KHN Morning Briefing

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Kaiser Health News Original Stories

Political Cartoon: 'Hold The Door?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Hold The Door?'" by Signe Wilkinson .

Here's today's health policy haiku:

PANEL QUESTIONS EFFECTIVENESS OF ARTHROSCOPIC KNEE SURGERY

Oh my aching knees!
There was an easy answer.
But now … maybe not.

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

Summaries Of The News:

Health Law

Alliances Cropping Up In Senate, Where Almost Every Vote Holds The Power To Destroy A Deal

Leadership can only lose two Republican votes to pass a health care plan through the upper chamber, giving each senator a great deal of bargaining power.

Politico: 52 Ways To Repeal Obamacare
Senate Republicans want to do their own Obamacare repeal plan — but nearly all 52 Republicans have their own ideas about how it should look. With his razor-thin majority, Majority Leader Mitch McConnell can afford to lose only two GOP votes. That turns each senator into a de facto powerbroker with the ability to shape — or kill — legislation simply by aligning with two other members. (Haberkorn, 5/11)

The Hill: GOP On Tightrope With Planned Parenthood 
Senate Republicans are treading a narrow path as they seek to defund Planned Parenthood through passage of a healthcare bill. Cutting off federal funds because of the abortion services provided by the organization is a goal of most congressional Republicans and the Trump administration. And with majorities in the House and Senate and control of the White House, the goal seems within reach after years of the party being thwarted by Senate Democrats and former President Barack Obama. (Carney, 5/10)

The Hill: Senate GOP Defends Writing Its Healthcare Bill In Private 
Senate Republicans are defending their decision to write their own ObamaCare replacement bill behind closed doors, bypassing the usual committee process. They say it is unlikely that the bill will go through hearings and markups in committee, though they stress that a working group of lawmakers, as well as the entire Republican caucus, will have heavy input on the bill. (Sullivan, 5/11)

Nashville Tennessean: Sen. Lamar Alexander: Women Will Have Important Role In Crafting Obamacare Replacement Bill
Sen. Lamar Alexander insisted Wednesday that women will have a seat at the table as Senate Republicans work to craft a bill to repeal and replace the Affordable Care Act...A 13-member working group appointed by GOP leaders to piece together a health care bill has sparked fire even from within Republican ranks because none of the senators selected for the panel are women. (Collins, 5/10)

In other news —

CBO Assessment Of Republicans' Health Plan Expected Week Of May 22

The Congressional Budget Office score is needed for the Senate to truly move forward on its own version because of the method it's using to repeal and replace the Affordable Care Act.

The Washington Post: CBO To Issue Cost Estimate Of House Health-Care Bill Within Two Weeks
The Congressional Budget Office is planning to release the week of May 22 an assessment of how the health-care legislation that the House just passed will impact federal spending. In a blog post on Wednesday, the CBO said that its staff and Congress’s nonpartisan Joint Committee on Taxation expect to issue the cost estimates early that week. The notice did not say whether the analysis of the Republicans’ Affordable Health Care Act will include a forecast of how the bill would affect the number of Americans with health insurance, and a spokeswoman for the office said she did not have that information. (Goldstein, 5/10)

Politico: CBO Score Of Obamacare Repeal Bill Expected Week Of May 22
The Senate parliamentarian can't review the legislation and the GOP cannot really start writing its bill in the upper chamber until the CBO scoring is complete. That’s because the Senate version has to save at least as much money as the House bill — otherwise the measure would violate the budget resolution and the GOP repeal effort would come to a swift end. (Haberkorn, 5/10)

CQ Roll Call: CBO Score For Health Bill Will Take Another Two Weeks
Senate Republicans, including Finance Committee Chairman Orrin G. Hatch of Utah, said this week they won't decide how they will change the House bill's cuts to the projected spending growth of the Medicaid program or its tax credits until they see the CBO's analysis of the House-passed bill. "We're going to have to have scores, that's for sure," Hatch said Tuesday. (Mershon, 5/10)

Brutal Town Hall For Moderate Who Helped Resuscitate GOP Plan Captures Snapshot Of Voters' Wrath

Rep. Tom MacArthur (R-N.J.) worked with conservatives to revive the stalled health care negotiations, and helped get the legislation through the House. But his voters, and others turning up at Republican town halls across the country, are not necessarily cheering the efforts.

The New York Times: In New Jersey, Democrats Hope No Good Health Care Compromise Goes Unpunished
It took a moderate Republican from New Jersey to wrestle a compromise out of his party’s hard-right naysayers and resuscitate the House health care plan. And for that, he may pay dearly. Less than a week after Representative Tom MacArthur helped legislation that would repeal the Affordable Care Act clear a gridlocked House, he faced hundreds of outraged constituents and protesters on Wednesday in his district’s Democratic stronghold. He has to defend the measure bearing his name that would undermine protections for patients with pre-existing conditions. (Huetteman, 5/10)

The Washington Post: ‘I Didn’t Come Here To Defend The President Tonight.’ Republican Who Rescued Health-Care Bill Faces Voters.
The mood was toxic from the start. Protesters lined up outside the town’s Kennedy Center event hall for hours before the 6:30 p.m. start time: an assemblage of local activist groups, including chapters of Indivisible, New Jersey Citizen Action and Our Revolution. Tax March, a group that grew out of protests demanding the president’s tax returns, inflated a balloon that approximated a chicken with golden, Trump-like hair; nearby, dozens of protesters lied down in a “die-in,” as a man wearing a Trump puppet head pretended to tee off on them. In the sky, a plane flew by, trailing letters that spelled out “MacArthur Tax Cut for 1% No Care.” MacArthur’s town hall was designed to weed out interlopers. District residents stood in line — at start time, it stretched as long as a football field — for one of the scarce seats inside. MacArthur entered the room through a curtain, with a sound system playing Coldplay’s anthem “A Sky Full of Stars.” Despite some of the trappings of a rally, there was little applause. (Weigel, 5/10)

Politico: MacArthur Endures Town Hall Trial-By-Fire
It was a prime example of the anger, confusion and raw emotion surrounding the GOP’s replacement health care plan, and a glimpse at why the party’s House majority suddenly seems in jeopardy in 2018. (Hutchins and Jennings, 5/11)

The Philadelphia Inquirer/Philly.com: N.J. Residents Angrily Confront MacArthur Over Health-Care Bill
Tom MacArthur, the South Jersey congressman who helped revive the GOP plan to replace the Affordable Care Act, came under fire Wednesday from constituents who expressed fear that they and others might lose health coverage if the bill is signed into law. At an emotionally charged town-hall meeting in heavily Democratic Willingboro, MacArthur, a second-term Republican, heard from exasperated residents in his district, including a man with a heart condition who worried he wouldn’t be able to afford insurance in a high-risk pool if he were to lose his job; a woman on Medicaid recovering from drug addiction, concerned she would end up “in jail, prostitution,” or dead without coverage; and a man whose wife had breast cancer. (Seidman, 5/10)

The Hill: GOP Lawmaker With Key Role In ObamaCare Repeal Faces Angry Town Hall 
Rep. Tom MacArthur (R-N.J.) effectively saved the House GOP’s effort to repeal and replace the healthcare law by crafting a compromise amendment. But his constituents didn’t gather here to give him a hero’s welcome. Instead, MacArthur coolly listened to nearly five hours of constituents in this suburban New Jersey town telling him he was an “idiot,” a “liar,” and had “blood on your hands.” (Marcos, 5/10)

Politico: Republicans Flub Defense Of Health Care Vote
House Republicans celebrated passing legislation to repeal Obamacare last week — but apparently forgot to figure out how to talk about the feat back home. The result has been a messaging mess, as lawmakers returned to their districts for a weeklong recess to face furious Obamacare defenders. (Cheney, 5/11)

Arizona Republic: 'Die-In' Rallies Protest 'Trumpcare' Across Arizona, U.S. This Week
People across the U.S. who are frustrated that the U.S. House of Representatives passed the American Health Care Act are expressing their anger by pretending to drop dead outside their representatives' offices. At least 48 "die-in" rallies are scheduled in 21 states this week, according to paybackproject.org, which hosts a schedule of protests for people looking to "pay back" the 217 Republicans in the House who voted for "Trumpcare" on May 4. (White and Barahona, 5/10)

Aetna Pulling Out Of All ACA Marketplaces Amid Uncertainty, Financial Losses

While the company's decision only affects two states, the move has political ramifications in an environment where everyone is tensed for a potential "death spiral."

The Washington Post: Aetna Exiting All ACA Insurance Marketplaces In 2018
Aetna will complete its withdrawal from Affordable Care Act insurance exchanges for 2018, announcing on Wednesday that lingering financial losses and uncertainty about the marketplaces’ future was prompting it to exit two final states. According to an Aetna spokesman, the insurer will not sell individual health plans next year in Delaware or Nebraska. Its announcement came a week after the company said it would stop offering ACA health plans in Virginia in 2018 and a month after it said it would leave Iowa. (Goldstein, 5/10)

The Wall Street Journal: Aetna To Pull Out Of Current Affordable Care Act Exchanges
Aetna said its individual plans are projected to lose more than $200 million this year, and “those losses are the result of marketplace structural issues that have led to co-op failures and carrier exits, and subsequent risk pool deterioration.” The insurer said that “at this time [we] have completely exited the exchanges.” (Wilde Mathews, 5/10)

Reuters: Aetna Fully Exits Obamacare Exchanges With Pull-Out In Two States
"This decision is not a surprise given continued uncertainty about market stability and whether cost-sharing subsidies will continue to flow," Evercore ISI analyst Michael Newshel said in an investor research note. He noted that only one health plan remains in both Delaware, where Highmark Blue Cross Blue Shield sells Obamacare coverage, and Nebraska, where Medica still offers coverage but has warned it may exit the program. (Beasley, 5/10)

CQ Roll Call: Aetna To Exit Obamacare Markets For 2018
The political significance is greater than the impact on consumers. Aetna had already scaled back its presence and did not rule out entering another state market in 2018. But it is the second major national insurance company, after Humana, to abandon the pool of customers who buy their insurance coverage from those companies on HealthCare.gov and state-based exchanges for 2018. (Mershon, 5/10)

Meanwhile —

Modern Healthcare: Health Insurers' Proposed 2018 Rate Hikes Are Early 'Warning Signs' 
Health insurers are asking state regulators to approve giant rate increases for 2018 individual policies, in part because they don't yet know if the Trump administration plans to help or hurt the Affordable Care Act's health insurance exchanges. Insurers in the three states that have published requested rates say their double-digit hikes, which exceed 50% in some cases, may climb even higher if the federal government doesn't take steps to ease their jitters over ACA repeal-and-replace efforts by funding cost-sharing reduction subsidies and enforcing the mandate that requires most people to enroll in coverage. (Livingston, 5/10)

Capitol Hill Watch

Controversy Over Comey Firing Could Cost GOP Support For Trump's Agenda In Senate

There's little wiggle room in the Senate, and hesitancy to support President Donald Trump's priorities could cause problems for any potential health care deal.

McClatchy: Comey Firing Trouble For Trump's Health Care, Tax Plans
Already in a struggle to find enough votes to back President Donald Trump’s agenda, Republicans are about to find the going even tougher after the firing of James Comey as FBI director... In the coming months, the Senate faces already-contentious Trump initiatives on overhauling the nation’s health care system, revamping the tax code and, more immediately, crafting a budget for the fiscal year that begins Oct. 1. (Tate and Wise, 5/10)

The Hill: GOP Centrist: FBI Firing Distracting From Healthcare Work 
President Trump’s firing of FBI Director James Comey is distracting from work in the Senate on repealing and replacing ObamaCare, says Sen. Susan Collins (R-Maine). “I think he already has,” Collins told reporters in response to a question about whether Comey could become a distraction. The Senate has begun working on a healthcare bill separate from the legislation passed by the House last week intended to replace parts of the Affordable Care Act. (Weixel, 5/10)

CQ Roll Call: Crucial Health Bills Have A Fraught Path Amid Partisan Blowups
A highly anticipated markup of a must-pass Food and Drug Administration bill was postponed Wednesday because of partisan sparring over the firing of Federal Bureau of Investigation Director James Comey. The delay comes after the Senate Finance Committee last week indefinitely postponed a hearing on the Children’s Health Insurance Program because of the toxic politics of the Republican health care bill (HR 1628). The cancelations raise questions about whether a deluge of drama consuming the Capitol could push lower-profile but important health care legislation off the rails. Both bills — which congressional leaders hoped to pass without major controversies — need to be addressed well before their Sept. 30 deadlines so the FDA employees and children’s health providers who rely on funding affected by the bills can keep working. (Siddons and Raman, 5/10)

Administration News

'Change-Agent' Tapped To Head HHS Mental Health Office, And Even Some Liberal-Leaning Psychiatrists Are Cheering

Dr. Elinore McCance-Katz, Trump's pick to lead the Substance Abuse and Mental Health Services Administration, is a proponent of shifting away from education-based approaches to aggressive treatment.

Stat: Trump's Pick To Run Mental Health Agency Is Poised To Shake Things Up
President Trump’s pick to run federal mental health services has called for a bold reordering of priorities — shifting money away from education and support services and toward a more aggressive treatment of patients with severe psychiatric disorders. The proposal has some psychiatrists — a generally liberal bunch — cheering despite their distrust of the Trump administration. But it’s also sparked concern among other health professionals, who worry that the administration will put too much emphasis on medicating and hospitalizing patients, and remove supports that might help them integrate successfully into society. (Keshavan, 5/11)

In other administration news —

Los Angeles Times: Four Things Americans Should Know About Dr. Scott Gottlieb, The New Head Of The FDA
America, you have a new commissioner at the Food and Drug Administration. Dr. Scott Gottlieb, a 44-year-old physician, was confirmed by the Senate this week in a 57-42 vote. Many Democrats expressed concern about Gottlieb’s financial ties to the pharmaceutical industry. Sen. Lamar Alexander (R-Tenn.), who chaired the panel that forwarded the nomination to the Senate floor, countered that Gottlieb’s extensive experience in the drug industry would be an asset in his regulatory role. Here are four things you’ll want to know about Gottlieb. (Healy, 5/10)

Stat: Tom Price Commends Police Who Arrested Journalist Asking Questions
Secretary of Health and Human Services Tom Price on Wednesday commended police in West Virginia for “doing what they thought was appropriate” in arresting a journalist who shouted questions at him, but added that it wasn’t his call to say whether they took the proper measures. Price said the reporter confronted him while he was walking down a hallway. “That gentleman was not in a press conference,” he said. Daniel Ralph Heyman, a reporter for the independent Public News Service, was arrested and charged with willful disruption of governmental processes, a misdemeanor, after police in West Virginia’s Capitol building said he was “aggressively” trying to get past Secret Service agents while yelling questions at Price. (Joseph, 5/10)

Chicago Tribune: Chicago Company Hires Andy Slavitt, Former Obama Health Care Official
A Chicago health care company has hired Andy Slavitt, a former top government health care official who oversaw Medicare and Medicaid under President Barack Obama and was instrumental in helping to build Obamacare. Avia announced Wednesday that Slavitt would act as a senior adviser to the company, which works to help hospital systems find digital ways to improve their operations, clinical work and finances. (Schencker, 5/10)

A Look At Who's Joining Chris Christie On Trump's Opioid Commission

And in other news on the crisis, Health and Human Services Secretary Tom Price traveled to New Hampshire for a listening session with the governor and other stakeholders and the Food and Drug Administration released guidelines touting the benefits of chiropractic care and acupuncture.

Stat: White House Names New Members Of Opioid Commission
Two governors, a former congressman in recovery, and an addiction researcher are set to join New Jersey Governor Chris Christie on President Trump’s opioid panel. The White House announced Wednesday that the president intended to appoint Republican Governor Charlie Baker of Massachusetts and Democratic Governor Roy Cooper of North Carolina to the Commission on Combating Drug Addiction and the Opioid Crisis. (Joseph, 5/10)

The Hill: Trump Appoints Opioid Commission 
Membership includes officials known for their work on issued related to prescription painkillers and heroin. The list includes Gov. Chris Christie (R-N.J.), Gov. Roy Cooper (D-N.C.), Gov. Charlie Baker (R-Mass.), former Rep. Patrick Kennedy (D-R.I.) and Bertha Madras. (Roubein, 5/10)

NH Times Union: HHS Secretary Gets Granite State View Of Opioid Crisis, And An Earful On Proposed Funding Cuts 
Health and Human Services Secretary Tom Price got an earful about New Hampshire’s opioid crisis at a “listening session” in the State House on Wednesday that was also attended by presidential adviser Kellyanne Conway and hosted by Gov. Chris Sununu. Afterward, Price tried to deflect concerns about proposed cuts in the Office of National Drug Policy and the impact of the Republican health care plan on efforts to combat addiction. (Solomon, 5/10)

Concord Monitor: Protesters Greet U.S. DHHS Secretary Tom Price As He Denies Cut In Drug Fight Money
At a stop in Concord for a “listening session” on the opioid epidemic, U.S. Health and Human Services Secretary Tom Price pushed back on the notion that there is less money going to fight the drug crisis under the Trump administration, amid news of dramatic budget cuts to the office of the national “drug czar.”...Outside the press conference, dozens of protesters laid in the State House halls like corpses, meant to symbolize the growing death toll in the state from drug overdoses. Price avoided the protesters by entering the Executive Council chambers through a back door. (Nisen, 5/10)

Stat: FDA Suggests Doctors Learn About Acupuncture For Pain Management
Chiropractors and acupuncturists who have lobbied for a bigger role in treating pain have won a preliminary endorsement from federal health officials. The Food and Drug Administration released proposed changes Wednesday to its blueprint on educating health care providers about treating pain. The guidelines now recommend that doctors get information about chiropractic care and acupuncture as therapies that might help patients avoid prescription opioids. (Thielking, 5/10)

And in news from the states —

The Philadelphia Inquirer: Ready To Get Off Opioids? How To Make Recovery Stick
There are a couple of things that everyone should know about recovery from addiction: It takes a village. And it takes a lifetime. Viewed that way, the failures, the repeat admissions, the relapses, are bumps on the road — although when a bump involves opioids, it can quickly turn into a fatal overdose. Keep in mind the big picture if you are trying to help a friend or loved one recover from opioid addiction.It also is important to remember that there are numerous paths to success. Still, experts we spoke with say there are some basic tips that may help you and your loved ones find a route to recovery, and stay on it. (Sapatkin, 5/11)

The Associated Press: Head Of Ring That Dealt Heroin On Reservations Gets 25 Years
The leader of a drug trafficking ring that brought heroin to Minnesota and North Dakota Indian reservations was sentenced Wednesday to 25 years in prison. Omar Sharif Beasley, 39, was among 41 people charged in the drug trafficking case in which he and others brought heroin from Midwest cities like Detroit, Chicago and Minneapolis to the Red Lake and White Earth reservations in Minnesota and to Native American communities in North Dakota, prosecutors said. (5/10)

Veterans' Health Care

Lawmakers Strike Deal On Bill That Would Make It Easier For VA To Fire Employees

The agreement on the accountability revision smooths the way for passage of the stalled legislation. Meanwhile, Republicans blast a procedural move by Democrats that postponed a hearing on veterans health care.

The Associated Press: Lawmakers Reach Agreement On Stalled VA Accountability Bill
Congressional Republicans and Democrats have reached agreement on a bill to make it easier for the Department of Veterans Affairs to fire its employees, part of an accountability effort touted by President Donald Trump. The deal being announced early Thursday could smooth the way for final passage on an issue that had been largely stalled since the 2014 wait-time scandal at the Phoenix VA medical center. As many as 40 veterans died while waiting months for appointments as VA employees created secret waiting lists and other falsehoods to cover up delays. (Yen, 5/11)

CQ Roll Call: Cancellation Of Hearing On Veterans' Health Care Draws Criticism
A Democratic blockade imposed on committees meeting Wednesday stalled a hearing featuring the secretary of Veterans Affairs, drawing criticism from a top appropriator who oversees veterans' programs. Sen. Jerry Moran, R-Kan., took to the floor to blast Democrats shortly after Sen. Richard J. Durbin made the procedural move. Durbin, D-Ill., cited President Donald Trump’s abrupt firing of FBI Director James B. Comey as the reason for blocking the meetings. (Mejdrich, 5/10)

Pharmaceuticals

For Fourth Straight Year, U.S. Prices On Prescription Drugs Go Up More Than 8%

In 2016, the cost of medications rose 8.8 percent. Brand-name medications went up 12.9 percent while generics only increased 0.3 percent. In other pharmaceutical news, Mylan takes issue with a Food and Drug Administration decision not to approve its generic version of GlaxoSmithKline's Advair.

Stat: Prescription Drug Prices Rose Almost 9 Percent In 2016, Continuing An Ongoing Trend
For those debating the cost of prescription drugs, here is still more evidence illustrating how costs are thinning the American wallet — prices rose 8.8 percent last year, which is the fourth consecutive year of overall price hikes that exceeded 8 percent, according to a new analysis. Moreover, this amounts to an annual average price increase of almost 10 percent over the past three years. (Silverman, 5/10)

Reuters: Mylan Disagrees With FDA Over Generic Advair Delay
Generic drug maker Mylan NV on Wednesday said it disagrees with the reasoning behind the U.S. Food and Drug Administration's decision not to approve its generic for GlaxoSmithKline Plc's blockbuster Advair in March. Mylan President Rajiv Malik said the FDA was asking it to comply with standards set out in draft guidance the agency issued, but that it believes it is not required to do so. An FDA spokeswoman declined to comment, saying she was prohibited by law from discussing a pending application. (Erman, Grover and Clarke, 5/10)

Medicaid

State Officials Seek More Federal Funds For Prosecution Of Medicaid Abuse

The state attorneys general are asking for more help to prosecute abuse and neglect of Medicaid patients in non-institutional settings, like home health care. Also in the news, federal officials are giving states more time to meet new Medicaid standards on home health care.

The Associated Press: Herring Asks Feds To Change Policy On Medicaid Cases
Virginia’s attorney general is calling on federal officials to let the states use federal funds to target more cases of abuse and neglect committed against Medicaid beneficiaries. Attorney General Mark Herring was among more than three dozen attorneys general who requested the policy change in a letter to U.S. Department of Health and Human Services Secretary Tom Price. (5/11)

Kaiser Health News: CMS Gives States Until 2022 To Meet Medicaid Standards On Home And Community-Based Care
The Trump administration has given states three extra years to carry out plans for helping elderly and disabled people receive Medicaid services without being forced to go into nursing homes. Federal standards requiring states find ways of delivering care to Medicaid enrollees in home and community-based settings will take effect in 2022 instead of 2019, the Centers for Medicare & Medicaid Services announced this week. (Galewitz, 5/11)

Women’s Health

Illinois Bill Expanding Public Financing For Abortion Faces Likely Veto On Governor's Desk

When running for governor, Bruce Rauner said he disliked existing law restricting taxpayer-funded abortion coverage, but has since walked back that opinion.

The Associated Press: Illinois Senate Approves Abortion Safeguards; Veto Likely
The Democratic-controlled Illinois Senate voted Wednesday to expand public financing for abortions and ensure legal access to the procedure across the state, although the measure likely awaits a veto by Republican Gov. Bruce Rauner. Senators voted along party lines, 33-22, in favor of the plan, which would permit abortion coverage by state employee health insurance and Medicaid funds. It would also strike statutory language expressing the state's intent to criminalize the procedure if the 1973 U.S. Supreme Court ruling that legalized it is ever overturned. (Sepeda-Miller, 5/10)

In other news —

The Associated Press: Alaska Lawmaker Censured Over Abortion Comment
The Alaska House voted Wednesday to censure a Republican member over comments he made suggesting there are women in Alaska who try to get pregnant to get a "free trip to the city" for abortions. The House voted 25-14 to take the highly unusual step of censure after hours of debate, during which Rep. David Eastman of Wasilla — who referred to himself as the "least politically correct legislator in our state" — said he was sorry he made the comments. (5/10)

Public Health And Education

Arthroscopic Knee Surgery Does Not Provide Lasting Relief, Panel Says

A group of international health experts says that fewer than 15 percent of patients feel an improvement in pain and function three months after the procedure -- which is the world's most common surgery -- and that those effects usually disappear after one year.

Stat: This Orthopedic Surgery Is The World's Most Common. But Patients Rarely Benefit, A Panel Says
That’s the conclusion of an international panel that strongly recommends against arthroscopic surgery in a new guideline published by the BMJ. The panel found that, while performed 2 million times per year worldwide, knee arthroscopy offers minimal benefits to patients with degenerative knee disease, which affects about 25 percent of people older than 50. The surgery’s persistence may have to do with a combination of financial incentives, patient frustration at more conservative approaches, and delays in incorporating new evidence into current practice, the panel said. (Ross, 5/10)

Kaiser Health News: For Knee Pain, Experts Say Don’t Think About Scoping It
A panel of international health experts and patients Wednesday challenged the effectiveness of one of the most common orthopedic procedures and recommended strongly against the use of arthroscopic surgery for patients with degenerative knee problems. The guidelines, published in the journal BMJ, relied on 13 studies involving nearly 1,700 patients that found the surgery did not provide lasting pain relief or improve function. Those studies compared the surgery with a variety of options, including physical therapy, exercise and even placebo surgery. (Heredia Rodriguez, 5/10)

Gut Bacteria Identified As Culprit Of Brain Defect, Making Scientists Wonder What Other Havoc It Can Wreak

The report is the first to suggest convincingly that these bacteria may initiate disease in seemingly unrelated organs. In other public health news, lithium and bipolar disease, lead dust from firearms, vaping, a tragic medication error and cotton swabs.

The New York Times: A Baffling Brain Defect Is Linked To Gut Bacteria, Scientists Say
Researchers have traced the cause of a baffling brain disorder to a surprising source: a particular type of bacteria living in the gut. Scientists increasingly suspect that the body’s vast community of bacteria — the microbiome — may play a role in the development of a wide variety of diseases, from obesity to perhaps even autism. (Kolata, 5/10)

Stat: Q&A: Why Lithium Helps Only Some People With Bipolar Disorder
We still don’t have a deep understanding of the basic biology of psychiatric disease. A new paper appearing in PNAS this week, however, begins to unravel the fundamental biological mechanisms of bipolar disorder — and why the drug lithium works only in some patients. The findings suggest a means to develop next-generation psychiatric drugs that might have fewer side effects than lithium, and perhaps ultimately allow for better diagnostics of bipolar disorder. (Keshavan, 5/10)

NPR: Lead Dust At Firearms Ranges Poses A Health Risk
Firearms safety is key for people who use weapons at work or for recreational shooting. But one risk has been little acknowledged: Lead dust exposure. In a standard bullet, a solid lead core wrapped in a copper jacket sits atop a stack of gunpowder and lead primer. When the gun fires, the primer ignites, the gunpowder lights, and some of the lead on the bullet boils. When the casing snaps out of the ejection port, lead particles trail behind it. As the bullet hurtles down the barrel of the gun, a shower of lead particles follows. (Chen, 5/10)

The New York Times: Vape Shops Want To Do Good, But Fear F.D.A. Won’t Let Them Do Well
Like so many entrepreneurs who have opened vaping shops lately, Stephen D’Angelo was a heavy smoker who finally kicked nicotine after switching to electronic cigarettes, which he viewed as a healthier — and less smelly — alternative. Mr. D’Angelo runs a 500-square-foot store on a suburban corner in Hartsdale, N.Y., and, after seven months in business, has just started to turn a profit. But now his future — and those of thousands of other vaping entrepreneurs who have gotten into the business recently — is cloudy, since new Food and Drug Administration regulations seem poised to clamp down on e-cigarettes for health reasons. (Kelly, 5/10)

USA Today: Medication Error: Woman's Skin 'Melts Off'
Three years ago, a Georgia woman went to the doctor because she was depressed. The medication worked at first, but then blisters broke out all over her body. For the first two weeks, "everything was OK," said Khaliah Shaw, 26. But then, "I was in excruciating pain. It felt like I was on fire," she said. Her skin was burning from the inside out. Her sweat glands melted. The doctor had prescribed lamotrigine in 2014. (Pierrotti and Wolfe, 5/10)

Columbus Dispatch: Cotton Swabs Cause Thousands Of Ear Injuries Each Year, Study Finds
In 73 percent of cases, children or caregivers were attempting to clean their ears with swabs, a practice that doctors say is dangerous. There is a misconception that cotton swabs are the perfect tool for cleaning the ear canal, said Dr. Kris Jatana, an associate professor at Ohio State University’s Wexner Medical Center and an otolaryngologist at Nationwide Children’s Hospital. (Viviano, 5/10)

State Watch

Fiery Debate Erupts In Texas House Over Bill Requiring Vaccines For Foster Children

The fireworks started after state Rep. Bill Zedler (R-Arlington) tried to add an amendment to a bill, aimed at improving the state’s Child Protective Services agency, that would restrict doctors from including vaccinations in initial medical examinations for children. The provision was ultimately adopted, 74-58.

Texas Tribune: Texas House Backs Measure Barring Mandatory Vaccines For Foster Children 
What started as Texas House members discussing a bill that would improve the state’s Child Protective Services agency turned into a heated debate over vaccines — and whether they should be required for children placed in foster care. And when the debate over House Bill 39 was over Wednesday, members passed a bill that would prevent new foster children from being vaccinated. (Samuels, 5/10)

State Highlights: Soda Industry Targets Calif. Legislature's Latino Caucus; Ohio's MetroHealth System Prices Hospital Bonds At $946 Million To Pay Construction Costs

Media outlets report on news from California, Texas, Massachusetts, Louisiana, Ohio, Wisconsin and Missouri.

KQED: Soda Industry Targeted Legislature’s Latino Caucus
As California lawmakers continue to kill soda tax proposals, a new analysis found that the industry has disproportionately directed campaign contributions to members of the Latino Caucus in Sacramento. Maplight.org, a nonprofit that tracks campaign spending, found that the soda industry gave, on average, twice as much campaign cash to members of the Latino Caucus as to the average member of the state Legislature in recent years. (Lagos, 5/11)

Houston Chronicle: Memorial Hermann To Pay $2.4M After Sharing Patient Name In Press Release 
Memorial Hermann Health System has agreed to pay a $2.4 million fine and adopt a corrective action plan after being accused by the federal government of improperly disclosing a patient's name to news media in 2015. The settlement announced Wednesday by the U.S. Department of Health and Human Services stems from a September 2015 incident that drew national press attention and sparked an uproar among immigrant rights activists. (Hixenbaugh, 5/10)

Boston Globe: Steward Accused By Doctors Of Failing To Make Millions In Payments
When a group of doctors in Southeastern Massachusetts joined Steward Health Care System’s physician network five years ago, the partnership was supposed to help both organizations. But now Steward and the doctors group, Compass Medical PC, are engaged in an ugly business dispute over millions of dollars in payments. (Dayal McCluskey, 5/10)

Modern Healthcare: Kaiser Raises Record $4.4 Billion In White-Hot Hospital Bond Market
Kaiser Permanente raised $4.4 billion through a series of three bond offerings this month. That's a record for the Oakland, Calif.-based health plan and hospital giant, which plans to use the proceeds to fuel expansion, said Chief Financial Officer Kathy Lancaster. The aggregate interest rate on the A+-rated bonds was a stellar 3.8%. (Barkholz, 5/10)

Los Angeles Times: L.A. City Attorney Accuses Home Healthcare Firm Of Stealing Workers' Wages
The Los Angeles city attorney filed suit Wednesday against a home healthcare business operator, accusing her companies of bilking hundreds of mostly immigrant workers out of their pay while violating minimum wage and overtime laws. "Stealing wages from hardworking men and women is reprehensible,” Mike Feuer said. “No worker should be forced into poverty because an employer denies them their basic rights to a minimum wage and overtime. My office will aggressively combat wage theft and fight to ensure all workers are paid what the law demands.” (Winton, 5/10)

New Orleans Times-Picayune: 4 New Orleans Doctors, 2 Others Convicted In $13.6 Million Medicare Fraud Scheme
A jury convicted four New Orleans doctors and two others on Tuesday (May 9) in federal court for participating in a Medicare fraud scheme prosecutors say netted more than $13.6 million in fraudulent Medicare reimbursements. The six defendants, all from the New Orleans area, worked for or with Abide Home Care Services, which federal prosecutors said routinely falsified diagnoses so Medicare reimbursements were inflated. Abide also falsified medical records that supported medically unnecessary home health services, prosecutors said. The company was owned by New Orleans businesswoman Lisa Crinel, who pleaded guilty to her role in the scheme in 2015. Eighteen other individuals or companies also previously pleaded guilty related to the scheme. (Lane, 5/10)

KQED: After Valero Refinery Outage, Three Probes … And Rising Gas Prices
State workplace regulators have begun an investigation into the power outage at Valero’s Benicia refinery that has been sending flames, smoke and toxic gas into the sky for close to a week. The outage is renewing concern among environmentalists and could soon be felt by consumers around the region: a leading oil expert says the refinery’s shutdown will increase the cost of gas throughout the Bay Area. (Goldberg, 5/10)

New Orleans Times-Picayune: 1 In 3 New Orleans Inmates Take Mental Health Drugs, Jail Monitors Say 
One in three Orleans Parish inmates take drugs used to treat addiction and mental illnesses, a federal jail monitors' report says. But only 160 of the more than 500 jail inmates prescribed with psychotropic drugs are included in a system that ensures people locked up in the troubled jail receive specialized monitoring and treatment for their illnesses, the report found. The prevalence of psychotropic drug prescriptions among the New Orleans inmate population is roughly double that of the average American adult population, research shows. (Lane, 5/10)

Milwaukee Journal Sentinel: Assembly OKs Bill Requiring Wisconsin Guards To Report Abuse
As a two-year-old investigation into child abuse continues at the state’s juvenile prison complex, the Assembly approved legislation Wednesday that would require guards to report suspected child abuse and neglect to law enforcement. Senate Bill 35, which passed on a voice vote without opposition, marks the first step lawmakers have taken in response to a criminal investigation that began in January 2015 of Lincoln Hills School for Boys and Copper Lake School for Girls. (Marley, 5/10)

Kansas City Star: Online Eyeglass Sales Take A Chunk Out Of Optometrists' Revenue 
Optometrists who also sell eyeglasses out of their practices have long faced competition from other brick-and-mortar stores: large chains like LensCrafters, retail giants like Wal-Mart and even the corner drug store selling readers. But now they’re facing a new challenge: glasses bought online, and how frequently they need adjustments. (Marso, 5/10)

Weekend Reading

Longer Looks: AHCA Fallout; Phage Therapy; And A Measles Outbreak

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

The Economist: Republicans Sign Up For Political Pain
Through the troubled seven-year history of the Affordable Care Act, Barack Obama’s health-care law, most Americans have agreed on one thing. They like the provision which ensures that people with pre-existing medical conditions can buy health insurance at the same price as everyone else. Even when more than half of Americans disapproved of “Obamacare”, more than four in five supported this bit of it. That simple political fact explains why the latest Republican attempt to rewrite the health-care law, which seemed likely to come to a vote in the House of Representatives soon after The Economist went to press, is probably doomed. (5/6)

Vox: A Conservative Wonk Makes The Case For The AHCA
Many conservatives have come to see the AHCA as a vessel, albeit a still imperfect one, for the kind of health reforms they have waited for years to achieve. Now that it has passed the House, they are one step closer to that goal. (Dylan Scott, 5/9)

Stat: Profit Motive — And Scant Evidence — Propel Dire Warnings About 'Surgical Smoke'
Just breathing the air in an operating room where hot surgical tools are being used to slice and cauterize tissue — emitting puffs of caustic smoke in the process — is said to be the equivalent of smoking up to 30 unfiltered cigarettes a day. The smoke contains an array of carcinogenic toxins. And nurses regularly exposed to it report they are are twice as likely as the general public to suffer congestion, coughing, and asthma. Citing such data, health care workers have launched national campaigns to push hospitals to require the use of devices that suction up surgical smoke as it’s produced. (McFarling, 5/11)

FiveThirtyEight: As U.S. Life Expectancies Climb, People In A Few Places Are Dying Younger
A series of papers published over the last couple of years showed a disturbing increase in mortality among white people without a college degree. In the wake of the divisive presidential election, that work drew grim headlines about the death of middle-aged whites. Some argued in response that the focus on whites was misplaced, given that mortality rates for black people and Native Americans are higher than those of other racial groups. But combining these socioeconomic and racial disparities with the variation in geographical outcomes paints a harrowing picture of a stark U.S. reality: The wealthiest country on earth, which also spends the most money on care for the sick, has far from the best health outcomes. (Anna Maria Barry-Jester, 5/8)

Texas Monthly: Will Texas Republicans Suffer For Their Obamacare Vote?
The Republicans had voted for the American Health Care Act, a health reform bill of dubious character. If the legislation gets through the Senate—which is a big if—millions of Americans will likely lose their health insurance or have to pay exorbitant prices in a high-risk pool. But, in this moment, once again the two major political parties that control the greatest legislative body on the planet demonstrated that to them this isn’t about improving the lives of most Americans, but rather a zero-sum game of political winners and losers. (R.G. Ratcliffe, 5/8)

Editorials And Opinions

Different Takes: Recast Health Policy Debate On System Flaws, Patient Needs; Learning Health Care Lessons From Spain

Opinion writers offer views on how to move forward in efforts to reform the nation's health care system, including thoughts on what's right in Obamacare, specific ways its shortcomings need to be addressed and deep problems in the GOP's American Health Care Act.

JAMA Forum: Reframing The Health Policy Discourse
Among the many confounding aspects of recent health policy debates was how much attention focused on the wrong issues. The conversation devolved into a proxy war over the Affordable Care Act instead of dealing with the deep-rooted flaws in our health system. Behavioral psychologists would label this an example of the substitution heuristic: addressing a simpler question in lieu of the actual, more difficult one. As the Senate embarks on its own deliberations, potentially starting with a clean slate, will we have a chance to take on the more fundamental problems around health in the United States? (Dave A. Chokshi, 5/8)

Milwaukee Journal Sentinel: The Time Is Now For Real Health Care Reform
I am suggesting several ways we can change the discussion for real health care reform by agreeing on immutable principles and viewing insurance coverage in a new way to improve American health care for the people for whom it is intended: patients in need of care. As an optimist, I believe that sustainable reform can happen if we keep our patients at the center of all we do while building reform on three pillars. (Nick Turkal, 5/10)

The New York Times: What Spain Gets Right On Health Care
Countries that provide good primary care have better health outcomes and lower costs because they provide efficient care of common and chronic illnesses. In America, the high cost of medical education, a reimbursement system that favors specialists and a poorly supported primary care network have decimated our primary care work force. In the 1980s, Spain created taxpayer-funded community health centers located within a 15-minute radius of every citizen. This dramatically improved health measures and provided a good base of primary care for everyone in the country. (Carolyn McClanahan, 5/11)

The New York Times: Republicans Don’t Feel Your Pain
What in fact would the Trump-backed measure passed by the House last week actually do? The bill cuts spending by Medicaid by more than $800 billion over ten years. This enormous cut endangers continued coverage for millions of struggling voters who cast ballots for Trump. The bill also includes starkly regressive tax provisions. (Thomas B. Edsall, 5/11)

Los Angeles Times: Where House Republicans And Democrats Might Actually Agree On Preexisting Conditions
House Republicans kicked up a healthcare furor by proposing to let states remove the ironclad protections in Obamacare for millions of Americans with preexisting conditions. But their approach to the issue is, on one level, not far removed from what progressives have long advocated. Stick with me here, it’s not as ridiculous as it sounds. No, the Republicans’ repeal-and-replace bill, the American Health Care Act, does not call for a single-payer system, universal coverage or anything so warm and fuzzy. What it does propose, however, is to dun federal taxpayers to make sure the sickest and riskiest Americans can obtain coverage. (Jon Healey, 5/10)

The Wall Street Journal: Fact Checking Health-Care Hysteria
After the House voted last week to repeal and replace ObamaCare, Democrats quickly launched a barrage of false attacks. Minority Leader Nancy Pelosi asserted that the bill would “gut” protections for patients with pre-existing conditions. Never one to shy away from melodrama, she added: “This is deadly. This is deadly.” Apparently the GOP proposal is the second health-care bill Mrs. Pelosi didn’t read. The legislation makes clear: “Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.” (Karl Rove, 5/10)

Lincoln Journal-Star: ACA Replacement Needs 3 Key Parts
As Congress continues its attempts at replacing the Affordable Care Act, or Obamacare, it is important to discuss what a successful effort should look like. Most health policy experts divide a good plan into two buckets -- increasing coverage and lowering costs. Although the ACA did a good job on coverage by decreasing the number of Americans without health insurance to the lowest levels recorded, its major failing was that it was weak on lowering costs. The recent Republican effort is struggling in part because estimates show that up to 24 million could lose health insurance while making only a small dent in costs. (Bob Rauner, 5/11)

Arizona Republic: Don't Count On The States To Bail Out Ryancare
Counting on the states to bail out Ryancare is bad policy and a bad bet. Simply put, in terms of creating a sustainable individual health insurance market, Ryancare is no better than Obamacare and would face the same fate, for the same reasons. (Robert Robb, 5/10)

Seattle Times: Muster Bipartisan Compassion To Fight Toxic AHCA
Kudos to U.S. Reps. Jaime Herrera Beutler, R-Vancouver, and Dave Reichert, R-Auburn, for showing courage and compassion in voting against the American Health Care Act. Although the coldhearted attack on Obamacare narrowly passed the House last week, the two Republicans stood their ground and resisted intense lobbying from their party’s highest levels. Let’s hope there are similarly brave Republicans in the Senate, which should give the far-reaching AHCA more deliberation and analysis than the rush-job it received in the House. Rep. Cathy McMorris Rodgers, R-Spokane, a wholehearted plan supporter, has some explaining to do if she expects to win re-election next year. (5/9)

Viewpoints: Unlocking Understanding Through Genomics And Precision Health; Alzheimer's Gender Gap

A selection of public health opinions from around the country.

JAMA: Introducing “Genomics And Precision Health”
The US health care system has seen significant changes over the last decade resulting from diverse factors including the widespread adoption of electronic health records, the opioid crisis, and the roll-out of the Affordable Care Act. Such changes have buffeted the day-to-day work of physicians and other health care practitioners, leaving many finding it challenging to address demands placed on them. Looking forward in 2017, it seems that the future will hold more turbulence. In this milieu, it is easily possible to overlook that medicine has been undergoing a much more gradual and deeper transformation. This shift is inexorably moving medicine from an endeavor in which care for individual patients is driven by trial and error informed by studies designed to measure population outcomes to one in which care is selected based on a deep understanding of health and disease attributes unique to each individual. (W. Gregory Feero, 5/9)

Stat: Gender Gap In Alzheimer's Disease Rates, Caregiving Needs More Attention
Women make up nearly two-thirds of the more than 5 million Americans with Alzheimer’s disease. A woman in her 60s is now about twice as likely to develop Alzheimer’s as breast cancer during her lifetime. And as described in a Viewpoint article published this week in JAMA Neurology, women shoulder the majority of caregiving for those with dementia. In fact, two and a half times as many women as men reported living full time with a person with dementia. The prevailing theory for why Alzheimer’s disease disproportionately affects women is that they generally live longer than men. However, mounting evidence suggests that longevity alone may not account for the difference. (Roberta Diaz Brinton, 5/10)

The Washington Post: When It Comes To Vaccines, Rich Parents Get Away With Child Neglect
Public health experts once again must defend the safety — and necessity — of vaccination, this time in response to misinformation spread among the Somali community in Minnesota by anti-vaccine activists. The rising skepticism about vaccines is dangerous on its own, of course. Last year, a study in the journal Pediatrics found that more parents than ever believe vaccines are simply unnecessary to prevent childhood diseases. But the anti-vaccine movement highlights another, troubling aspect in the world of child health: Wealthy people are more likely to be let off easy when they do things that can harm their children than low-income people are. (Linda C. Fentiman, 5/10)

Stat: Why Autistic People Like Me Need To Help Shape Autism Science
This week I will join roughly 2,000 scientists and autistic advocates in San Francisco for IMFAR — the International Meeting for Autism Research. As an autistic adult, I feel it’s important to be in the midst of this gathering and to offer scientists my opinions about research, unmet needs, and unanswered questions. We have a saying in the disability advocacy community, “Nothing about us, without us.” When it comes to autism research, if we want science to address our concerns, we first need to make sure that researchers know what those concerns are. (John Elder Robison, 5/10)

The Columbus Dispatch: Daily Exercise Crucial For Kids
Dr. Stanley Herring, director of the University of Washington Sports Health and Safety Institute, says exercise is essential to a child’s long-term health. The concussion protocols published last month in the British Journal of Sports Medicine are designed to keep athletes as safe as possible and all youth sports programs should adopt them. But parents also need to keep their kids active. (5/11)

The Washington Post: Don’t Blame Democrats’ Problems On Support For Abortion Rights
Like a steady drip from a broken faucet, a lot of blame has been thrown around since Hillary Clinton’s shocking loss in November. Predictably, and without any evidence, some have begun drawing connections between Clinton’s loss and her support of abortion rights, specifically her call to end the Hyde Amendment, the law first passed in 1976 that effectively denies low-income women insurance coverage for abortion. A common thread has emerged: Women’s issues and racial justice — both of which intersect in support of abortion rights — are being positioned as a key vulnerability of today’s Democratic party, rather than part of its core. (Destiny Lopez, 5/10)

Georgia Health News: Veto Will Have Painful Consequences For Rural Patients 
Rural Georgians are once again bearing the brunt of myopic health care policy decisions coming from Atlanta. On Tuesday, just days after the Jenkins County Hospital closure announcement, a bill designed to restore delegated prescriptive authority to Georgia’s board-certified physician assistants (PAs) treating painful injuries and other medical emergencies was vetoed by Gov. Nathan Deal. The legislation, Senate Bill 125, sponsored by Sen. Rick Jeffares (R-McDonough), would have authorized a physician to delegate to a PA the authority to prescribe hydrocodone compound products, with suitable restrictions and controls. (Jason Spencer, 5/10)