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Summaries Of The News:

Health Law

Insurers Press CMS For Reassurance On Subsidies But Leave Meeting Empty-Handed

The "insurer bailouts" have been a Republican target for years, but their future has become even more uncertain after President Donald Trump said he may use them as a bargaining chip to get Democrats to the table to negotiate over health care.

The Wall Street Journal: Trump Officials Offer Scant Assurance To Health Insurers On Key ACA Payment
The executives had hoped that Tuesday’s meeting at the Department of Health and Human Services would provide a clearer signal on whether they will continue getting “cost-sharing” payments, which help insurers bring down costs for about six million low-income customers enrolled through ACA insurance exchanges. President Donald Trump has unnerved insurance companies recently by sending mixed signals on the payments, just as the companies are making decisions on whether or not to take part on the ACA exchanges in 2018. (Hackman, Radnofsky and Wilde Mathews, 4/18)

CQ Roll Call: Insurers Meet With CMS To Press For Exchange Subsidy
"We welcomed the chance to share perspectives on the value of coverage delivered to more than 70 million Americans through Medicare Advantage and Medicaid health plans, but reiterated our most pressing concern: the instability in the individual market created by the uncertainty of funding for the cost sharing reduction (CSR) program," said Kristine Grow, an AHIP spokeswoman, in a statement. (Young, 4/18)

Meanwhile, the subsidies may play a role in the brewing spending fight —

The Hill: Health Subsidy Demand Jams Up Shutdown Fight 
Democrats’ demand that ObamaCare subsidies be wrapped into a must-pass spending package is complicating GOP efforts to prevent a government shutdown at the end of next week. Speaker Paul Ryan (R-Wis.) has signaled no plans to include the subsidies in a bill to keep the government open, but President Trump’s recent threat to withhold the subsidies to insurers has led several top Republicans to intervene. (Lillis and Marcos, 4/19)

Trump Continues To Ring Optimistic Bell Over Republican Health Care Plans

President Donald Trump called on supporters at an event in Wisconsin to urge their representatives to support the GOP's efforts. Meanwhile, over in Iowa, Republican Sen. Chuck Grassley fields single-payer questions during a town hall, and a pro-Trump group targets a Colorado lawmaker with TV ads in his district.

Politico: Trump Issues Bold New Promises On Health Care, Tax, Infrastructure
President Donald Trump on Tuesday promised big wins in the next stretch of his administration, glossing past the reality that the political newcomer will celebrate his first 100 days without a major legislative victory. In a speech that could be seen as a messaging test for that milestone, Trump hailed the opening days of his administration as a wild success and pledged to quickly deliver on health care, tax reform and infrastructure. (McCaskill, 4/18)

Des Moines Register: Town Meeting Crowd Challenges Grassley On Single-Payer Health Care
Health care dominated U.S. Sen. Chuck Grassley’s town meeting on Tuesday, as southeast Iowa constituents pressed him on insurance affordability and challenged him to embrace a single-payer solution. Congress is currently considering several proposals with the potential to lower insurance premiums, Grassley said, while a single-payer system in which government supplants private insurers is a nonstarter.  One woman described to Grassley how the insurance plan her family bought on the state’s Affordable Care Act exchange rose from $1,400 to $2,200 per month – and will go away altogether in 2018. (Noble, 4/18)

Denver Post: Donald Trump Group Pressures Scott Tipton With New Obamacare Ad
Allies of President Donald Trump this week are targeting Congressman Scott Tipton of Colorado with a new TV ad that uses an unusual tactic — reverse psychology — to get him to support a second effort to repeal and replace the Affordable Care Act. The 30-second spot, paid for by the Trump-aligned group America First Policies, urges viewers to call Tipton and thank him for “his courage and for standing with President Trump to repeal Obamacare now.” The oddity comes from the fact that Tipton, R-Cortez, was the only House Republican from Colorado to publicly declare that he would have voted against the GOP health-care plan that collapsed last month — telling The Daily Sentinel in Grand Junction afterward that he was opposed to the legislation. (Mattews, 4/18)

In other health law news —

The Fiscal Times: No Health Insurance? Didn’t Check The Box On Your 1040 Tax Form? So What? 
Since the Affordable Care Act was formally launched in 2014, taxpayers have had to check a box on line 61 of their 1040 federal tax returns declaring whether they or members of their family have qualified health insurance -- and provide documentation to prove it. This was required as part of Obamacare’s “individual mandate” to make nearly everyone without insurance eventually sign up. (Pianin, 4/18)

UnitedHealth, A Bellwether For Insurance Industry, Reports Profit Surge After Cutting Back ACA Participation

The insurer saw rapid growth in its Medicare business, according to its earnings statement for the first quarter of 2017.

The Associated Press: UnitedHealth 1Q Profit Soars As ACA Business Shrinks
UnitedHealth's first-quarter profit soared 35 percent as the nation's biggest health insurer slashed participation in Affordable Care Act exchanges but grew just about every other part of its business. The insurer also hiked its 2017 earnings forecast on Tuesday, and company shares started climbing shortly after it detailed results. (4/18)

Administration News

Pioneer Or 'Embarrassment': Psychiatrist Eyed For Top Mental Health Post Gets Mixed Reviews

Michael Welner is the leading contender for a position at the Department of Health and Human Services that was created as part of the 21st Century Cures Act in response to the shooting in Newtown, Conn.

The Wall Street Journal: Trump’s Latest Pick For Mental-Health Post Has Helped Prosecutors Secure Convictions
The Trump administration is struggling to fill a top mental-health post, a job created last year to coordinate the efforts of far-flung federal agencies. The assistant secretary position in the Department of Health and Human Services was first offered to a Florida judge, but the offer was withdrawn due to his lack of a medical background, according to people familiar with the matter. A second candidate had broad support but pulled out. Now a leading contender is Michael Welner, a forensic psychiatrist who has testified for the prosecution in numerous high-profile criminal cases, according to a half-dozen people familiar with the process including Dr. Welner himself. He faces opposition for some controversial positions. (Hackman, 4/18)

In other Trump administration news —

The Associated Press: Feds Practice Ebola Evacuations Despite Past Trump Criticism
Donald Trump railed against President Barack Obama’s decision to bring patients with Ebola to the United States for treatment in 2014. Now that Trump is president, his administration is preparing for similar, and possibly larger-scale, evacuations. The State Department and Department of Health and Human Services said Tuesday they led an unprecedented inter-agency drill last week to test their preparedness to deal with a new outbreak of Ebola or another deadly, highly infectious disease. (Lee, 4/18)

Kaiser Health News: Trump Set To Extend Flawed ‘Fix’ For VA Health Scandals
It was a “fix” that didn’t fix much — but Veterans Choice is expected to be extended anyway, with a stroke of President Donald Trump’s pen that could come as early as Wednesday. Veterans Choice is a $10 billion response to the 2014 scandal in which Veterans Affairs health facilities altered records to hide months-long waits for care in Phoenix and elsewhere. The troubled Choice program pays for private-sector health care for veterans and was set to expire in August, but the VA and some of the program’s harshest critics in Congress have agreed to extend it, with a few changes, until January. They said that will give the VA time to propose a more comprehensive package of reforms — fixes for the fix. (Whitney, 4/19)


Theranos Agrees To Full Refunds For All Of Its Arizona Customers

The settlement, the second in two days to hit the troubled blood-testing startup, will cost the company about $4.65 million.

The Associated Press: Theranos Agrees To Pay $4.65 Million In Arizona Refunds
Embattled blood testing company Theranos, Inc. has agreed to pay $4.65 million to cover full refunds for every Arizona customer who used the company's testing services, Arizona Attorney General Mark Brnovich announced Tuesday. The settlement with the Palo Alto, California-based company covers more than 175,000 Arizonans who paid for blood tests between 2013 and the suspension of Theranos services last year, Brnovich said. (4/18)

The Wall Street Journal: Arizona Attorney General Reaches Settlement With Theranos
The pact is the second legal settlement in two days involving claims that Theranos had faulty blood-testing technology or lab practices. On Monday, Theranos resolved regulatory and legal matters with federal health regulators after the company and its founder Elizabeth Holmes agreed to stay out of the medical-lab business for two years. Theranos has said it has shifted its focus to developing lab equipment to sell to other companies rather than doing tests itself. (Weaver, 4/18)

Stat: Theranos To Return Every Dollar It Made On Tests In Arizona
Embattled diagnostics startup Theranos said it will return $4.65 million to Arizona residents for the blood testing services they received between 2013 and 2016. ... Some 1.5 million blood tests were performed on 175,000 customers — and more than 10 percent were ultimately voided. The deal, made with the Arizona attorney general’s office, is Theranos’s second for the week: The Silicon Valley company also told the Centers for Medicare and Medicaid Services that it wouldn’t conduct any blood testing for at least two years, in exchange for pared-down penalties from federal health authorities. (Keshavan, 4/18)

Cardinal Health Lays Out $6.1B To Acquire Medtronic Supplies Business

The health services company plans to acquire Medtronic's patient care, deep vein thrombosis and nutritional insufficiency medical-supply units.

Modern Healthcare: Cardinal Health To Acquire Medtronic Medical Supplies Business For $6.1B
The drug and medical products distributor Cardinal Health plans to acquire Medtronic's medical supplies business for $6.1 billion, the company announced on Tuesday. The cash deal would give the Dublin, Ohio-based company access to Medtronic's 23 product categories in its patient care, deep vein thrombosis and nutritional insufficiency business, which "are used in nearly every U.S. hospital," Cardinal said. (Kacik, 4/18)


Federal Officials To Adjust Hospitals' Penalties For High Readmissions Of Some Patients

The new formula will provide some relief to hospitals that have large numbers of "dual eligible" patients, or those that are covered by both Medicare and Medicaid, because they tend to be poorer and sicker than the general population. Also, Iowa Sen. Chuck Grassley is pushing federal officials to get tougher with Medicare Advantage plans.

Modern Healthcare: Dual-Eligibles: The Next Target In Hospital Readmissions Penalties 
The CMS is proposing to adjust penalties in its Hospital Readmissions Reduction Program according to a hospital's proportion of dual-eligible patients, garnering praise from industry stakeholders even though they say the move is an incremental change. The proposed rule, released Friday, would take effect in fiscal 2019. ... The change stems from the 21st Century Cures Act, which was enacted in December 2016. The law required Medicare to take patient background into account when calculating payment reductions to hospitals under the Hospital Readmission Reduction Program, and to adjust those penalties based on the proportion of patients who were dually eligible for Medicare and Medicaid. Such patients are disproportionately expensive for hospitals. (Whitman, 4/18)

Kaiser Health News: Sen. Grassley Demands Scrutiny Of Medicare Advantage Plans
Sen. Chuck Grassley (R-Iowa) wants federal health officials to tighten scrutiny of private Medicare Advantage health plans amid ongoing concern that insurers overbill the government by billions of dollars every year. Grassley, the influential chairman of the Senate Judiciary Committee, has asked Centers for Medicare and Medicaid Services (CMS) officials to explain why they failed to collect nearly $125 million in potential overcharges identified at five Medicare Advantage plans audited in a single year. (Schulte, 4/18)


Financially Troubled Kansas Hospital Faces Closure And Cites Lack Of Medicaid Expansion

St. Francis Hospital in Topeka is not far from the state capitol where the Republican governor has been a staunch opponent of Medicaid expansion. The owners say they will keep it open for a couple of months, but it's not clear if another company will come in to take over the beleaguered facility. In other news, a look at how the Trump administration might change Medicaid rules and federal officials announce they will evaluate Montana's program.

KCUR: St. Francis Health Owner Says Hospital ‘Not Sustainable'
The owner of St. Francis Health left no doubt it won’t continue to run the Topeka hospital for more than a few months. The lingering question is whether anyone else will step in to keep it from closing. Mike Slubowski, president and CEO of SCL Health, said in a news release Tuesday that he hopes to have a clear answer about the hospital’s future by the first week of May. SCL, formerly known as the Sisters of Charity of Leavenworth, is based in Denver. (Wingerter, 4/18)

KCUR: Hundreds Rally Against Closure Of Topeka Hospital At Center Of Medicaid Expansion Debate 
Several hundred people turned out Monday night to protest the possible closure of St. Francis Health in Topeka. The financial struggles of the 378-bed hospital have taken center stage in the debate over whether to expand KanCare, the state’s privatized Medicaid program. Republican Gov. Sam Brownback recently vetoed an expansion bill that would have generated an additional $10 million a year in federal funding for St. Francis, according to the Kansas Hospital Association. (McLean, 4/18)

Modern Healthcare: CMS To Evaluate Montana's Medicaid Expansion
The CMS will evaluate Montana's Medicaid expansion program despite past protests from key Trump administration officials against similar audits. In 2015, the state received CMS approval for a waiver to expand Medicaid coverage to individuals who earn up to 138% of the poverty line starting Jan 1, 2016. The initiative, known as the Montana Health and Economic Livelihood Partnership, or HELP, was expected to provide coverage to approximately 70,000 people. (Dickson, 4/18)


CMS Considers Making Confidential Reports On Hospital Safety Public

The inspection information offers detailed descriptions of hospitals' errors and mistakes. Meanwhile, a study finds that a simple post-surgery checklist can save lives.

ProPublica: Secret Hospital Inspections May Become Public At Last
The public could soon get a look at confidential reports about errors, mishaps and mix-ups in the nation's hospitals that put patients' health and safety at risk, under a groundbreaking proposal from federal health officials. The Centers for Medicare and Medicaid Services wants to require that private health care accreditors publicly detail problems they find during inspections of hospitals and other medical facilities, as well as the steps being taken to fix them. Nearly nine in 10 hospitals are directly overseen by those accreditors, not the government. (Ornstein, 4/18)

The Washington Post: A Simple Checklist Prevents Deaths After Surgery, A Large New Study Suggests
Surgery checklists save lives, a study released Monday found. Hospitals in South Carolina that completed a voluntary, statewide program to implement the World Health Organization's Surgical Safety Checklist had a 22 percent reduction in post-surgical deaths. The study, set to publish in the August 2017 issue of Annals of Surgery, is one of the first to show a large-scale impact of the checklist on the general population. (Naqvi, 4/18)

And in other news —

California Healthline: California Hospitals Lose Ground In Quality Of Care, Report Card Shows
Nearly half of California hospitals received a grade of C or lower for patient safety on a national report card aimed at prodding medical centers to do more to prevent injuries and deaths. The Leapfrog Group, an employer-backed nonprofit group focused on health care quality, issued its latest scores last week. The report card is part of an effort to make consumers and employers aware of how their hospitals perform on key quality measures, so they can make better-informed health care decisions. The scores are updated twice a year, in spring and fall. (Terhune, 4/18)

Public Health And Education

Addiction Hijacks The Brain, Creating Vicious Cycle Of Relapse For Those Trying To Recover

“We have to realize they are unable to maintain abstinence not for lack of desire but because their brain is damaged,” said Eric Nestler, a professor of neuroscience. Meanwhile, in the race to combat the raging opioid epidemic, some people are looking at possible security measures for the containers holding the pills.

Stat: How Drug Use Changes The Brain — And Makes Relapse All Too Common
The opioid epidemic ravaging the United States has brought new impetus to understanding how addiction hijacks the brain. More and more, scientists are shifting their focus to what’s going on in the brain after people like Mooney go off drugs. Their quest has unveiled a troubling picture: Repeated drug use leads to long-term changes to the brain. Some of those changes, new research suggests, might be hard to reverse and might even intensify right after withdrawal, explaining why it is so hard to stay off drugs. (Wesphal, 4/19)

Stat: Deterring Drug Abuse, Starting With The Vial
In a summit full of addiction experts, each looking for the next big solution to curb opioid abuse, everything from treatment policies to the containers holding prescription pills are being considered. Owners of several drug supply companies say prescription vials holding drugs have done little to slow the nation’s epidemic. With seven out of 10 people who abuse prescription opioids getting drugs from a friend or family member’s medicine cabinet, some medical entrepreneurs are pushing security measures from locks to iPhone alerts as a way to deter drug abuse. (Blau, 4/19)

And in the states —

Cleveland Plain Dealer: Ohio's Heroin Epidemic To Be Addressed In Churches Across The State April 23
As an outgrowth of the parish's Greater Than Heroin outreach effort - which includes the website - a clearinghouse of community resources, advocacy and news related to heroin addiction - [Bob] Stec has asked more than 300 religious leaders [to] speak about the issue to their congregations on April 23. The Easter season, with its message of renewal, provides a perfect opportunity to speak on the growing epidemic of opioid addiction, Stec said. (Lisik, 4/18)

Columbus Dispatch: Ohio Expands Program To Help Kids Hurt By Parents' Drug Abuse
Adams, Brown, Lawrence and Scioto counties are to receive money to bring the pilot program — called Ohio START (Sobriety, Treatment and Reducing Trauma) — to their communities, Ohio Attorney General Mike DeWine said Tuesday. That makes 18 counties, all of them hard-hit by the state’s heroin and opioid-medication crisis, participating in the program. (Price, 4/18)

Device Promises Relief From 'Suicide Headaches,' But Is It All Hype?

The gammaCore device did show benefits in a small group of people, but experts are skeptical. In other public health news: Parkinson's drugs, the March for Science, measles in Minnesota and marijuana for epilepsy.

Stat: Patients With 'Suicide Headaches' Just Got A New Therapy Option
Cluster headaches, as the rare condition is known, are characterized by bursts of severe pain in cyclical patterns. They’re often misdiagnosed and undertreated. But on Tuesday, the Food and Drug Administration cleared a new, first-of-its kind option for such patients: a handheld device, designed to be used by patients to zap their own necks with a mild electrical signal to relieve symptoms. The hitch: It’s not clear how much difference the “gammaCore” device will make for the several hundred thousand people in the United States with the condition. (Robbins, 4/18)

Chicago Tribune: New Drug Provides Long-Awaited Breakthrough For Parkinson's Psychosis
Most people recognize Parkinson's patients through tremors, slow body movements and other motor problems. Yet up to half of patients develop psychosis at some time during the disease's course, often in the later stages and sometimes as a side effect from drugs prescribed to help motor skills. Tackling the psychosis has proved difficult, in part because doctors struggled for decades to address the motor problems, [Dr. Rajesh] Pahwa said. As gains happened there, the nonmotor problems became a bigger and bigger challenge to manage, he said. (McGuire, 4/18)

Stat: Who's Going To The March For Science?
Routes are planned. Speakers are announced. But there’s still one question about this weekend’s March for Science that is begging to be answered: Who exactly is going to show up? The march has carved a wide mandate for itself as a non-partisan “celebration of science,” leaving the door open for many different groups to gather under its umbrella. Now, in recent weeks, the organizers of the Washington march and the hundreds of satellite marches across the US and overseas have been trying to anticipate who is going to turn up on April 22, including surveying social media and asking marchers to RSVP. (Sheridan, 4/19)

Minnesota Public Radio: Think Your Child Has The Measles? Call Before You Seek Care 
Dr. Jon Hallberg is having fewer conversations with vaccine skeptics at his Minneapolis practice now. He credits that to the spread of information that vaccines are safe and the debunking of any false claims otherwise. Still, as of Tuesday, there have been nine recent cases of measles in Minnesota kids — all of them unvaccinated. (Crann and Nelson, 4/18)

Women’s Health

20-Week Abortion Ban Sent To Iowa Governor's Desk

The legislation also includes a 72-hour waiting period for women seeking abortions. Meanwhile, in Texas, a fetal remains measure moves forward.

The Associated Press: Iowa Lawmakers OK 20-Week Abortion Ban, 3-Day Wait Period
Iowa legislators sent Gov. Terry Branstad a measure Tuesday that would ban most abortions at 20 weeks of pregnancy and impose a 72-hour waiting period on women seeking the procedure, a move highlighting the state's conservative shift since the November election. The Republican-majority state Senate voted 30-20 along party lines for the legislation, after the GOP-led House approved it earlier this month. Branstad, a Republican, is expected to sign it. (4/18)

Texas Tribune: Texas Bill Requiring Burial Of Fetal Remains Passes Out Of House Committee 
Texas hospitals and abortion clinics would have to bury or cremate fetal remains under a measure that passed out of a House committee on Tuesday. It's a rule that has its roots in Texas' fiery reproductive rights debate: While supporters argue the bill has nothing to do with abortion and is about "ensuring the dignity of the deceased," opponents say it's yet another way for the state to punish women who choose to legally terminate a pregnancy. (Samuels, 4/18)

State Watch

New Program At Penn State Focuses On Improving Health Of Abused Children

Abused children as a group tend to have more problems with a range of health issues, including obesity, sexually transmitted disease, teen pregnancy, depression and anxiety.

The Associated Press: Penn State Launches New Research Effort To Help Abused Kids
A new research program at Penn State aims to improve the health of neglected and abused children and test an innovative approach to screen kids for head injuries. Penn State said Tuesday it will establish the Center for Healthy Children at its main campus, supported by nearly $8 million from the National Institutes for Health. The university is putting in more than $3 million. The program will supplement the university’s Child Maltreatment Solutions Network , established in response to the Jerry Sandusky child molestation scandal. (Scolforo, 4/18)

In other news —

City In Minnesota May Become First In State To Raise Tobacco Age To 21

The Edina City Council may pass the ordinance in its May meeting. Media outlets report on tobacco regulations out of California, Kansas and Iowa, as well.

The Star Tribune: In Late Debate, Edina Considers Raising Age For Legal Tobacco Sales To 21
In a much anticipated City Council meeting, Edina residents waited till almost midnight Tuesday to voice their opinions on an ordinance that would change the minimum age of tobacco sales in the city. Not until 11:50 p.m., after lengthy discussion of a project at 50th and France, did Mayor Jim Hovland and Edina City Council members hear the public’s views on raising the age from 18 to 21 — an effort to curb teen tobacco use. (Zamora, 4/19)

California Healthline: SF Seeks To Ban Sale Of Menthol Cigarettes And Flavored Tobacco Products
San Francisco has unveiled a tough anti-tobacco ordinance that would ban the retail sale of menthol cigarettes and other flavored tobacco or tobacco-related products that are often the first choice of minority group members and teenagers who smoke. Supervisor Malia Cohen, the proposal’s sponsor, joined Tuesday with public health experts and community advocates to announce the measure, which she said goes beyond more narrow laws on flavored tobacco in cities such as Chicago, Berkeley and New York. (Korry, 4/19)

Kansas City Star: Push For Tobacco Law Moves Beyond JoCo Cities 
A campaign that has successfully changed laws to limit the sale and purchase of nicotine products in 10 Johnson County cities will be considered on Thursday for unincorporated parts of the county. If it is approved, it will raise the legal age to buy nicotine products to 21. (Hammill, 4/18)

Iowa Public Radio: GOP Bill Bans Underage Sales Of E-Cigarettes Online 
Electronic cigarettes and other so-called vaping products sold to Iowans on the internet would be regulated for the first time under a last-minute spending bill as the GOP majority strives toward adjournment of this year’s legislative session. Under the bill, sellers would be required to obtain a permit to sell the alternative nicotine products online. (Russell, 4/18)

State Highlights: Ariz. Tops Federal Tally For Complaints Against Medical-Debt Collectors; Fla. Republicans Push To Undo Hospital Certificate-Of-Need Rule

Outlets report on news from Arizona, Florida, Michigan, New Hampshire, Louisiana, California, Georgia and Tennessee.

Arizona Republic: Complaints Mount Against Medical-Debt Collectors
The complaints offer a narrow glimpse into what can happen long after a patient leaves a doctor’s office or hospital and disputes or refuses payment of a bill. Hospitals and doctors often deal with unpaid bills. Some turn to debt collectors to get what the insurance company, the consumer or both refused to pay. (Alltucker, 4/18)

Miami Herald: House Republicans Push To Give Hospitals Greater Say In Expansion 
For four decades, hospitals wanting to expand or open new facilities have had to get the state to agree there’s a need for more healthcare in their community. It’s a rule that Republicans in the Florida House say creates unnecessary burdens on the free market. This week, they’ll be passing a bill to repeal it. (Auslen, 4/18)

Arizona Republic: CVS MinuteClinics To Relieve Stress On Phoenix VA, Open Doors To Many Veterans In Arizona
Veterans in the Phoenix VA Health Care System can now get immediate medical treatment for minor illnesses and injuries from CVS MinuteClinics under a pilot project announced Tuesday. The program will be open to about 120,000 veterans, enabling them to call VA triage nurses and, if their symptoms qualify, receive an appointment within two hours at one of the drugstore chain's 24 clinic outlets in central Arizona. (Wagner, 4/18)

New Hampshire Union Leader: Business Is Booming For Long Term Care Partners 
A Portsmouth company that fills a unique niche in the insurance market is confident its services will be in demand for years to come. Long Term Care Partners on Arboretum Drive is a third-party administrator of insurance services for federal employees. Under a seven-year contract regulated by the U.S. Office of Personnel Management, LTC is responsible for the Federal Long Term Care Insurance Program, which has about 275,000 enrollees and an eligible population of 4.4 million-plus federal employees, annuitants and qualified family members. LTC is also contracted to administer BENEFEDS, an exchange and service platform through which more than 2.5 million federal employees can manage their dental and vision coverage, with the choice of coverage from more than a dozen major national carriers. (Haas, 4/18)

New Orleans Times-Picayune: Registry Tracks New Orleans Elderly, Disabled For Evacuations 
New Orleans has a plan in place to help evacuate around 40,000 people who might not be able to get out on their own ahead of a hurricane. But during an evacuation, how does the city know where to find of the most vulnerable people, the elderly and disabled? Enter the Special Needs Registry, created to provide transportation and shelter for New Orleanians with special medical needs during emergencies such as a power outage, evacuation or hurricane. The registry keeps a database of information on around 4,400 people who will need extra help during an evacuation, and comes equipped with a small outreach team to update the records and annually. (Evans, 4/18)

California Healthline: As California Weighs Soda Warning Labels, Tax In Berkeley Shown To Dilute Sales
A new study of the soda tax in Berkeley, Calif., shows that residents are doing what public health experts had hoped — they’re ditching sugary drinks and opting for healthier beverages. The study, the largest to date of Berkeley’s soda tax, comes as California lawmakers this week again consider legislation to put a warning label on sweetened beverages — a bill that died in committee three times in three years. (Ibarra, 4/18)

Sacramento Bee: Disabled Placards For Thousands Of Dead Californians Part Of Program Abuse 
California’s Department of Motor Vehicles needs to significantly beef up efforts to prevent fraud and abuse in the state’s disabled person placard program, a new state audit recommends, noting that officials accept applications lacking required medical documentation, issue too many duplicates, and fail to cancel the placards of people who have died. Almost 3 million people had disabled placards or special license plates as of June 2016, according to Tuesday’s Bureau of State Audits report. (Miller, 4/18)

Georgia Health News: Fraudsters, Beware! Health IT Firm Launched In Georgia Is After You 
Companies in the industry provide a range of products and services, from electronic health records, medical billing and revenue management to diagnostics, preserving the security of information exchanges, and consumer health information... The revolution in patients’ medical records has accelerated the IT spurt, with physicians’ offices across the U.S. giving up folders full of written notes and turning to digital data. (Miller, 4/18)

Nashville Tennessean: For Stealing $1.5M From Children's Food Program, Tennessee Woman Gets 3 Months Prison
A La Vergne woman who stole $1.5 million from state programs that feed children in need was sentenced last week to three months in prison, records show. Federal sentencing guidelines recommended more than five years prison time, according to court records. The reason U.S. District Judge Aleta Trauger handed LaShane Hayes the shorter term is unclear because several court documents are sealed, however other filings indicate Hayes wanted a probation sentence because of a medical condition. (Barchenger, 4/18)

Prescription Drug Watch

While Drugmakers Lick Wounds From Public Outrage Over Prices, One Company Remains Defiant

News outlets report on stories related to pharmaceutical pricing.

The New York Times: Defiant, Generic Drug Maker Continues To Raise Prices
Congressional hearings. Federal investigations. Consumer outrage. In the wake of developments like these, many drug company executives are laying low. Their favored business models, based on raising drug prices indiscriminately, are now seen as a liability; many pharmaceutical companies are curbing increases on their products and accepting that this once-lucrative jig may be up. (Morgenson, 4/14)

Stat: Want To Avoid A Drug Price Backlash? Keep The Cost To Yourself
All the recent rancor over drug pricing has led biotech to change its ways. Not by making new drugs cheaper, of course, but by holding off on naming a price — and thus inviting controversy — until the last possible minute. Nowadays, as soon as a drug wins Food and Drug Administration approval, so begins a debate about whether it’s worth the thousands of dollars a year new therapies generally cost. And so companies, perhaps mindful of how a few scolding tweets can snowball into a market-moving event, are starting to keep that information under wraps for as long as possible. (Garde, 4/12)

The Wall Street Journal: Cardinal Health Feels Pain Of Falling Drug Prices
Making money when drug prices were rising was easy. Now comes the hard part.The latest signal: Distribution giant Cardinal Health lowered earnings expectations Tuesday morning and told investors that business wouldn’t pick up until the middle of 2018. The company is being hit by falling prices of generic drugs, which are expected to decline by a percentage in the low double digits for the fiscal year ending in June. (Grant, 4/18)

Stat: Bill Would Make It Easier For Pharma To Talk Off-Label Drug Uses
In a bid to loosen off-label communications, a congressman quietly introduced a bill late last month that would expand the ability of drug makers to discuss unapproved uses of their medicines with doctors. The legislation, which was proposed by Representative Morgan Griffith (R-Va.), addresses a controversial, if technical term called “intended use.” The Food and Drug Administration maintains that discussion of an unapproved, or off-label use, creates a new intended use for which a drug maker must have regulatory approval. (Silverman, 4/18)

The Washington Post: 1st Drug OK’d For Movement Disorder Caused By Certain Meds
U.S. regulators have approved the first drug for treating a neurological syndrome that causes uncontrollable body movements that can also interfere with speech, swallowing and breathing. The sometimes-disabling disorder, tardive dyskinesia, is caused by some widely used prescription medicines for psychiatric and gastrointestinal disorders. It can surface while patients are on those medicines or years after they stop. It affects about 500,000 U.S. patients. (Johnson, 4/11)

Kaiser Health News: Nonprofit Linked To PhRMA Rolls Out Campaign To Block Drug Imports
A nonprofit organization that has orchestrated a wide-reaching campaign against foreign drug imports has deep ties to the Pharmaceutical Research and Manufacturers of America, or PhRMA, the powerhouse lobbying group that includes Eli Lilly, Pfizer and Bayer. A PhRMA senior vice president, Scott LaGanga, for 10 years led the Partnership for Safe Medicines, a nonprofit that has recently emerged as a leading voice against Senate bills that would allow drug importation from Canada. (Kopp and Bluth, 4/19)

Stat: Patient Groups, Backed By Pharma, Fight Nevada Drug Pricing Bill
Abill that was recently introduced in Nevada to fight the cost of diabetes medicines is quickly generating vociferous opposition from several patient organizations, some of which receive financial support from the pharmaceutical industry. The groups include the National Organization for Rare Disorders, Caregiver Voices United, the Myositis Association, the International Pain Foundation, RetireSafe, and the Epilepsy Foundation. And most of their letters, which were sent to Nevada state senators, use nearly identical language in citing concerns. (Silverman, 4/17)

Boston Globe: Alere Agrees To Be Bought By Abbott For Reduced Price
The long and contentious purchase of Alere Inc. of Waltham by Abbott Laboratories appears at hand, after the two health care companies said Friday they have a new deal that lowers the takeover price by $500 million. The amended takeover, under which Abbott will pay $51 for each share of Alere, is valued at $5.3 billion, down from the $5.8 billion the parties had initially agreed to in February 2016. (Weisman, 4/14)

Stat: A Surprise FDA Rejection Puts Lilly's Turnaround In Jeopardy
Eli Lilly’s path to what looked like a surefire blockbuster got derailed by an unforeseen FDA rejection, clouding the future of a drug the company viewed as a pipeline in a pill. The Food and Drug Administration declined to approve Lilly’s baricitinib, an oral treatment for rheumatoid arthritis. According to Lilly, the agency wants to see more clinical data to determine the safety and ideal doses for the drug. Lilly didn’t disclose whether that means it will have to recruit and run new studies of the treatment, but if so, a resubmission could be delayed by months. (Garde, 4/14)

Forbes: The Billionaire And The Drug Price-Fixing Scandal
In September 2015, Satish Mehta, the billionaire chief executive of the Indian drug company Emcure Pharmaceuticals, wrote an effusive email congratulating Jeffrey Glazer, the CEO of his U.S. crown jewel, Heritage Pharmaceuticals, on a job well done. "In a short span of 4.5 years, you have taken Heritage to another level," Mehta wrote, adding that he considered Glazer to be "an integral part of our family." (Vardi and Karmali, 4/18)

Nashville Tennessean: Senate OKs Prescription Drug Redistribution Program, But Not For Opioids
The Senate unanimously approved a measure Monday to create a prescription drug-share program that would allow donations of packaged cancer drugs, but not opioids. The bill would allow nonprofit organizations to donate and redistribute prescription drugs still in their manufacturer packaging to people who don't have health insurance and meet other criteria. Multiple senators said the medication will largely come from long-term care facilities, which throw away a large amount of unused medication. (Lowary, 4/17)

Stat: Drug Research Firms Push For Tax Break Amid Foreign Competition
The legislation, which was introduced by Pennsylvania Representative Patrick Meehan, a Republican, was co-sponsored by two North Carolina congressmen, Republican George Holding and Democrat G.K. Butterfield. In their home state, CROs employ some 24,000 people. Today, North Carolina is home to 152 CROs, which include powerhouses like PPD, PRA Health Sciences, and INC Research, as well as smaller outfits like Rho and Cato Services. CROs — which are also often referred to as contract research organizations — are a boon to North Carolina’s life science industry, which raked in nearly $2.2 billion in state and local government tax revenues in 2016, according to an economic impact report from the North Carolina Biotechnology Center. (Broadfoot, 4/18)

Perspectives: Pharma Desperately Needs Some Sunshine In Its Life

Read recent commentaries about drug-cost issues.

Bloomberg: Take The Mystery Out Of Drug Pricing
Americans have clear reason to think they’re paying too much for prescription drugs. The cost of medicines is rising faster than any other category of health-care spending, standing at almost 17 percent of total health costs. What’s harder to discern is what to do about it, in part because so little is known about how drug prices are set, what discounts and rebates drugmakers negotiate with wholesale buyers, and to what extent savings are passed along to customers at the pharmacy counter. Addressing this lack of transparency would be a good first step. (4/18)

Roll Call: Stifling Competition Reduces Access To Affordable Prescriptions
Americans are rightfully concerned with rising medical costs, but some of the ways by which costs rise can be tedious and difficult to understand for those not already familiar with broader regulatory issues. What’s going on, though, is actually pretty straightforward: Brand-name producers regularly take advantage of systems designed to protect consumers to instead protect their bottom lines and crush out competition from their generic competitors. One common way by which anti-competitive behavior occurs is by preventing access to the materials needed to test generic or biosimilar alternatives. In other words, pharmaceutical companies refuse to let competitors prove their safety, and then enjoy the monopoly that results when theirs are the only drugs proven to be safe. (Jonathan Bydlak, 4/18)

RealClear Health: Canada Cannot Be America's Drugstore
The drug importation debate, sparked by Sen. Bernie Sanders’ introduction of legislation that would allow Americans and pharmacies to import medicines not approved by the FDA from foreign countries through and including Canada, is largely focused on one key question: A­re medications imported from outside the FDA’s jurisdiction safe for consumers? (Marvin D. Sheperd, 4/19)

Morning Consult: America Needs An Rx For Its Prescription Drug Prices
When President Donald Trump and Sen. Bernie Sanders, (I-Vt.) see eye to eye on an issue, you know that it is politically volatile. That is the state of the current debate around prescription drug pricing, which has become a cause célèbre for lawmakers across the political spectrum. The frustration is justified. For too long, patients have endured repeated price hikes for the medicines they need to go about their daily lives. An opaque pricing system and supply chain that effectively operates as a “black box” of rebates, clawbacks and middlemen only serves to exacerbate patient anger. (Larry Smith and Larry Ellingson, 4/18)

RealClear Health: Is Drug Pricing At An Inflection Point?
In recent months, we have seen encouraging signs of a new commitment to the social contract drug makers have with patients. Novo Nordisk and Allergan have made pledges to hold the line on drug prices. Mylan has taken responsibility for the price increases for EpiPen, and is promising to do more to advance affordability. More recently, Regeneron engaged early on in a meaningful and responsible way to discuss pricing of a new therapy. (Steve Miller, 4/14)

Bloomberg: How Drug-Company 'Benevolence' Silences The Sick
Among the drugs that helped bring Valeant Pharmaceuticals International low, none did more damage to its reputation and stock price than Syprine. Syprine is a drug that treats a rare illness called Wilson disease, which prevents the body from metabolizing copper and can lead to liver failure and death if left untreated. For decades, the price of Syprine was $1 per 250-milligram tablet, according to a recent article in the medical journal Hepatology. For most people, a maintenance dose requires four pills a day, bringing the price during that era to $1,460 a year. (Joe Nocera, 4/18)

Sacramento Bee: Transparency Needed On Companies That Manage Prescription Drugs
If you’re like most Californians who have health insurance, you know two things about how prescription drugs fit into your health plan. You know that you receive some level of coverage for medications, and you know that soaring prices for prescription drugs are a major cost-driver that have caused insurance premiums to soar. What you don’t know is how your coverage for prescription drugs works, who determines which drugs are covered, or who gets how much from the money you pay for your prescription drugs. The fact is, almost no one knows those things. (Jim Wood, 4/17)

San Francisco Chronicle: Require Drugmakers To Report When They Raise Prices 
Big Pharma wants us to believe that such costs reflect the expensive nature of research and development. But what the pharmaceutical companies spend on research, clinical trials and their 24/7 advertising campaigns is kept hush-hush. One study found that for every $1 drug companies spend on R&D, they spend $19 on advertising. (Ed Hernandez and Tom Steyer, 4/18)

Medscape: Destroy Them: One Way To Up Price Of Generic Cancer Drugs
In a now-leaked email, a senior executive at a large  pharmaceutical company discussed destroying supplies of generic cancer drugs as part of a pricing battle with health authorities in Spain, according to a report in the British newspaper The Times. The idea was floated in 2014 in an exchange with another staff member at Aspen Pharmacare, which has a market valuation of $10 billion and sells products globally, including in the United States, according to the company website. (Nick Mulcahy, 4/17)

Bloomberg: Lilly's New-Drug Promise Is Fading
It's much easier to tell a story of unlimited promise and sales growth than to deliver on it. Eli Lilly & Co. has been aggressively talking up its revamped drug pipeline. Investors who bought into this got a rude awakening Friday, when the company disclosed that the FDA had declined to approve baricitinib, an expected blockbuster arthritis treatment. Many investors assumed baricitinib would hit the market this year. But the FDA has asked for data on the drug's safety and optimal dose, meaning it may not be approved for years. (Max Nisen, 4/17)

Editorials And Opinions

Food For Thought: Ideas For The GOP On Pushing People Toward Coverage; And What If Some Places Have No Health Plans?

Editorial writers across the country contemplate different aspects of how Republicans continue to mull repealing and replacing Obamacare and how some states are continuing to consider and act on the Medicaid expansion.

The Wall Street Journal: How The GOP Could Nudge The Uninsured Toward Coverage
Republicans in Congress say they’ll keep working on health-care reform. It never made sense to give up after only a few months of trying, but their plan would have better prospects if they modified it to address the criticism that it would leave too many people without insurance. The solution is to enroll uninsured Americans automatically in no-premium health coverage. (James C. Capretta and Lanhee J. Chen, 4/18)

Los Angeles Times: Republicans Base Their New Obamacare Repeal On A Maine Program They Call A Success. Don't Believe Them
When our hard-working members of Congress return to work next week refreshed from their 18-day Easter recess, they’re planning to take up healthcare reform again. This time, their Affordable Care Act repeal effort has been dressed up with a new provision known as “invisible risk sharing,” based on what they assert was a successful program in Maine. They’re blowing smoke. (Michael Hiltzik, 4/18)

The (Baton Rouge, La.) Advocate: Roll Out Of Medicaid Popular In State
Perhaps it sounds a little odd, but people both in Louisiana and elsewhere are sometimes fuzzy about the differences between the Affordable Care and Patient Protection Act, expanded Medicaid, and “Obamacare” — the politically charged term that involves the whole of the parts. ... The survey, conducted by the LSU Public Policy Lab, found that Louisiana residents approve of the state’s decision to expand its Medicaid program last year under the auspices of the Affordable Care Act, or ACA — but respondents to the survey remain deeply divided over the ACA itself. ... Many GOP members of [the] House and Senate balked at Medicaid expansion when it was a party litmus test during the terms of former Gov. Bobby Jindal; now, though, [Gov. John Bel Edwards] actions have provided a significant financial lifeline for working people in low-wage jobs who had no meaningful access to health care before. (4/19)

The Kansas City Star: Reconsider Medicaid Expansion Before Another Kansas Hospital Closes Its Doors
Let’s be clear: Expanding Medicaid might not have been enough to save St. Francis Health, the Topeka hospital that stands on the brink of closure. But few doubt that the millions of dollars that expansion would have brought to the nonprofit Catholic health center would have made a substantial difference. Most likely, the doors would have remained open for months longer. In the words of House Minority Leader Jim Ward, a “lifeline” would have been extended. (4/18)

Viewpoints: Slashing The NIH Budget Is A 'Seismic Disruption' In Biomedical Research; Global Health Efforts At Risk

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

The Washington Post: Why Slashing The NIH Budget Is Indefensible
One of the most threatening of those policies is in President Trump’s budget blueprint: a cut of nearly $6 billion to the National Institutes of Health (NIH). As The Post reported last month, the proposal would slash roughly a fifth of NIH’s funding in fiscal year 2018, “a seismic disruption in government-funded medical and scientific research.” The administration has also proposed a separate $1.2 billion reduction in the remainder of this year’s NIH funding, along with severe cuts to the National Science Foundation, the Environmental Protection Agency .... the debate over NIH funding is further evidence of what has been clear for quite some time: Science is now political. In response, scientists are becoming more political, too. (Katrina vanden Heuvel, 4/18)

Los Angeles Times: Global Health Efforts Are In Jeopardy: A Polio Survivor Reflects On Proposed Cuts To Foreign Aid
In 1988, my family traveled from America to India to visit the homeland of my birth. At age 11, I vividly remember seeing beggars crippled by polio, crawling on the ground. I remember them staring at me. I, too, have polio, but I am able to walk with leg braces and crutches. I contracted polio as a baby in India. I was adopted from an orphanage at age 3 and moved to America. (Minda Dentler, 4/18)

Stat: I Was Confident In My Patient’s Care. Then My Senior Doctor Overruled Me
Attendings have more experience than residents — sometimes decades more — but that doesn’t mean residents can’t occasionally be right when there’s a disagreement. A resident might be familiar with new research or guidelines because he or she has had more recent education on a topic. Attendings who are specialists in a field like cardiology or oncology may be less comfortable with conditions outside their expertise. Perhaps the most common reason that residents can be right is because they typically spend much more time with patients and their families than attendings. That means they may have a stronger understanding of important psychosocial factors that affect patients’ clinical care. (Alex Harding, 4/19)

The Washington Post: Incarceration Is The Wrong Way To Fight Opioid Overdoses
Just about every week now, we see a new round of headlines about the crisis in overdose deaths from opioids. This is the class of drugs that includes prescription medications such as hydrocodone and street drugs such as heroin and fentanyl. There’s no question that the United States has seen a surge in addiction and deaths from overdose, although there are a couple of important things to keep in mind when reading such reports. (Radley Balko, 4/18)

RealClear Health: Up-Grading Prostate Cancer Screening
The U.S. Preventive Services Task Force is changing their guidelines about prostate cancer screening. In 2012, the Task Force gave it a D grade – meaning they recommended against prostate specific antigen (PSA) screening because its harms exceeded its benefits. Earlier this week, in their draft recommendation, the Task Force upped it to a C grade for men ages 55 to 69 – meaning the decision to screen should be based on professional judgment and patient preference. (H. Gilbert Welch, 4/19)

The Charlotte Observer: N.C. Considering A Surgery Bill That Kentucky Regrets Passing
As a professor of ophthalmology and a teacher of eye surgeons, I implore North Carolina not to make the mistake my Kentucky made six years ago, blindly rushing into law a bill that let non-surgeons operate on people’s eyes – a move legislators later regretted, and which Kentucky’s citizens opposed four-to-one. (Woodford S. Van Meter, 4/17)

Miami Herald: Foundation Envisions A World Without Parkinson’s Disease
As we recognize Parkinson’s Awareness Month in April, one of our most pressing priorities at the Parkinson’s Foundation is to improve the standard of care for this disease. It affects a growing number of people of all genders, ages, races and ethnicities. Every nine minutes, someone in the United States is diagnosed with this neurodegenerative disease that often progresses slowly over decades. People with Parkinson’s disease struggle to find a way to live with their symptoms — such as tremors that make even the smallest tasks like a buttoning a shirt or tying a shoe seem impossible. (John L. Lehr, 4/17)

The Kansas City Star: Kansas Should Make It More Expensive To Smoke
Kansas lawmakers are still discussing ways to close a two-year, $1 billion budget gap. They need to come up with a plan quickly: They reconvene May 1 for what’s expected to be a long and difficult veto session. Before adjourning their regular meeting, legislators correctly rejected Gov. Sam Brownback’s half-baked budget ideas. They crushed a flat income tax, which would have disproportionately hurt the poor. (4/18)

The New York Times: Big Tobacco Attacks Sensible F.D.A. Rules On Vaping
As smokers turned to electronic cigarettes to reduce the health risks of smoking, big tobacco companies started buying e-cigarette makers and producing and selling their own. Now those companies are lobbying Congress to prevent the Food and Drug Administration from regulating electronic cigarettes and cigars, as it does conventional cigarettes. If they succeed, they will be able to sell and market addictive nicotine products to young people with few restrictions. (4/19)

Miami Herald: Voters OKd Medical Marijuana; Florida Lawmakers Should Simply Comply 
The devastation of the opiate epidemic cannot be understated, nor can the urgency of doing something — anything — to alleviate its effects. Gov. Scott and Attorney General Pam Bondi understand the gravity of this crisis, working with law enforcement, the Legislature and other stakeholders to attack the insidious threat to public health and safety from multiple fronts. (Ben Pollara, 4/18)