KHN Morning Briefing

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Health Law

'Political Punt' Or GOP's Best Chance: Attention Shifts To Skinny Plan As Other Options Fail

The plan would roll back only a few of the Affordable Care Act's provisions, but in such a divided Senate, it might be Republicans' only hope of getting something passed.

The Associated Press: GOP Eyes Narrow Bill To Advance Goal On 'Obamacare' Repeal
They couldn't pass a repeal of "Obamacare," or find the votes for a White House-backed replacement. So now Senate Republicans are lowering their sights and trying to unite behind a so-called "skinny repeal" that would merely undo just a few of the most unpopular elements of Barack Obama's law. The "skinny bill" is an admittedly lowest-common-denominator approach, and it may not even have the votes to pass, either. But as Republicans search for how to keep their years-long effort to repeal and replace "Obamacare" alive, they're coming to believe that the "skinny bill" may be the only option left. (Werner, 7/27)

Politico: 'Skinny' Obamacare Repeal Still Lacks Votes To Pass
Even a bare-bones repeal of Obamacare is no sure thing in the Senate. A handful of key Republican senators who had spurned earlier overtures from GOP leadership endorsed the latest plan to gut Obamacare’s individual and employer coverage mandates and its medical device tax. But several centrists said they’re undecided on the so-called skinny repeal, leaving the GOP in limbo through at least the end of the week. (Everett, Haberkorn and Kim, 7/26)

Boston Globe: Senate GOP Fails In Obamacare Repeal, Setting Up Bid To Chip Away At Some Rules
The impact of the new proposal has not been measured by the nonpartisan Congressional Budget Office or formally presented to the American public, but the office has said similar ideas would result in 15 million fewer people having health insurance and increase premiums. Despite the unknowns, some Senate Republicans were already backing the proposal Wednesday as a means of salvaging a slim political victory. (Herndon, 7/27)

The Washington Post: GOP Momentum Grows For More Modest Plan To Overhaul Obamacare
Top Republicans such as Sen. John Thune (S.D.), the chamber’s third-ranking Republican, said that although leaders have not yet found “the sweet spot” between conservatives and centrists, they had picked up support for a more modest plan because it did not include deep cuts to Medicaid. Some Republican senators were simply open to any legislation that could keep alive the roller-coaster push for an overhaul. (Eilperin, Snell and Sullivan, 7/26)

The Wall Street Journal: Senate GOP’s Fallback Plan Gains Support After Vote To Repeal Health Law Fails
Republican senators said they recognized passing a “skinny repeal” would essentially postpone tough decisions on health care until later, but they seized on it as potentially their best option as the Senate this week began considering and rapidly discarding other plans, with no alternative appearing likely to attract the 50 Republican votes needed to pass. (Peterson, Hackman and Armour, 7/26)

Los Angeles Times: Running Out Of Options To Overhaul Obamacare, Senate Republicans Ponder A 'Skinny' Repeal
"I’ve got to think about moving things along to get to conference to hopefully get a good product," said Sen. Charles E. Grassley (R-Iowa), who viewed the skinny alternative as a step toward something more comprehensive. On Wednesday, GOP senators spent another frustrating and fruitless day debating and rejecting possible approaches. After voting down their leaders' most comprehensive overhaul plan a day earlier, Republicans rejected another long-standing GOP idea on Wednesday: to simply repeal most of Obamacare. (Mascaro, 7/26)

San Francisco Chronicle: Republicans See A Narrow Path To Health Care Repeal
A razor-thin Senate vote Tuesday to begin the health care debate gave Republicans an opening to pass a stripped-down “skinny repeal” by the end of the week that would repeal mandates in the current law on individuals to buy insurance and most employers to provide it, and a tax on the sale of some medical devices. Health and Human Services Secretary Tom Price described the approach as finding the “lowest common denominator” of what Senate Republicans can pass with the 50 votes they need, along with a tie-breaking vote from Vice President Mike Pence. (Lochhead, 7/26)

CNN: Health Care Debate: Senate Vote-A-Rama And The 'Skinny Bill'
The Senate will enter the home stretch of a dramatic debate to overhaul Obamacare on Thursday, with lawmakers bracing for what could be a long and grueling marathon series of votes that extends well into the night and morning. And the text of the GOP plan -- what is expected to be a so-called "skinny bill" that rolls back Obamcare's individual and employer mandates -- remains unseen by senators or the public. (Lee, Fox, Barrett, and Mattingly, 7/27)

Bloomberg: GOP Promise To Torch Obamacare Veers Toward Bare-Bones Repeal
Senate Minority Leader Chuck Schumer of New York warned that the passage of a "skinny repeal" alternative is a gambit to get Senate and House Republicans together in talks on a broader replacement plan. “There is no such thing as ‘skinny’ repeal,” Schumer said Wednesday on the Senate floor. “It’s a ruse to get to full repeal, with all the concomitant cuts to Medicaid and tax breaks, which are so unpopular and which so many of my Republican colleagues here on the other side have opposed.” (Litvan and Kapur, 7, 27)

If the legislation does pass, it will next go to conference with the House, where more changes and fights are expected —

The Washington Post: The Senate’s Possible ‘Skinny Repeal’ Of Obamacare Faces Skepticism In The House
Some in the Senate have suggested that the downsized bill would represent a bridge to a conference committee, where the two chambers would meet to resolve their differences. But House Republicans who fought tooth and nail over the course of months earlier this year to expand the scope of the repeal legislation are saying “fat chance” to the skinny repeal — including key members on the conservative and moderate ends of the GOP — and say it is difficult to see what legislative product could span the divide between the chambers. (DeBonis, 7/26)

The Hill: Bare Bones Repeal Plan Gains Steam In Senate
One House GOP lawmaker close to leadership said it's possible the House could stay in until Saturday to pass the skinny repeal bill, which would mean skipping a conference committee. But the lawmaker said the course had not been decided. (Sullivan and Weixel, 7/26)

Politico: House GOP Wary Of ‘Skinny’ Repeal
House Republicans say they understand the complicated intraparty dynamics of the Senate, where several moderate GOP senators don’t want to repeal Obamacare without replacing it. Yet they privately worry that a number of vulnerable House Republicans have already taken tough votes — cutting $800 billion from Medicaid, for instance — that their Senate GOP colleagues refuse to support, exposing those House members to serious political jeopardy in November 2018. (Bresnahan and Haberkorn, 7/26)

Marketplace Will Slide Into Death Spiral Under Skinny Plan, Insurers Warn

Young, healthy people would no longer have an incentive to buy insurance if the individual mandate is scrapped, thus driving costs up for everyone. Meanwhile, KHN offers a look at how "things went badly" when states tried to lift coverage requirements.

The Wall Street Journal: Insurers Warn About Lack Of Coverage Mandate In Senate’s ‘Skinny Repeal’ Option
Health insurers came out strongly against the idea of any bare-bones health-care bill that would repeal the ACA’s coverage mandate without other measures aimed at stabilizing the law’s insurance exchanges. “If there is no longer a requirement for everyone to purchase coverage, it is critical that any legislation include strong incentives for people to obtain health insurance and keep it year-round,” the Blue Cross Blue Shield Association said in a statement. “A system that allows people to purchase coverage only when they need it drives up costs for everyone.” (Armour, Wilde Mathews and Hackman, 7/26)

Kaiser Health News: States Have Tried Versions Of ‘Skinny Repeal.’ It Didn’t Go Well.
Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a “skinny repeal” that rolls back an unpopular portion of the federal health law. But experts warn that the idea has been tried before, and with little success. Senators are reportedly considering a narrow bill that would eliminate the Affordable Care Act’s “individual mandate,” which assesses a tax on Americans who don’t have insurance, along with penalties for employers with 50 or more workers who fail to offer health coverage. (Appleby, 7/27)

Politico: 'Skinny' Repeal Could Have Big Ramifications For Obamacare Markets
Senate Republicans are hoping a “skinny” repeal bill can solve their stalemate over dismantling Obamacare. But this partial Obamacare repeal — which is gaining steam in the Senate — could destabilize already wobbly Obamacare insurance markets, make premiums jump and increase the number of uninsured by millions, health policy experts say. “I call it the 20-percent-increase-in-premiums-and-at least-15-million-out-of-insurance plan,” Sen. Claire McCaskill (D-Mo.) said. “It’s a terrible idea.” (Demko, 7/26)

Los Angeles Times: Obamacare 101: Would A 'Skinny Repeal' Trigger A Death Spiral?
Few experts believe that the employer mandate has had much effect, largely because the vast majority of large employers already provide health benefits. In fact, when the Obama administration delayed implementation of the mandate, there was little evidence that employers started dropping coverage. Repealing the so-called individual mandate is potentially more problematic. Independent analyses by the Congressional Budget Office, or CBO, and others suggest that without some kind of penalty, many healthy Americans would not get insurance until they were sick. That would push up health insurance costs, causing what people in the business call a death spiral. (Levey, 7/26)

Boston Globe: Baker Signs Letter Urging Senate To Set Aside ‘Flawed’ Health Care Proposal
Governor Charlie Baker has signed a letter urging US Senate leaders from both parties to set aside a “flawed” attempt to repeal the Affordable Care Act, which is commonly referred to as Obamacare. Senate Republicans are now trying to pass what has been referred to as a “skinny repeal” of Obamacare, which would likely include changes to the law such as dropping its requirements that people buy insurance and large employers provide health plans to their employees, but no outright repeal. (McDonald, 7/27)

Given The Option To Repeal Obamacare, Senators Balk

The "clean" repeal proposal would have given lawmakers two years to come up with an alternative, but some Republicans found the idea untenable.

The New York Times: Senate Soundly Rejects Repeal-Only Health Plan
The rejection of “clean repeal” laid bare the deep divisions within the Republican caucus about how best to proceed. The night before, nine Republicans, including both conservatives and moderates, voted against comprehensive legislation to repeal the health law and provide a replacement. Without the votes to replace the health law or to simply repeal major parts of it, Senate Republicans appeared increasingly likely to try to pass a modest measure that would repeal only a few provisions of the law, such as the tax on medical devices and the requirements that most individuals have insurance and that large employers offer coverage to workers. (Kaplan, 7/26)

Murkowski's 'Spine Of Steel' On Display During Health Care Debate

Sen. Lisa Murkowski (R-Alaska) has remained an unshakable opponent to Republicans' health care efforts even after President Donald Trump accused her of letting the party down.

The New York Times: Lisa Murkowski, A Swing Vote On Health Care, Isn’t Swayed
Lisa Murkowski had heard enough. As President Trump pressed her and her fellow Senate Republicans last week to fall in line behind a repeal of the Affordable Care Act in the interest of party loyalty and protecting the Republican brand, she felt compelled to speak up. “With all due respect, Mr. President,” she said, according to some of the people at the private White House lunch, “I didn’t come here to represent the Republican Party. I am representing my constituents and the state of Alaska.” (Hulse, 7/26)

The Hill: Trump’s Attacks Stun Republican Senators
In another shot heard loud and clear in the Senate, Trump blasted Sen. Lisa Murkowski (R-Alaska) on Wednesday after she joined Sen. Susan Collins (R-Maine) in voting against a motion to proceed to healthcare legislation despite heavy lobbying from the president. (Bolton, 7/27)

With Vote-A-Rama Looming, Dems Are Fed Up: 'This Is A Joke, And We’re Not Going To Participate Anymore'

The Democratic senators say they see no point in offering up their proposals if they’re amending what they say is a shell of a health care bill.

The Hill: Dems Don’t Want To Help GOP Improve Repeal Bill
Democrats are walking a fine line as they try to keep their caucus unified ahead of a showdown on repealing and replacing ObamaCare. The Senate is expected to start up an hours-long marathon session, known as a vote-a-rama, as soon as Thursday, giving both parties a chance to try to force the other side of the aisle to take politically tough votes. The free-wheeling floor drama could give Republicans a shot at putting the spotlight on Democrats. As GOP senators have been beset by months of outside ads and waves of angry constituents, Democrats have been largely unified despite having 10 senators up for reelection in states won by President Trump. (Carney, 7/26)

Politico: Dems To GOP: No Amendments Until You Show Us Your Bill
Senate Democrats are taking their ball and going home in the looming health care vote-a-rama — until Republicans finally cough up their actual Obamacare repeal plan. Fed up with the GOP’s constant vacillations over how to dismantle Obamacare, Democrats say they will hold back on offering any more amendments in the health care floor fight until Senate Majority Leader Mitch McConnell (R-Ky.) shows what plan the GOP will ultimately coalesce around. (Kim, 7/26)

USA Today: Democrats Seize On John McCain’s Message In Health Care Fight
Democrats are seizing on GOP Sen. John McCain’s call for a back-to-the-drawing-board approach to health care reform, with committee hearings and input from both parties if the GOP bill fails. The Arizona Republican’s message — delivered Tuesday during his dramatic return to the Senate after revealing he has brain cancer — bolstered Democrats’ long-running complaints about being cut out of the process. (Guadiano, 7/26)

The Washington Post: Sanders Won’t Vote For Republican ‘Single-Payer’ Amendment
A spokesman for Sen. Bernie Sanders (I-Vt.) said Wednesday night that he and other members of the Democratic caucus would reject an amendment to the Republican health-care bill designed to smoke out support for single-payer health care. The amendment proposed by Sen. Steve Daines (R-Mont.), said a Sanders spokesman, was a “sham” that could be ignored. (Weigel, 7/26)

The New York Times: Former Obama Aides Lead Opposition To Health Care Repeal
Several former Obama administration officials were on their regular Wednesday morning conference call this week, plotting against Republican efforts to repeal the Affordable Care Act, when Tom Price, the secretary of health and human services, said on CNBC that his party should shoot for “the lowest common denominator” on health care. (Shear and Pear, 7/27)

Reconciliation Was Never Intended For Policy As Complex As Health Care -- And It Shows

Because of the process Republicans are using to roll back health care is tied to how the provisions affect the budget, they have backed themselves somewhat into a corner.

The New York Times: Republican Gamble On Fast-Track Rules For Health Care Hits Wall
With the economy stagnating and Congress bridling at President Richard Nixon’s heavy-handed spending controls, lawmakers in 1974 created a fast-track procedure to help make the tough decisions on rising budget deficits and swelling entitlement spending. Since then, that process — called reconciliation — has been warped for many purposes, including large tax cuts, but never has it been used for the kind of complex policy making that Republicans are trying to do now with health care. And it is showing. (Pear, 7/26)

Meanwhile, a look at what the vote-a-rama actually is —

Atlanta Journal-Constitution: The Byzantine Ritual That Sits Between The GOP And Health Care Reform
Senators must endure dozens of policy amendments in rapid-fire succession stretching late into the night, a marathon procedure former New Hampshire Sen. Judd Gregg once described as “the Senate’s equivalent to Chinese water torture.” Only after the Democrats tire themselves out do Republican leaders get the opportunity to tee up a final vote on some sort of health care proposal, although the end game remains extraordinarily fuzzy at this point. (Hallerman, 7/27)

Uncertainty In Washington Keeping Insurers, State Commissioners Off Balance

In an industry that relies on predictability the debate in Washington and the ever-looming threat that the president will cut off subsidies have rocked those trying to keep it stable.

The Wall Street Journal: Anthem Seeks Clarity From Health Law Debate
Anthem Inc. said that if it doesn’t quickly get more certainty about the future of the Affordable Care Act exchanges, it will likely further pull back its planned participation for next year, a threat that adds to the pressure on Senate Republicans as they struggle to pass health-care legislation. (Wilde Mathews, 7/26)

Bloomberg: Obamacare Chaos in Washington Leaves Health Investors Unfazed
Wall Street’s apparent indifference to the possibility that Republicans will succeed in repealing the ACA shows how the for-profit health industry has largely separated itself from the law’s fate. While Obamacare brought insurance to 20 million people, drugmakers say it hasn’t boosted their profits. Publicly traded insurers have largely quit the health law’s markets after losing money. And hospitals have bigger problems, tied to structural shifts in how people are getting care. (Bloomberg, 7/26)

NPR: 'Sky-High' Pay For CEOs Of Health Care Firms Raises Questions
In the seven years since the Affordable Care Act was passed, CEOs of U.S. health care companies have made a lot of money. Their compensation far outstrips the wage growth of nearly all Americans, according to reporter Bob Herman, who published an analysis this week of "the sky-high pay of health care CEOs" for the online news site, Axios. (Siegel and Columbus, 7/26)

Administration News

Trump Bans Transgender People From Military, Citing Medical Costs Among Reasons

The announcement comes just as a storm over whether taxpayer money should pay for gender transition and hormone therapy for transgender service members was brewing on the Hill, threatening to derail a $790 billion defense and security spending package that includes funds for President Trump's border wall.

The New York Times: Trump Says Transgender People Will Not Be Allowed In The Military
President Trump abruptly announced a ban on transgender people serving in the military on Wednesday, blindsiding his defense secretary and Republican congressional leaders with a snap decision that reversed a year-old policy reviled by social conservatives. Mr. Trump made the declaration on Twitter, saying that American forces could not afford the “tremendous medical costs and disruption” of transgender service members. He said he had consulted generals and military experts, but Jim Mattis, the defense secretary, was given only a day’s notice about the decision. (Davis and Cooper, 7/26)

The Washington Post: Trump Announces That He Will Ban Transgender People From Serving In The Military
Trump’s decision comes two weeks after the House rejected an amendment to the annual defense policy bill that would have blocked the Pentagon from offering gender transition therapies to active-duty service members. Twenty-four Republicans joined 190 Democrats voting to reject the measure. But conservative lawmakers — many of them members of the House Freedom Caucus — had threatened to withhold support for a spending bill if Congress did not act to prohibit the Pentagon from paying for the procedures. The impasse broadly threatened government spending, but most importantly for Trump, it potentially held up money that had been appropriated for the border wall between the United States and Mexico, a key promise he had made during the campaign. (Phillip, Gibbons-Neff and DeBonis, 7/26)

Politico: Inside Trump’s Snap Decision To Ban Transgender Troops
After a week sparring with his attorney general and steaming over the Russia investigation consuming his agenda, President Donald Trump was closing in on an important win. House Republicans were planning to pass a spending bill stacked with his campaign promises, including money to build his border wall with Mexico. But an internal House Republican fight over transgender troops was threatening to blow up the bill. (Bade and Dawsey, 7/26)

The Washington Post: Hill Democrats Slam Trump’s Military Transgender Ban, While GOP Is Caught By Surprise
Lawmakers in both parties slammed President Trump’s decision on Wednesday to bar transgender Americans from serving in the military, while many of his allies on Capitol Hill remained largely perplexed or silent. The president’s decision, announced in a series of tweets, is yet another move that confused and divided elements of his party at a time when it is already roiled by disagreements over the future of a proposed health-care overhaul and of embattled Attorney General Jeff Sessions, who has faced a barrage of criticism from Trump in recent days. (DeBonis and O'Keefe, 7/26)

The Washington Post: GOP Reps. Comstock, Taylor Votes On Transgender Issue Reflect Political Landscape Under Trump
President Trump’s decision to ban transgender individuals from serving in the military highlights recent votes on a related issue by two Republican members of Congress from Virginia whose districts are being targeted by Democrats in 2018. They took opposite stances on a measure that would have blocked an Obama-era practice requiring the Pentagon to pay for gender transition surgeries and hormone therapy. The “Hartzler amendment” — named after Rep. Vicky Hartzler (R-Mo.), who proposed adding it to the annual defense policy bill — failed by a vote of 214 to 209. (Portnoy, 7/26)

McClatchy: Pentagon Caught Off Guard By Trump's Transgender Ban
The Pentagon was blindsided by President Donald Trump’s announcement on Wednesday that his administration would block transgender people from the U.S. military, and the Defense Department has no idea yet how it will affect troops already serving. The president’s declaration on Twitter, saying transgender people would not be allowed to serve “in any capacity,” came a year after the Defense Department under former president Barack Obama lifted its ban on transgender troops serving openly. (Bergengruen, 7/26)

The New York Times: For Transgender Service Members, A Mix Of Sadness, Anger And Fear
Joining the Navy was one of the best decisions Alec Kerry said she had ever made. The other was coming out as transgender. “The Navy taught me how people can come together and work hard to achieve something bigger than themselves,” said Petty Officer Kerry, 24, who is training to operate nuclear reactors and soon plans to adopt the name Eva. “Strangely enough, I think what the Navy taught us about integrity was what gave me the courage to come out. I had to be honest about who I was with myself and the people I served with.” (Philipps, 7/26)

Los Angeles Times: Transgender Veterans Outraged By Trump's Sudden Ban On Military Service
Carla Lewis enlisted in the U.S. Air Force in 1990. But the next year, after a background check for a top-secret position revealed that she had seen a counselor for gender identity issues, she was honorably discharged for what her military papers described as “Conditions That Interfere With Military Service — Not Disability — Mental Disorders.” (Pearce, 7/26)

KQED: ‘You Don’t Just Quit’: California Hits Back At Trump’s Transgender Military Ban
President Donald Trump’s announcement early Wednesday that transgender people would no longer be allowed to serve was met with swift reaction and strong opposition among California’s transgender military community and congressional delegation. Trump made the announcement in a series of tweets, concluding with: “Our military must be focused on decisive and overwhelming … victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail.” (Leitsinger, 7/26)

Columbus Dispatch: Transgender Ohioans With Military Ties Shocked, Angry Over Trump's Ban
In a series of tweets posted around 9 a.m. Wednesday, Trump said: “After consultation with my Generals and military experts, please be advised that the United States Government will not accept or allow Transgender individuals to serve in any capacity in the U.S. Military. Our military must be focused on decisive and overwhelming victory and cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail. Thank you.” (King, 7/27)

San Francisco Chronicle: Transgender Ban Is All About Trump Shoring Up His Base
Banning transgender personnel from the military was an easy way for Trump to appeal to his conservative base, which has shown signs of turning on him in recent days because of his ongoing criticism of Attorney General Jeff Sessions. “Time will tell” if Sessions remains employed, Trump said earlier this week. (Garofoli, 7/26)

'Tremendous Cost' Put In Perspective: Military Spends 10 Times More On Viagra Than Transgender Services

Two recent studies seem to contradict the president's justification for banning transgender people from service.

Stat: Trump Says It's Too Pricey To Have Transgender Troops. Here's The Truth
But at least two studies in recent years have found that the cost of medical care for transgender service members would be minimal. A June 2016 study from the RAND Corporation estimated that there were between 1,320 and 6,630 transgender active-duty service members — out of 1.3 million service members in total — and noted that not all of them would seek treatment related to gender transitioning. The study also estimated that the cost associated with medical care for gender transition would only increase military health care expenditures by between $2.4 million and $8.4 million each year — an increase of between 0.04 and 0.13 percent. (Joseph, 7/26)

Cox Media Group: Report: Transgender Health Care Would Cost Fraction Of What Military Spends On Viagra, Similar Drugs
President Donald Trump said Wednesday that “tremendous medical costs” were partially behind his decision to bar transgender Americans from serving in the military. However, a report from The Washington Post showed that estimates for the cost of caring for transgender service members amount to just a fraction of what the military currently spends on erectile dysfunction drugs. (Seiger, 7/26)

Capitol Hill Watch

Conservatives, Angry Over CBO's Health Law Numbers, Fail In Bid To Slash Agency's Budget

"Just like you wouldn't drive a car while blindfolded, you shouldn't be voting on legislation without knowing what the real costs are, intended or unintended," Rep. Jim Costa, D-Calif., told House colleagues in defending the agency.

McClatchy: House Soundly Rejects Conservative Bid To Enviscerate Congressional Budget Office
Conservative House Republicans, enraged by the nonpartisan Congressional Budget Office’s findings that Obamacare’s repeal would leave millions without health care coverage, failed Wednesday in a bid to cut the agency’s budget and staff, a move that would have dramatically weakened its effectiveness. The House rejected, 309-116, an effort by four conservative Republicans, including Rep. Mark Meadows, R-N.C., to eliminate the CBO’s Budget Analysis Division. (Siripurapu, 7/26)

The Hill: CBO Survives Two House Amendments Targeting Funding
“We rely on CBO’s analysts to provide, fair, impartial, and fact-based analysis. Without that analysis, Congress could not do its work or stay within the very budget constraints we set up for ourselves in law,” Ways and Means Chairman Kevin Brady (R-Va.) and Ranking Member Richard Neal (D-Ma.) wrote in a “dear colleague” letter opposing the amendments. (Elis, 7/26)

In other news from Capitol Hill —

McClatchy: House Committee Blocks Bill To Let VA Doctors Prescribe Pot For Pain
Republican lawmakers have blocked a vote on a bill that would have allowed Veterans Affairs doctors to recommend medical marijuana as a pain treatment in states where the drug is legal. The House Rules Committee stopped a proposed “Veterans Equal Access” amendment from moving to debate on the House floor by keeping the measure out of the House’s proposed VA funding bill for next year. (Kime, 7/26)

Pharmaceuticals

Closely Watched Oncology Drugs Fail To Deliver Promising Results

AstraZeneca, which had touted the new approach to cancer treatment, saw its stocks plunge after a disappointing clinical trial.

The Wall Street Journal: AstraZeneca Faces Major Setback Over Cancer Drugs
AstraZeneca said a combination of two of its new oncology drugs failed to shrink lung cancer tumors in a closely watched clinical trial, casting doubt on a central part of the company’s ambitious growth plans. The trial, dubbed Mystic, centered on the combination of two immuno-oncology drugs, which are designed to boost the immune system’s ability to eradicate cancer cells. AstraZeneca said the combination was no better than standard chemotherapy at shrinking tumors in advanced lung cancer. (Roland, 7/27)

Stat: AstraZeneca Lung Cancer Immunotherapy Trial Failure Sends Shares Plunging
highly anticipated clinical trial combining two immunotherapy drugs failed to delay tumor growth in patients with newly diagnosed lung cancer, sending AstraZeneca sharply lower Thursday.The negative results from the so-called MYSTIC study are a stinging setback to AstraZeneca’s ambition to leapfrog over its cancer immunotherapy rivals. (Feuerstein, 7/27)

In other pharmaceutical news —

The Wall Street Journal: Glaxo Slashes R&D Projects To Focus On Top Prospects
GlaxoSmithKline axed more than 30 drug-research projects to focus on four key disease areas, in a push by new Chief Executive Emma Walmsley to sharpen the company’s research-and-development operations. U.K.-based Glaxo said Wednesday it would now focus its research on respiratory diseases, HIV and other infectious diseases, cancer and immuno-inflammatory conditions. (Roland, 7/26)

Public Health And Education

Special Cells In Small Part Of Brain May Be A Primary Culprit Behind Aging

“This is a really important study … in the field of aging research,” Dr. Shin-Ichiro Imai, professor of developmental biology at Washington University in St. Louis, says of new findings on the role played by the hypothalamus. And today's other's public health stories report developments on brain cancer, editing embryo genomes, hospitals' Yelp reviews, the opioid crisis and tainted water.

Stat: A Tiny Part Of The Brain Appears To Orchestrate The Whole Body's Aging
Why do we age? It’s a seemingly simple question that nonetheless scientists don’t have a great answer to. Some amount of aging seems to be controlled by our genetic makeup, while other evidence shows that our cells have an upper limit to how many times they can divide. But a new study points to a different player: a special population of cells in a tiny region of the brain. Middle-aged mice that got an infusion of stem cells to their hypothalamus — the hormone-releasing center of the brain — had less memory loss and longer lives than normal mice, indicating that the hypothalamus plays a role in whole-body aging. (Wosen, 7/26)

The Washington Post: These Experimental Treatments Target Brain Cancer Like John McCain’s
When Sen. John McCain (R-Ariz.) returned to work Tuesday, he seemed his tough old self, saying it would be hard to call the Senate the “world's greatest deliberative body” with a straight face. He added he was headed home soon for treatment for the aggressive brain cancer recently discovered during surgery. McCain hasn't announced his medical care plans, but for most patients, the first-line treatment for glioblastoma is radiation and chemotherapy. But if the cancer recurs, as it usually does, what then? (McGinley, 7/26)

Stat: Genome Of Viable Human Embryos Edited In Controversial Study
In a step that some of the nation’s leading scientists have long warned against and that has never before been accomplished, biologists in Oregon have edited the DNA of viable human embryos efficiently and apparently with few mistakes, according to a report in Technology Review. (Begley, 7/26)

USA Today: Contaminants In Water Are Legal But Still Pose Big Health Risks, Environmental Group Says
Contaminants detected in water samples throughout the country pose health risks but are perfectly legal under the Safe Drinking Water Act, according to data released Wednesday by an environmental advocacy group. “Most people turn on their tap water and think: It’s clear, I live in America, we have these laws, I’m being protected,” said Nneka Leiba, director of the Healthy Living Science Program for the Environmental Working Group (EWG). “What people don’t realize is that there have been no additions to the list of regulated chemicals for drinking water since 1996.” (Toy, 7/26)

Health IT

A Different Kind Of Virus To Worry About: Hospitals Try To Shore Up Defenses Against Cyberattacks

Demand for cybersecurity talent in health care has exploded, but it's not that easy to recruit into the industry.

NPR: Health Care Facilities Lag In Fending Off Hacking Attacks
In the neonatal intensive care unit of Cook Children's Hospital in Fort Worth, Texas, a father is rocking a baby attached to a heart monitor. While doctors roam the halls trying to prevent infections, Chief Information Officer Theresa Meadows is worried about another kind of virus. "The last thing anybody wants to happen in their organization is have all their heart monitors disabled or all of their IV pumps that provide medication to a patient disabled," Meadows says. (Silverman, 7/26)

In other health technology news —

Modern Healthcare: Hospitals Can Expect Financial Pain From EHR Installs
Hospitals installing new electronic health record systems should expect a sizable cash drain as the process disrupts business and adds technology and training expense, Moody's Investors Service said in a report this week. During the first year of EHR installations, the median decline in operating cash flow for hospital systems is 10% with a 6% falloff in days cash on hand, Moody's said after examining system installs over the past several years. EHR installations can cost anywhere from several million dollars for a small, stand-alone hospital to a half-billion dollars for larger systems. (Barkholz, 7/26)

State Watch

State Highlights: Texas Bill Requiring Women To Pay Separate Premium For Abortions Advances; Mass. Governors' Plan To Curb Health Costs Rebuffed

Media outlets report on news from Texas, Massachusetts, California, Maryland and Florida.

Texas Tribune: Bill Restricting Abortion Insurance Gets Initial Nod In Texas Senate
Texas women would have to pay a separate health insurance premium to get coverage for non-emergency abortions under a bill tentatively passed by the Texas Senate on Wednesday. State Sen. Brandon Creighton, the Conroe Republican who is the lead author of the bill, said opponents of abortion should not be forced to pay for the procedure through their insurance plans and employers should be able to choose whether to include abortions in their health coverage. (Smith, 7/26)

Austin American-Statesman: Texas Senate Give Initial OK On Ban On Abortion Insurance Plans
The Texas Senate on Wednesday gave initial approval to Senate Bill 8, which would ban general insurance plans from covering abortions for private citizens, government employees and those who get insurance through the Affordable Care Act. The bill — approved 20-10 along party lines with Sen. Eddie Lucio Jr., D-Brownsville absent — would require women to purchase separate abortion coverage through a supplemental plan, said the bill’s author, Sen. Brandon Creighton, R-Conroe. (Lindell, 7/26)

Boston Globe: Lawmakers Again Reject Baker’s Plan To Rein In Health Care Costs
The Democrat-controlled House and Senate on Wednesday approved a related Baker proposal to raise $200 million a year for the state’s Medicaid program through new fees on employers and use it to help fund health costs. But they rejected a complementary set of proposals to curb spending, which Baker wanted lawmakers to approve as a package. (Dayal McCluskey, 7/26)

Los Angeles Times: USC President Admits University 'Could Have Done Better' In Handling Reports Of Medical School Dean's Drug Use
USC President C.L. Max Nikias acknowledged Wednesday that the university “could have done better” in its handling of a former medical school dean who a Times investigation found took drugs and associated with criminals and drug abusers. Nikias didn’t detail how the university could have done more but said USC currently has “only loosely defined procedures and guidelines for dealing with employee behavior outside the workplace.” He announced a new committee that would look at strengthening those procedures. (Hamilton, Pringle and Parvini, 7/26)

San Jose Mercury News: UC-Berkeley Fights Back Over CRISPR Patent Rights
On Tuesday, UC filed an appeal of the U.S. Patent Office’s decision last February that the patent claims to CRISPR by Feng Zhang of the Broad Institute of MIT and Harvard do not interfere with those put forth by UC Berkeley biochemist Jennifer Doudna and her European collaborator, Emmanuelle Charpentier. ...UC asserts that its team was the true inventor of the gene editing technology. (Krieger, 7/26)

Houston Chronicle: Texas Records First Locally Transmitted Zika Case Of The Year
A South Texas man was diagnosed with Zika this month, likely the first in the state so far this year to be infected by a local mosquito bite. The man, a resident of Hidalgo County in the Rio Grande Valley, had not traveled out of the area, leading health officials to conclude he had contracted the disease locally. (Hixenbaugh, 7/26)

San Jose Mercury News: Palo Alto State Assemblyman Tackles Food Insecurity With Bill
The first bill proposed by a Palo Alto state assemblyman to be signed into law will make it easier for low-income California residents to access emergency food services. ...The bill, which Gov. Jerry Brown signed earlier this month, allows revision to the national 2-1-1 referral service so that residents can use the free phone number or online database to find entities that provide food to needy residents, including those with pending CalFresh applications. (Lee, 7/26)

Baltimore Sun: Investors Back Out Of Evergreen Health Deal
A group of investors that had applied to acquire Evergreen Health said Wednesday that they were backing out of the deal, leaving the Baltimore-based health insurer’s future in doubt. The investors said in a joint statement that “new financial information came to light that raised significant concerns” as they moved toward closing. (Wells, 7/26)

San Jose Mercury News: Stanford: Measles Could Spread As Vaccination Rates Decline
In a new study, scholars at Stanford’s School of Medicine and the Baylor College of Medicine find that slight declines in childhood measles vaccinations would cause disproportionately big increases in measles cases and public health costs. According to the study, published this week in JAMA Pediatrics, if just 5 percent fewer children in the 2-11 age range were inoculated against the measles, mumps and rubella (the MMR vaccine), the number of annual measles cases among that group would triple. (Deruy, 7/26)

Sacramento Bee: CA Latinos More Likely To Live In Polluted Communities
California has made great strides in scrubbing smog from its skies, yet pollution remains a problem in some parts of the state, with 44 percent of Latinos living in communities with poor air quality compared to about one-quarter of non-Latinos, according to a new state Senate report. The study, commissioned by the Legislative Latino Caucus, comes as Gov. Jerry Brown will be in Bell Gardens at 1:30 p.m. Wednesday to sign Assembly Bill 617, part of last week’s package of bills to extend the state’s cap-and-trade program to reduce greenhouse gas emissions. (Miller and Luna, 7/26)

San Jose Mercury News: Smoked Out: Antioch Council Bans New Tobacco Stores
Antioch’s city council on Tuesday tentatively approved an ordinance prohibiting new retail businesses that specialize in tobacco products and drug paraphernalia. The 3-0 vote cleared the way for the proposed ordinance to become part of the Municipal Code at a subsequent council meeting. (Coetsee, 7/26)

San Antonio Press-Express: Young Texas ‘Medical Marijuana Refugee’ Sues Sessions Over Cannabis Laws
An 11-year-old Texas cannabis “refugee” has joined a retired NFL football player, an Iraq War veteran and two others in a lawsuit challenging beleaguered Attorney General Jeff Sessions and the federal government’s stance on medical marijuana. The 88-page complaint comes as Sessions’ Task Force on Crime Reduction and Public Safety is expected to release a review of ties between marijuana use and violent crime. (Brezosky, 7/26)

Weekend Reading

Longer Looks: Immigrants And Obamacare; Surprise ER Bills & Canada's 'Killer Nurse'

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

The New York Times: The Company Behind Many Surprise Emergency Room Bills
Early last year, executives at a small hospital an hour north of Spokane, Wash., started using a company called EmCare to staff and run their emergency room. The hospital had been struggling to find doctors to work in its E.R., and turning to EmCare was something hundreds of other hospitals across the country had done. That’s when the trouble began. Before EmCare, about 6 percent of patient visits in the hospital’s emergency room were billed for the most complex, expensive level of care. After EmCare arrived, nearly 28 percent got the highest-level billing code. (Creswell, Abelson and Sanger-Katz, 7/24)

Slate Magazine: Elizabeth Wettlaufer, Canada’s Killer Nurse, And The Archetype Of The Health Care Murderer.
The two go on to make some small talk — they chat about the price of Toronto Blue Jays playoff tickets, among other things — and then Bethe Wettlaufer begins to tell her story. “It seems so stupid now,” she says, referring to the eight murders and six attempted murders she committed between 2007 and 2016 while caring for elderly patients at a series of nursing homes. She then clambers to her feet and tries to clear her head. (Daniel Engber, 7/24)

The Atlantic: The Bankruptcies That Would Follow An Obamacare Repeal
Even without more specifics on the details of the legislation, one thing is clear: The options under consideration would increase the number of uninsured by 15 to 30 million over the next 10 years, the Congressional Budget Office has estimated. A consequence of this will be not only a loss of access to medical services, but an increase in financial crises for millions of American families. Insurance, after all, is also a financial product, protecting people from economic ruin. (Annie Lowrey, 7/25)

Politico Magazine: How Democrats Won The Health Care War
"The mover on health care loses,” Democratic operative James Carville said in January. “To do something is to lose.” That cold-hearted political proverb has been repeatedly proven true, if the standard is short-term electoral gain. In terms of policy, it’s another story. Now that Obamacare repeal has fizzled, Democrats have officially won the eight-year health care war. (Bill Scher, 7/20)

The Verge: I Hacked My Body For A Future That Never Came
In fall 2012, I implanted a rare earth magnet in my right ring finger. Magnets were one of the most accessible forms of DIY biohacking, a niche subculture riding the start of a massive mainstream publicity wave. My colleague Ben Popper got one while writing a biohacking feature, and it sounded like magic. (Adi Robertson, 7/21)

Editorials And Opinions

Political Perspectives: The Trump Administration's 'Below-The-Radar' War On Obamacare; Analyzing John McCain's Controversial Health Care Vote

Editorial pages across the country include a variety of thoughts on what is happening in Washington to the Affordable Care Act.

The New York Times: Killing Obamacare Softly
Unable — at least so far — to kill the Affordable Care Act outright, the Trump administration has conducted a sustained war of attrition designed to inflict fatal damage on Obamacare. This war, often operating below the radar, entails the use of a quintessentially conservative strategy, and the cooperation of Congressional Republicans. In a way, it’s pretty simple: You cut the budget, impose debilitating regulations, track the subsequent missteps and then attack the program as a failure. (Thomas B. Edsall, 7/27)

The Des Moines Register: Don't Call John McCain A Hypocrite For Health-Care Vote
Sen. John McCain’s dramatic return to the Senate on Tuesday and his speech castigating the body’s malaise resonated with many Americans. “We’re getting nothing done,” he said. No kidding, everybody else responded. The Arizona Republican, who returned to Washington just days after surgery and being diagnosed with brain cancer, pleaded for a return to bipartisan work on legislation. “Let’s trust each other. (Kathie Obradovich, 7/26)

Stat: No Respect For John McCain's Vote On The Senate Health Care Bill
I had hoped that the recent experience of having ready access to complex diagnostic services and surgery — involving expensive technology possibly developed with taxpayer-subsidized research and paid for by the generous health benefits that members of Congress receive — would have impressed upon McCain the vulnerabilities that we all have to unexpected health care crises. I expected that this experience would have caused him to reconsider his role in enabling the headlong Republican rush to eliminate the possibility for tens of millions of his fellow citizens to get the same kind of rapid, excellent treatment he received. (Renée M. Landers, 7/26)

The Wall Street Journal: ObamaCare’s GOP Preservers
The Senate voted 45-55 Wednesday not to repeal ObamaCare with a two-year delay to replace it, and the only consolation for Republicans is the clarity of seeing who voted to preserve and protect rather than repeal and replace. Congress had passed and sent to Barack Obama’s desk a similar measure in 2015, with support from every current Senate Republican except Susan Collins of Maine. This time seven voted no, including Rob Portman of Ohio and Shelley Moore Capito of West Virginia, who aren’t up for re-election until 2022 and 2020, respectively. If you’re going to renege on your political promises, better to do it early, we suppose. (7/26)

Reuters: Want Congress To Fast Track Health Reform? Write Bills To Support Business Rather Than People.
With John McCain’s support, and a tie-breaking vote by Vice-President Mike Pence, the Republican party managed to bring the Better Care Reconciliation Act of 2017 to repeal and replace the Affordable Care Act (aka Obamacare) to the Senate floor for debate. Originally proposed in March 2017, made it out of committee in record time. The Senate rejected the bill Wednesday, but Republican leaders are now trying to gain support for a slimmed-down version. It’s unclear exactly what the “skinny” bill would include, but so far all versions of the Republican health plans include variations of measures to decrease government support of Medicaid by approximately 850 billion dollars over the next 10 years and leave 20-25 million more Americans without health insurance. Many of them substantially increase average premiums. (Michael Rosenbaum, 7/26)

USA Today/Investors Business Daily: What Should GOP Do Next On Health Care? How About Getting Advice From Hillary Clinton
Once the GOP gets tired of the circular firing squad over its failure to pass an ObamaCare repeal-and-replace bill, it might want to take a look at how Hillary Clinton handled a similarly embarrassing health care disaster during her husband's presidency. Despite the fact that Democrats controlled both houses of Congress and the White House in 1993, Clinton couldn't even get her Health Security Act to the floor of the Senate. The main reason for her failure — aside from her political ineptitude — was a series of "Harry and Louise" ads put out by the insurance industry. (John Merline, 7/26)

Arizona Republic: I Get All The Health Care I Need While Poor Workers Struggle. That's Unfair.
Health care for the wealthy and not for those who struggle to make ends meet isn’t real fair, now is it? The polls are terrible, the protests are constant and many Republicans have nagging doubts about the drive to repeal the Affordable Care Act and replace it with large tax cuts for people who already have way more money than they could possible spend in several lifetimes. (Jennifer Anne Moses, 7/26)

When Policies Get Thin: Critiques On The Senate GOP's Next Big Idea -- A 'Skinny" Repeal

Opinion writers offer strong warnings about the problems with the skinny repeal -- both in terms of using it as a strategy to advance Republican health reforms and as a policy construct that threatens to damage the individual health insurance market. One voice, however, sees it as the GOP's chance to eliminate the despised individual mandate.

The Washington Post: The Hefty Downsides Of The ‘skinny’ Health-Care Proposal
After voting to move forward on repealing and replacing Obamacare — precipitously, and without any sense of where they would end up — Senate Republicans are trying to slap together a major health-care bill on the Senate floor. If their partisan power play works, the result would be the passage of bad legislation hiking deductibles and stripping insurance coverage from millions of people. If, on the other hand, they fail to bridge their disagreements, they may turn to what some are calling a “skinny repeal” and Health and Human Services Secretary Tom Price has termed a “lowest common denominator.” It sounds bad, and it is. (7/26)

The New York Times: Why ‘Skinny’ Obamacare Repeal Is A Terrible Idea
Skinny is often read as good today. We like skinny jeans, skinny models and, apparently, skinny health reform. It is likely that the Senate, which has just rejected repeal-and-replace and repeal-without-replace bills, will vote on a “skinny repeal” of the Affordable Care Act. What does this actually mean, and what would it produce? The proposal most often labeled “skinny” would repeal the insurance mandate for individuals and larger employers under the banner of choice and freedom — both standard objectives of conservatives. It also would repeal taxes on medical-device manufacturers and, perhaps, also on insurers, with the goal of reducing the costs that must be reflected in premiums. (J.B. Silvers, 7/26)

The Washington Post: Republicans Have A Chance To Eliminate The Individual Mandate. They Should Take It.
On Tuesday, the Senate voted to proceed with debate on a bill to replace Obamacare with market-oriented health reforms. The commencement of formal debate in the Senate is a critical milestone in the effort to make American health care more sustainable and affordable. Many have focused — understandably — on where Senate Republicans disagree on health-care reform. But Republicans also agree on much, and bringing the Better Care Reconciliation Act to the floor allows those agreements to take legislative form. (Avik Roy, 7/26)

USA Today: GOP 'health' Bill Isn't About Health. It's About Winning And Job Protection.
Somewhere along the line, the health care debate stopped being about health care and devolved into how we are getting used to seeing the Trump administration do business. Threats to fire people or, if they’re in Congress, to work against them. So with any pretense gone, Trump’s point person on health care, Health and Human Services Secretary Tom Price, described the administration’s new goal as “what gets us 50 votes so we can move forward.” Not a law which covers more people? Or reduces the cost of care? Or protects American families from bankruptcies? (Andy Slavitt, 7/27)

Bloomberg: What's Next For The Republican Health-Care Bill
How did Mitch McConnell finally come up with the votes -- 50 of the 52 Republicans plus the vice president to break the tie -- to begin Senate debate and the amendments process on a Republican health-care bill? While it's hard to prove anything, Tuesday's big vote, like everything else that's happened so far since January, is consistent with the view that most Republicans in Congress believe this ends in failure, and (almost) all of them are scrambling to shift blame elsewhere. Which means it's still quite possible that they'll almost accidentally blame-shift their way into passing something none of them really want to see as law. (Jonathan Bernstein, 7/26)

Viewpoints: Patients Should Know If A Doctor Is On Probation; Keep FDA's Powers Strong

Here's a review of editorials and opinions on a range of public health issues.

Boston Globe: Don’t Limit The Powers Of The FDA
Repeated scandals helped create the Food and Drug Administration we know today: a thriving agency that effectively protects consumers and patients from unsafe food and drugs. However, Congress is overdue in passing legislation necessary to keep the FDA running, with one senator threatening further delay to force adoption of a policy that limits the powers of the agency. (Alison Bateman-House and Ameet Sarpatwari, 7/27)

Slate: Transgender Service Members’ Medical Costs Are Not A “Burden”
The word to focus on in this statement is burdened. Not only does the president think transgender service members would be a distraction, but he also believes their health care would be so exorbitantly expensive that their service to our country would not be worth it. A 2016 paper by the Rand Corporation titled “Assessing the Implications of Allowing Transgender Personnel to Serve Openly” estimated that about 2,450 transgender people are on active duty (out of 1.3 million active-duty service members altogether), and of that number, around 29 to 129 service members would seek care related to a gender transition in any given year. The total cost of their health care would increase overall expenditures on health care by between $2.4 million and $8.4 million annually, which amounts to a 0.04 to 0.13 percent increase in total active component health care expenditures. (Jonathan Foiles, 7/26)

JAMA Forum: 'America’s Health First': A Misnomer
On July 7, Tom Price, MD, secretary of the Department of Health and Human Services (HHS), announced the appointment of Brenda Fitzgerald, MD, as the 17th director of the Centers for Disease Control and Prevention (CDC). To this position, Dr Fitzgerald brings her experience as Commissioner of the Georgia Department of Public Health, a role in which she championed infant health and survival, tobacco control, and obesity prevention. Other significant choices of individuals to head agencies that affect the public’s health include the recent nomination of Jerome Adams, MD, MPH, as surgeon general, and reappointment of Francis Collins, MD, PhD, as National Institutes of Health director. (Lawrence Gostin, 7/25)

JAMA: Practical Improvements For Medical Device Evaluation
Passage of the Medical Device Amendments Act in 1976 confirmed the US Food and Drug Administration’s (FDA’s) primary responsibility for evaluating the safety and effectiveness of medical devices in the United States. Although there have been modest legislative updates in the ensuing decades, the broad structure of the FDA’s risk-based framework for premarket evaluation has remained largely unchanged. High-risk (“class III”) devices (such as pacemakers and insulin pumps) are subject to stringent premarket requirements including demonstration of clinical effectiveness, typically done through the Premarket Approval pathway. Medium-risk devices (such as glucose monitors and CT scanners) generally earn marketing clearance through the “510k” pathway, which assesses whether a given device raises new safety or effectiveness concerns compared with a currently-marketed device to which the technology being evaluated is deemed “substantially equivalent.” (Daniel B. Kramer and Robert W. Yeh, 7/25)

JAMA: Advances And Gaps In Understanding Chronic Traumatic Encephalopathy
Traumatic brain injury (TBI) is a major public health concern, affecting an estimated 10 million people worldwide per year and more than 40% of US residents over the course of a lifetime. Mild TBI, also referred to as concussion, is defined as blunt, nonpenetrating head trauma associated with transient symptoms (eg, headache, nausea, dizziness, visual changes, confusion, or difficulty concentrating) and accounts for more than 80% of all TBI cases. Beyond the morbidity of the immediate trauma, patients who experience mild TBI are at increased risk of developing neurological and psychiatric disorders later in life. The majority of TBI is caused by motor vehicle crashes and falls, although brain injuries also occur during participation in contact sports, with an estimated 1.6 million to 3.8 million sports-related concussions occurring in the United States per year. (Gil D. Rabinovici, 7/25)

Seattle Times: Stop Exploiting Student Athletes
Seattle school administrators and coaches were misusing the system designed to help homeless students to bolster their sports teams. [Claudia] Rowe found that some schools labeled student-athletes as homeless so they could bypass normal playing restrictions based on grades or residency. (7/27)

The Washington Post: Why It’s So Hard To Die In Peace
For those of us who had hoped that American attitudes toward death were shifting in ways that would promote a wider reconstruction of the health-care system, there’s discouraging news from Health Affairs, the preeminent journal of health policy. It devotes its latest issue to “end-of-life” care and finds that — at least so far — the power to make health care more compassionate and cost-effective is limited. (Robert J. Samuelson, 7/26)

The New York Times: No Insurance, But For 3 Days, Health Care Is Within Reach
For a man who needed 18 teeth pulled, Daniel Smith was looking chipper. Anxious, too, for he was facing a pair of forceps. But Smith, 30, a contractor with no health or dental insurance, who hadn’t seen a dentist in more than 20 years, was looking forward to an imminent end to the pain and rot in his mouth. (Nicholas Kristof, 7/27)

Stat: To End HIV, Discriminatory Laws Must Be Repealed
More than 30 states have laws that can be used to prosecute people living with HIV. Some of these laws criminalize HIV transmission. That means individuals can be thrown into jail if they don’t disclose their status prior to sex, whether or not they transmit HIV. The legislation is aimed at vulnerable populations, such as people who use drugs or sex workers, all of whom have a higher risk of being infected with HIV. But it is counterproductive, because it actually heightens their risk of contracting the disease: Increased stigma leads to people not getting tested. That delays treatment, which reduces the likelihood of transmitting HIV to almost zero. (Chris Beyrer, 7/26)

Stat: Dear Sen. McCain: Here’s What I’ve Learned From Living With Glioblastoma
Dear Sen. McCain, I was saddened to hear that you received a diagnosis of glioblastoma. I also live with this particularly aggressive type of brain cancer. On the surface, you and I are very different. I am a 35-year-old dad with three sons aged 5 and under. I have a beard and listen to indie rock. I hold undergraduate and graduate degrees in philosophy. My home is in the heartland, though in my childhood I lived in your beautiful state of Arizona. You are 80, a distinguished member of the U.S. Navy, a war hero, and a long-serving U.S. senator at home in the Southwest and Washington, D.C. Yet we’re now connected by this terrible brain cancer. (Adam Hayden, 7/26)