los Angeles Times: Despite California's Strict New Law, Hundreds Of Schools Still Don't Have Enough Vaccinated Kids
Even with a new law that has boosted kindergarten vaccination rates to record highs, hundreds of schools across California still have so many children lacking full immunization that they pose an increased risk of disease outbreaks, according to a Times analysis of state data. At nearly 750 schools, 90% or fewer kindergartners had been fully vaccinated last year, the analysis found. Experts say the rate should be at least 95% to prevent the spread of highly contagious diseases such as measles. (Karlamangla and Poindexter, 8/13)

Austin American-Statesman: Texas Ranks 11th Worst State For Health Care
The state of Texas ranks as the 11th worst state for health care, according to the personal-finance website WalletHub’s study of the year’s best and worst states for health care. ...The study compared each state and the District of Columbia 35 different measures of cost, accessibility and outcome to determine which state offered the best health care to citizens. (Hubby, 8/11)

The Philadelphia Inquirer: Ironstone Wins North Philadelphia Health System Bankruptcy Auction
Ironstone Real Estate Partners won Friday’s North Philadelphia Health System (NPHS) bankruptcy auction, agreeing to pay $8.5 million in cash with no contingencies, but with some twists to make the deal for the behavioral health operation work. Philadelphia-based Ironstone’s price is less than the baseline, or stalking-horse, bid of $10 million set by Meridian Behavioral Health Systems LLC, a Tennessee chain with facilities in four states, but Meridian’s offer was laden with conditions on the city and on unions that would have made it hard to complete the purchase. (Brubaker, 8/11)

Santa Rosa Press Democrat: New Sonoma County Jail Wing Seeks To Improve Care For Mentally Ill Inmates
When Sonoma County sheriff’s officials publicly revealed their plans last spring to build a $48 million jail wing for the mentally ill, a common question quickly emerged. Why not build a psychiatric hospital instead in Sonoma County? After all, the only local hospital beds for mental health patients are operated by a for-profit company, while many low-income residents suffering a psychiatric crisis often wait for hours in an emergency room, waiting for a bed to free up in a psychiatric hospital in another county. (Espinoza, 8/12)

Santa Rosa Press Democrat: Jail Is Largest Psychiatric Facility In Sonoma County
The largest psychiatric facility in Sonoma County is not a hospital.It’s the jail.If not by design then by default, jail cells have essentially replaced psychiatric hospital beds for many of Sonoma County’s most severely mentally ill residents. It is a trend that began before the closure of Santa Rosa’s two secured mental health hospitals a decade ago, and has continued since. Now, nearly 40 percent of the 1,100 inmates held at the county’s main jail and its lower-security North County Detention Facility near the Charles M. Schulz-Sonoma County Airport have some form of mental health issue, from mild depression to bipolar schizoaffective disorder. (Espinoza, 8/12)

Milwaukee Journal Sentinel: Seven People Sickened By Salmonella From Shelled Peas Purchased At Farmers Markets
Seven people have been sickened by salmonella bacteria after eating fresh shelled (loose) peas purchased at three farmers markets in Wisconsin, state health officials said Friday. The announcement came as federal health officials reported that the number of cases from a fatal nationwide salmonella outbreak linked to imported papayas -- which includes one case in Wisconsin -- has risen to 141. (Garza, 8/11)

Boston Globe: Parts Of N.H. Hospital Evacuated After Staff Sickened
Two sections of Exeter Hospital were evacuated Friday after 19 staff members reported flu-like symptoms in the inpatient operating room, a hospital official said. The cause of the staff members’ sickness at the New Hampshire hospital remained a mystery Friday, officials said. (Ellement and McDonald, 8/11)

San Antonio Express-News: Will Medical Air Transport Be There For You?
Much like many rural hospitals that are faced with impossible financial circumstances, air medical transport bases are being forced to close around the nation, leaving Americans without access to life-saving care. Already, 85 million of our fellow citizens (1 in 4) can only reach a Level 1 or 2 Trauma Care facility within an hour if they are brought there by a helicopter air ambulance. (LaRue, 8/13)

Editorials And Opinions

Viewpoints: Democrats Could Repeat GOP's Mistake On Health; Business Isn't Waiting For Congress To Act

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

The Washington Post: The Bernie Bros And Sisters Are Coming To Republicans’ Rescue
Things could go well for the Democrats in next year’s midterm elections — if they don’t Bern out. ... Bernie Sanders’s advisers are promoting a “litmus test” under which Democrats who don’t swear to implement single-payer health care would be booted from the party in primaries. Sanders pollster Ben Tulchin penned an op-ed with a colleague under the headline “Universal health care is the new litmus test for Democrats.” Nina Turner, head of the Sanders group Our Revolution, told Politico this week that “there’s something wrong with” Democrats who won’t “unequivocally” embrace “Medicare-for-all.” (Dana Milbank, 8/11)

The New York Times: Single Payer Or Bust?
If you’re a normal person who doesn’t have much time to burrow into the details of policy, you can be forgiven for thinking that the health care choice we face in this country is between the current improving but still inefficient and dissatisfying status quo and a single-payer system. After all, single payer, in which the federal government acts as every American’s insurance provider, is the only alternative that ever gets discussed. But that isn’t the case. Single payer is a policy choice, not a principle. The principle is universal coverage. Single payer is one way to get there. It’s how Britain and Canada do it. But there are other ways. (Michael Tomasky, 8/14)

Los Angeles Times: Forget About Single-Payer Healthcare. This California Congressman Has The Real Solution: Medicare For All
Dreaming of a state-run single-payer healthcare system? Wake up and enter the real world. Want universal healthcare for all Americans? Medicare for all is the solution. Not this year or next, but possibly in the future — when Democrats recapture the presidency and Congress. That’s the clear-eyed, pragmatic fight to engage in, and one advocated by U.S. Rep. John Garamendi (D-Walnut Grove), a longtime healthcare warrior. “Medicare is far, far more efficient than private insurance companies,” he said. “Using the tax system to collect money for healthcare delivery is extremely efficient. No profits. No commissions. No advertising.” (George Skelton, 8/14)

Georgia Health News: Medicaid Expansion Is A Proven Loser, So Don’t Fall For It
The chaos that continues to engulf the health care debate in Washington, D.C.. reaffirms the assertion that states must forge their own paths to protect the most vulnerable people in their communities. But too many states have turned to an expansion of Medicaid through Obamacare as a solution — putting their truly needy at risk and leaving taxpayers with surging costs as a result. (Jason Spencer, 8/13)

The New York Times: On Health Care, Who Needs Congress?
Regardless of whether Congress enacts health care reform, the private sector isn’t waiting. Health care for our employees is too expensive, and the employer-based system must be reformed. ... The United States government defines health care as “affordable” if it costs less than 9.7 percent of a household’s income. By that standard, in less than 10 years more than half of employees who are heads of families are projected to be unable to afford their health care costs, creating a significant problem for everyone. (Robert Andrews, 8/11)

The New York Times: An Assault On Efforts To Prevent Teenage Pregnancy
With flimsy justification, and in small type buried in routine documents, the Trump administration has informed 81 local governments and health groups that it will end grants they have received to run teen pregnancy prevention programs, two years before the grants are scheduled to end. The decision is unsettling even by the disquieting standards of this anti-science administration. (8/11)

Los Angeles Times: Please Mr. President, Don't Criminalize Opioid Addicts As Part Of Emergency Response
Trump focused instead on stepping up law enforcement and border security, leading many to fear he is more interested in a taking an old-school “war on drugs” approach than treating the epidemic appropriately as a public health issue and addicts as people who are sick. ... The LA Times’ editorial board has some suggestions for the feds and states on how to do this: First and foremost, do not treat this as a law enforcement problem. The nation’s “war on drugs” was an expensive failure that didn’t stop drug abuse. It just filled up jails and ruined lives. Let’s not repeat that mistake. In that same vein, please don’t criminalize addicts. Help them. Especially if they are pregnant women. (Mariel Garza, 8/11)

The Washington Post: How Seeing A Dead Body Brought The Maryland Opioid Crisis Home
With some apprehension, I agreed to join colleagues from the Maryland General Assembly on a tour of the Maryland Office of the Chief Medical Examiner to learn about forensic investigations, evidence collection and cause and manner of death, issues relevant to topics debated in the House Judiciary Committee. They also are relevant to the state’s opioid epidemic. (Del. Pamela E. Queen, 8/12)

The New York Times: Stop Treating 70- And 90-Year-Olds The Same
Just as we don’t confuse toddlers with teenagers, or young adults with their middle-age parents, so, too, are we able to distinguish 70-year-olds from the nonagenarians a generation ahead of them. Those two groups — the “young old” and the “old old” — don’t just differ in how they look and spend their days; they also differ biologically. As a result, it’s likely that we are incorrectly vaccinating a significant number of the 47 million Americans over 65. (Louise Aronson, 8/11)

The New York Times: The Foolish Transgender Debate In Texas
While much of the nation appears to be adjusting to the transgender rights movement, social conservatives in the Texas Legislature — prodded by Lt. Gov. Dan Patrick, a Republican — continue their obsessive campaign to restrict the bathroom rights of transgender citizens. They are fighting to the very end of the current special session, in the face of a storm of powerful opposition that ranges from the state’s Fortune 500 companies and business leaders to police chiefs, sports and tourism executives, concerned parents, and pastors in an evangelical community divided over the lack of basic charity underlying the anti-transgender legislation. (8/11)

The Wall Street Journal: Philadelphia’s Soda Tax Bust
The best laid plans of politicians often go awry, and then there’s Philadelphia’s soda tax. A new Tax Foundation report finds that the 1.5-cent-an-ounce levy that took effect in January is hurting low-income workers and producing less revenue than promised, but at least it’s helping beer sales. (8/13)

The Washington Post: I Worked All My Life And Then Had A Stroke. I Need Disability. But I’m So Ashamed.
There may be some folks receiving disability benefits fraudulently, but I do know I got a good going over. A few weeks after my stroke, when I realized I wasn’t going to be able to work, my wife drove me to the Social Security office to apply for benefits. ... Months on, I still haven’t received a single check. Without help from family, I would be homeless, despite over forty years in the work force. To them, I am forever grateful, but also deeply ashamed. (Robert Fowler, 8/10)

Morning Consult: CMS Must Ensure Seniors Have Access to Diabetes Prevention Resources
The scourge of type 2 diabetes across the United States costs American taxpayers billions of dollars every single year. Diabetes and diabetes-related treatment is one of the biggest drivers of rising healthcare costs for every payer — with Medicare spending more on treating those with the disease every year. ... Last month, for the first time in the agency’s history, the Centers for Medicare and Medicaid Services laid out proposed rules to reimburse providers to proactively prevent chronic disease by paying for the evidence-based Diabetes Prevention Program for eligible beneficiaries. ... But unfortunately, the proposed rule missed a huge opportunity to extend access to this benefit to the area most in need: rural America. (Sean Duffy, 8/14)