KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Kaiser Health News Original Stories

Hurricane's Health Toll: A Texas Doctor Taps Lessons From Katrina

After weathering the catastrophe in New Orleans 12 years ago, Dr. Ruth Berggren moved to Texas, where she again finds herself in the center of a hurricane crisis. In a Q&A, she draws parallels between the harrowing events and pinpoints risks in Harvey’s aftermath. (Shefali Luthra, 9/6)

How Below-The-Radar Mergers Fuel Health Care Monopolies

Most acquisitions by hospitals of physician practices are too small to trigger antitrust attention, study says. But a buying spree of “onesies and twosies” doctor practices has driven competition down and prices up. (Jay Hancock, 9/5)

Move To End DACA Leaves Some Young Immigrants Fearing For Their Health

The Deferred Action for Childhood Arrivals program made it possible for young adults who came into the country illegally as children to get jobs with insurance and, in some states including California, Medicaid. Now that coverage is in peril.    (Barbara Feder Ostrov and Anna Gorman, 9/6)

Political Cartoon: 'Special Delivery?'

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

Here's today's health policy haiku:


If outreach efforts
Don’t bring in new customers,
Trump says pull the plug.

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

A Tone Shift On Capitol Hill As Lawmakers Try To Come Up With Bipartisan Health Solution

Republicans are now in the position to have to work with Democrats so make sure the marketplace doesn't collapse. The Senate Health, Education, Labor and Pensions Committee is holding four hearings to kick off those efforts. Meanwhile, President Donald Trump isn't ready to give up on repeal just yet.

The Associated Press: Senators Seek Bipartisan Deal To Shore Up Insurance Markets
Senators want to forge a modest bipartisan deal for shoring up the nation's individual insurance markets. But lingering raw feelings over the Senate's failed attempt to obliterate the Obama health care law won't make the task any easier. The Senate health committee is holding the first of four scheduled health care hearings Wednesday. Testimony was planned from five states' insurance commissioners. (Fram, 9/6)

The Washington Post: Senate Panel Begins Bipartisan Hearings To Try To Improve Affordable Care Act
Four hearings being held by the Senate’s Health, Education, Labor and Pensions Committee are part of a push by the panel’s top Republican and Democrat, who are racing to negotiate an agreement before the month ends. At the moment, however, the parties differ on specifics, and it remains uncertain whether any accord — even a narrow one — is possible. This circumscribed effort follows Senate Republicans’ dramatic failure in late July to overturn central parts of the ACA. The new effort may yield a practical bipartisan response acknowledging that the insurance exchanges — conduits to medical coverage for about 10 million Americans — will continue to exist. Or it could provide another piece of evidence that the ACA is so politically toxic that compromise on it eludes even the senators most open to collaboration on health policy. (Goldstein and Eilperin, 9/5)

NPR: After Health Care Reform Efforts Fail, Republicans Look For Small Bipartisan Victories
Committee Chairman Lamar Alexander, R-Tenn., says he's looking to do something "small, bipartisan and balanced." What's remarkable is that he made that statement in a joint press release last month with the committee's ranking Democrat, Sen. Patty Murray, D-Wash.Up until recently, all major Republican efforts to alter Obamacare were launched with no Democratic support, and no attempts to get any. (Kodjak, 9/5)

Modern Healthcare: What To Watch For As Senate Healthcare Hearings Get Underway 
Committee members on both sides of the aisle have pledged to work on a bipartisan bill, with the goal of passing something by mid-September, before insurers are slated to deliver final rates.​ Rodney Whitlock, vice president of ML Strategies and a former Republican health policy aide on the Senate Finance Committee, said it's possible that the bill ends up being more than just a year or two of appropriations for cost-sharing reduction payments, and a few tweaks to the 1332 waiver process or parameters. (Lee, 9/5)

CQ Roll Call: Senate Poised To Debate Health Care Stabilization Package
Witnesses are expected to hit a few common themes. Insurance commissioners have been calling for certainty on whether the administration will keep paying cost-sharing payments, subsidies created in the 2010 law. Commissioners also could point to programs like reinsurance as a way to lower premiums. Alaska and Minnesota are two states that use reinsurance, which provides government funding to insurers to compensate for high-cost patients. For example, Alaska, whose insurance commissioner will testify Wednesday, received a health care law waiver to create its reinsurance program earlier this year. That will likely come up Wednesday. (McIntire, 9/5)

Bloomberg: Congress Returns To More Modest Plans For Changes To Obamacare 
The other big question is how any bill gets through Congress, given the crowded legislative agenda and issues like tax reform, hurricane relief, immigration and North Korea. One likely vehicle is a planned reauthorization of the Children’s Health Insurance Program, which provides health coverage to millions of low-income children. (Edney, 9/5)

Politico: Trump Wants One Last Senate Push On Obamacare Repeal
President Donald Trump and some Senate Republicans are refusing to give up on Obamacare repeal, even after this summer’s spectacular failure and with less than a month before a key deadline. The president and White House staff have continued to work with Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana over the summer on their proposal to block grant federal health care funding to the states. And though the bill is being rewritten and Congress faces a brutal September agenda, Trump and his allies on health care are making a last-gasp effort. (Everett and Dawsey, 9/5)

The Hill: Dems To Try Adding ObamaCare Outreach Funds To Bipartisan Fix
Senate Democrats will push to restore ObamaCare outreach funding in a bipartisan health care bill this month after the Trump administration announced drastic cuts to the program. Democratic aides say the party will seek funding for ObamaCare sign-up efforts in a bipartisan market stabilization bill that the Senate Health Committee is negotiating, a move that comes after the administration announced a 90 percent cut to outreach efforts. (Sullivan, 9/5)

The Hill: MacArthur: Agreement Reached With House Freedom Caucus Chair On Health Plan 
Rep. Tom MacArthur (R-N.J.) says he has reached an agreement with Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus, on the terms for a bill aimed at stabilizing ObamaCare markets. MacArthur, who is more centrist than Meadows and previously worked with him on a deal for ObamaCare repeal legislation, says he has reached agreement with Meadows on the outline of a proposal, though some details need to be worked out. (Sullivan, 9/5)

Industry Groups Urge Congress To Guarantee Insurer Subsidies For Two Years

"Persistent uncertainty" about whether the Trump administration will block the funds "is a significant driver of current market instability," write the organizations that include America's Health Insurance Plans, the American Medical Association and the American Hospital Association.

The Associated Press: Health Care, Business Groups Want Congress To Pay Insurers
A coalition of powerful health industry and business groups asked Congress on Tuesday to finance federal subsidies to insurers for at least two years, a stance that defies President Donald Trump's threats to halt the payments. The money — which cost taxpayers $7 billion this year — reimburses insurance companies for trimming out-of-pocket costs for millions of lower-earning customers. Those cost reductions and the subsidies are required by President Barack Obama's health care law, but a federal judge has said Congress didn't legally authorize the money. (Fram, 9/5)

The Hill: Groups Press Senators For Two Years Of ObamaCare Subsidy Funding
In a letter to the Senate Health Committee, groups including the America’s Health Insurance Plans, the U.S. Chamber of Commerce, the American Hospital Association and the American Medical Association said Congress needs to fund cost-sharing reduction (CSR) payments through at least 2019. (Weixel, 9/5)

The Hill: Groups Press Lawmakers To Stabilize ObamaCare Markets 
Nearly 100 consumer, patient and provider organizations are asking lawmakers to quickly pass a bipartisan bill to stabilize the ObamaCare insurance markets as the Senate Health Committee gears up for a series of hearings on the issue beginning Wednesday. In a letter to Republican and Democratic leaders in both chambers of Congress, the groups specifically included three main items they’d like to see in a bill. (Roubein, 9/5)

Meanwhile —

The Wall Street Journal: Industry Groups Push For Repeal Or Delay Of Two Affordable Care Act Taxes
Industry groups are ramping up a campaign to repeal or delay two Affordable Care Act taxes that have critics in both parties, the latest effort to tackle the health-care system following the collapse of the broad Republican push to repeal the Obama-era law. The taxes, one on medical devices and another on health-insurance plans, were previously delayed in late 2015 as part of a larger spending package. They now are set to take effect beginning in 2018, unless Congress postpones them again or kills them off entirely. (Hackman, 9/5)

The Hill: Chamber Of Commerce Urges Congress To Stop ObamaCare Tax
The U.S. Chamber of Commerce launched a six-figure digital media campaign Tuesday urging Congress to repeal an ObamaCare tax on health insurance plans. The Health Insurance Tax is an annual fee owed by insurers that is set to go into effect in December. (Hellmann, 9/5)

Meet The People With 'The Worst Job To Have Right Now': State Insurance Commissioners

These officials are tasked with the unenviable job of keeping the markets stable as uncertainty reigns supreme. Meanwhile, a look at one who's made national headlines for her candid take on the state of the exchanges.

Kaiser Health News: State Insurance Commissioners In Hot Seat In National Health Care Drama
With insurance premiums rising and national efforts at health reform in turmoil, a group of 50 state bureaucrats whom many voters probably can’t name have considerable power over consumers’ health plans: state insurance commissioners. As insurers threaten to exit state markets and voters at town halls complain about unaffordable prices, the state commissioners are central characters in the unfolding drama that is America’s health coverage. (Appleby, 9/6)

Nashville Tennessean: Julie Mix McPeak, Tennessee's Insurance Chief, Leads Broad Agency
Last Wednesday, the commissioner of the Tennessee Department of Commerce and Insurance jumped between a meeting with an insurer and another to coordinate teams the state would dispatch to Houston to assist with Hurricane Harvey recovery efforts. ... She's traveled to Washington a few times, and does so again this week to testify at a high-profile U.S. Senate hearing Wednesday at the request of Sen. Lamar Alexander. The veteran Republican lawmaker said McPeak is a hit with Senators from both sides of the aisle because she turns insurance jargon into plain English. (Fletcher, 9/5)

And in other health law and marketplace news —

The Philadelphia Inquirer/ Penn Study: It's Still Harder To Get Insurance Coverage For Mental Health, Substance Abuse Treatment
Despite years of efforts and multiple laws, insurance coverage for mental health and substance abuse still is not on a par with benefits for physical health, according to a new study of Affordable Care Act plans. University of Pennsylvania researchers, analyzing details of insurance plans around the country, found that “narrow networks” were far more common for behavioral health providers, especially psychiatrists, than they were for primary care providers. Narrow networks — which mean a more limited selection of providers — have become more common as insurers look for ways to contain premium costs. (Sapatkin, 9/5)

Georgia Health News: Premium Increases For Georgia’s 2018 Exchange May Not Be Over
The four insurers offering coverage in Georgia’s insurance exchange next year are increasing their proposed rates beyond the big premium hikes that they first sought, state officials said Tuesday. ... The ever-increasing premiums proposed by insurers reflect the instability surrounding the insurance exchanges, which provide health plans for individuals and families who don’t have job-based or government coverage. (Miller, 9/5)

The Baltimore Sun: Evergreen Health To Be Liquidated After Being Found Insolvent
Evergreen Health, a Baltimore-based insurer created to sell coverage on Maryland’s health exchange, is to be liquidated and all members’ policies are to be canceled at the end of September after a judge ruled that the company is insolvent and regulators determined there are no viable investors. The decision by Baltimore Circuit Judge Yolanda Tanner last week will leave about 24,000 Evergreen customers looking for new coverage by the end of the month. Tanner ordered a special 30-day enrollment period, which began Sept. 1, during which Evergreen members may choose a new plan. (Gantz, 9/5)

For First Time In Years, Democrats Are 'On The Offense' Over Health Care And They're Raring To Go

A group called Protect Our Care says it intends to spend more than $1 million on digital ads accusing Republicans of working to sabotage the Affordable Care Act.

Public Health And Education

Prestigious Prize -- 'The American Nobels' -- Awarded To Planned Parenthood, Developers Of HPV Vaccine

The Lasker-Bloomberg Public Service Award is known for honoring groundbreaking scientific advances and humanitarian efforts. The citation for the award credits Planned Parenthood “for providing essential health services and reproductive care to millions of women for more than a century” and for helping “men as well.”

The New York Times: Lasker Prizes Go To Planned Parenthood And Developers Of HPV Vaccine
One of the nation’s most prestigious prizes in medicine will go to Planned Parenthood and two scientists who played a crucial role in developing the vaccine to combat HPV, a sexually transmitted virus that can cause cervical cancer. A third honor will go to a Swiss molecular biologist, who made a groundbreaking discovery about cell growth. The Lasker Awards, sometimes called the “American Nobels” because 85 of the awardees have gone on to win the international honor, were announced by the Albert and Mary Lasker Foundation Wednesday. Each prize comes with $250,000. (Murphy, 9/6)

The Washington Post: HPV Researchers, Planned Parenthood Win Prestigious Lasker Medical Awards
In announcing the awards, sometimes referred to as “America’s Nobels,” the foundation lauded the recipients’ efforts to protect and enhance women’s health. Its praise of Planned Parenthood seemed designed to counter attacks on the nonprofit by President Trump and top congressional Republicans, who want to end all federal funding to the organization. Planned Parenthood, the nation’s biggest abortion provider, already is barred from using federal dollars for abortions. The foundation also honored Michael N. Hall, a molecular biologist at the Biozentrum University of Basel, for discoveries involving the role of proteins called TOR in controlling cell growth. It said his discoveries “have broadened our understanding of the fundamental mechanisms that underlie growth, development and aging.” (McGinley, 9/6)

The Wall Street Journal: Two U.S. Government Researchers Honored With 2017 Lasker Award
“Many women have nowhere other than Planned Parenthood to turn for basic medical services. Its highly trained clinicians and counselors provide essential, low-cost care,” the Lasker foundation said. Planned Parenthood said it has led the effort to expand and protect reproductive health and rights in the U.S., and it was honored to receive the Lasker award. (Loftus, 9/6)

Chemical Plant's Close Brush With Public Health Disaster From Harvey May Serve As Wake-Up Call

Public health fears following the flooding of the plant and the resulting explosion didn't come to fruition but it was a close call. Media outlets report on other news from the storm as well.

The New York Times: Crisis Is Over At Texas Plant, But Chemical Safety Flaws Remain
Residents have returned to their homes here in the shadow of the Arkema chemical plant now that the fires at the plant are out and the immediate safety hazard has passed. The fires, a result of flooding in the wake of Hurricane Harvey that caused chemicals to become unstable, had little health impact beyond the 21 emergency workers who were treated for smoke exposure. The returning homeowners now face more common problems that follow a flood: crumbling plasterboard, ruined furnishings and, above all, mold. Still, the accident at the plant has exposed large flaws in regulation of chemical safety, risk disclosure and emergency planning. (Krauss, Tabuchi and Fountain, 9/5)

WBUR: How Hospitals Cope With Natural Disasters Like Harvey
Medical professionals across the country are taking cues from Harvey and past storms, like Sandy and Katrina, about how hospitals can better prepare for future natural disasters. Here & Now's Robin Young talks with Dr. Eric Toner, a senior associate with the Johns Hopkins Center for Health Security, about disaster preparedness and resilience in the health care industry. (Young, 9/5)

Kaiser Health News: Hurricane Health Toll: A Doctor Tending To Texans Taps Lessons Learned From Katrina
As Dr. Ruth Berggren digests the calamity affecting her new home state of Texas, she admits to some PTSD. In 2005, she was an infectious-disease doctor at the nearly 3,000-bed Charity Hospital in New Orleans, one of a small number of physicians left managing patients and performing triage in the wake of Hurricane Katrina. She spent weeks and month dealing with the aftermath, before moving to Texas, where she heads the University of Texas-San Antonio’s Center for Medical Humanities and Ethics, part of its Health Science Center. (Luthra, 9/6)

Rape And The Opioid Epidemic: How Sexual Assault Is Becoming 'Normalized' In A Crisis

Those who are victims of such an attack often don't report it out of shame, distrust of police or fear they'll be labeled a "cop caller" and have trouble buying heroin. In other news: the opioid epidemic view through an economic lens; states worry that a federal logjam is hampering efforts to fight the crisis; and more.

WBUR: Opioid Drug Users Tell Of Rarely Discussed Injury: Rape
Kristin says she, like many women who live on the streets, cope with the daily fear of an attack that they are too sedated to fend off -- or of waking up to find their pants pulled down, bruises and other signs of an assault. It's an injury active drug users often don't report out of shame, distrust of police or fear they'll be labeled a "cop caller" and have trouble buying heroin. (Bebinger, 9/6)

Politico Pro: States Urge Trump Administration To Approve Stalled Opioid Treatment Plans
State proposals to tackle the deadly opioid epidemic have been piling up at the Trump administration for months, as state officials worry that the federal logjam is hampering efforts to combat a crisis that President Donald Trump has labeled a national emergency. About a half dozen states have been waiting for the Trump administration to approve plans to expand substance abuse treatment to their poor residents enrolled in Medicaid. (Pradhan, Ehley and Jennings, 9/5)

Boston Globe: Bridgewater State Says It Will Be First US University To Make Narcan Publicly Available
Bridgewater State University will offer public access to Narcan in locations across campus to combat potential overdoses, the university said. The university’s police department is launching an “aggressive” opioid overdose prevention program, making the overdose-reversing drug available in 50 defibrillator boxes across campus buildings, including all 11 residence halls, university officials said. (Thompson, 9/5)

Kansas City Star: Doctor Who Prescribed Opioid Spray Subsys Now Subject Of Two Lawsuits
A lawsuit filed Friday alleges that Steven Simon urged Johnson County resident Carey Ballou to take Subsys, an oral fentanyl product with a high potential for addiction, even though less risky, less expensive alternatives existed, and she was reluctant to take the drug. The complaint was similar to a lawsuit filed the same day on behalf of Olathe resident James Whiting, who told the Star in July that Simon pressured him to take Subsys without informing Whiting that he was being paid by the drug’s Arizona-based manufacturer, Insys Therapeutics. (Marso, 9/5)

Supercomputer Watson Was Going To Revolutionize Cancer Treatment. It Has Yet To Live Up To Hype.

Stat looks at the reasons why this lofty project faltered. In other public health news: HIV crime laws, CAR-T therapy, gene editing, pediatric blood-pressure guidelines, and Zika.

Stat: IBM Pitched Watson As A Revolution In Cancer Care. It's Nowhere Close
It was an audacious undertaking, even for one of the most storied American companies: With a single machine, IBM would tackle humanity’s most vexing diseases and revolutionize medicine. Breathlessly promoting its signature brand — Watson — IBM sought to capture the world’s imagination, and it quickly zeroed in on a high-profile target: cancer. (Ross and Swetlitz, 9/5)

Stateline: HIV Crime Laws: Historical Relics Or Public Safety Measures?
Robert Suttle clearly remembers telling his boyfriend that he was HIV positive the night they met. But after they split, three quarrel-filled months later, that became a point of contention: His “ex” pressed charges against him. Suttle’s home state, Louisiana, is one of 33 states with laws that can be used to prosecute people living with HIV. And in Louisiana, intentionally exposing someone to HIV/AIDS is a felony punishable by up to 11 years in prison. (Wiltz, 9/6)

Stat: Cellectis Off-The-Shelf CAR-T Therapy Grounded Following Patient's Toxic Death
Two clinical trials of an off-the-shelf CAR-T cancer therapy from Cellectis (CLLS) have been placed on clinical hold following the death of a patient caused by a severe toxic reaction to the treatment. Cellectis’ stock price is down 30 percent to $22.79 in early Tuesday trading. The biotech company, with operations in Paris and New York, announced the FDA clinical hold on Sunday night. (Feuerstein, 9/5)

KCUR: Shawnee Woman Was Among First In The World To Undergo New FDA-Approved Cancer Therapy 
CAR: It’s a mouthful, but it stands for chimeric antigen receptors. The therapy involves removing a patient’s T cells, a type of white blood cell, and genetically engineering them to recognize and attack the patient’s tumors. The T cells are then put back into the patient’s body. ...KU’s clinical trial involved patients like [Emily] Dumler with an extremely aggressive form of non-Hodgkins lymphoma. One of those patients, a 47-year-old Australian who traveled to KU to undergo CAR-T therapy in late 2015, died last year. But a significant percentage of patients – nearly half – achieved complete remissions. (Margolies, 9/6)

The Washington Post: Was The Big Paper About The Successful Editing Of Human Embryo Genes Wrong?
A month ago, an international team of researchers announced that they had used a gene-editing technique to safely erase a heritable heart condition from a human embryo. This blockbuster news was greeted with both excitement and fear. Now the scientific community is buzzing about a new critique that questions the main conclusions of their paper. Columbia University's Dieter Egli, Harvard University’s George Church and other respected names in the field are raising doubts about whether the experiment — using the groundbreaking laboratory tool known as CRISPR (or Clustered Regularly Interspaced Short Palindromic Repeats) — was successful at all or at least in the way the researchers originally described it. (Cha, 9/5)

The Philadelphia Inquirer/ New Guidelines Mean More Kids Will Be Diagnosed With High Blood Pressure - And That's A Good Thing
Newly announced pediatric blood-pressure guidelines may result in more youngsters getting flagged for hypertension, but that will likely help more children and teenagers get started earlier on healthy lifestyle changes. That’s the take-away for parents on the new standards for identifying and treating high blood pressure in children and adolescents, published in the September issue of the journal Pediatrics. The recommendations and accompanying study are the work of a 20-person American Academy of Pediatrics (AAP) panel. (Giordano, 9/6)

Medical Exemption Rates Hint Parents May Have Found Workaround To California Vaccination Law

A California law, passed in 2015, eliminated personal-belief exemptions for school vaccinations, but a new report suggests that parents are finding doctors who are willing to sign off on medical exemptions instead.

Los Angeles Times: After California Got Rid Of Personal Exemptions For Vaccines, Medical Exemptions Went Way Up
The rate of medical exemptions for immunizations for incoming kindergartners rose sharply the year after California eliminated the personal-belief exemption, a new study finds. The results, published in the Journal of the American Medical Assn., hint that some parents who don’t want to vaccinate may have found doctors willing to give medical exemptions to students — a potential trend that may undercut the collective protection against contagious diseases that the state law sought to bolster. (Khan, 9/5)

California Healthline: Another Way For Anti-Vaxxers To Skip Shots For Schoolkids: A Doctor’s Note
Dr. Tara Zandvliet was inundated with calls and emails from parents last year, after California passed a law nixing personal beliefs as an exemption from school vaccinations. Suddenly, many parents sought exemptions for medical reasons. Someone even faked two medical exemption forms purportedly written by the San Diego pediatrician, copying a legitimate document she’d provided for a patient and writing in the names of students she’d never treated, she said. She learned of the forgeries only when the school called for verification. (Ibarra and Feder Ostrov, 9/5)

In other news —


Help Wanted: Iowa Looking For New Medicaid Director, A Position That Faces Intense Scrutiny

The person that takes current director Mikki Stier's position will have a lot to do because of Iowa’s controversial shift to private management of Medicaid. Meanwhile in Oregon, lawmakers hold a hearing on a tax that would close a hole in the state's Medicaid budget.

Des Moines Register: Iowa Medicaid Director Job, Which Is A Controversy Magnet, Comes Open As Stier Is Promoted
The state's Medicaid director, Mikki Stier, has been promoted to deputy director of the Iowa Department of Human Services. Stier will continue to oversee the state’s $4 billion Medicaid program while the department seeks her successor, the agency's spokeswoman said. Whoever takes Stier's old job will face intense scrutiny because of Iowa’s controversial shift to private management of Medicaid, which is the joint state and federal health-care program for poor or disabled people. (Leys, 9/5)

The Oregonian: Medicaid Tax Opponents, Supporters Both Say Ballot Summary Language Unclear 
Oregon lawmakers held the first and only public hearing Tuesday on the exact words they want put before voters deciding whether to overturn much of a $550 million health care tax. Back in June, lawmakers passed the package of hospital and health insurance taxes to close a hole in the state's Medicaid budget. Since then, three Republicans from the Oregon House launched an effort to refer much of the law to voters. They want voters to reject a new 1.5 percent tax on health insurance premiums and an increase in taxes on certain hospitals' revenues. (Borrud, 9/5)

And in other Medicaid news —

Kaiser Health News: To Insure More Poor Children, It Helps If Parents Are On Medicaid
Efforts by Republican lawmakers to scale back Medicaid enrollment could undercut an aspect of the program that has widespread bipartisan appeal — covering more children, research published Tuesday in the journal Health Affairs suggests. The study focuses on the impact of Medicaid’s “welcome-mat” effect — a term used to describe the spillover benefits kids get when Medicaid eligibility is extended to their parents. (Luthra, 9/5)

State Watch

State Highlights: After Police-Nurse Altercation In Utah, Officers Barred From Patient Care Areas; Last Abortion Clinic In Ky. Braces For Fight

Media outlets report on news from Utah, Kentucky, Massachusetts, New York, Georgia, Minnesota, Colorado, New Hampshire, Wisconsin, Ohio and Tennessee.

The New York Times: Utah Hospital Bars Police From Patient-Care Areas After Nurse’s Arrest
Police officers will be barred from patient-care areas at a hospital in Utah that drew widespread notice for an officer’s arrest of a nurse, hospital officials said this week. The new policy, announced at a news conference on Monday, was put into effect soon after a Salt Lake City police officer arrested Alex Wubbels, who on July 26 refused to allow an officer to take a blood sample from an unconscious patient at University of Utah Hospital. Video footage of the encounter surfaced last week, leading to fierce condemnation of the police tactics, including a rally in Salt Lake City on Saturday. (Victor, 9/5)

The Hill: Utah Hospital Bars Police From Interacting With Nurses 
The Utah hospital where a nurse was arrested for refusing to give a patient’s blood sample to police  announced new policies to keep police away from its nursing staff. Margaret Pearce, chief of nursing at the University of Utah health system, announced the changes in response to the incident. In a video that went viral last week, an officer is seen forcefully grabbing nurse Alex Wubbels and arresting her as she cries for help. (Sullivan, 9/5)

NPR: Kentucky Could Become The Only State Without A Clinic That Performs Abortions
Kentucky is down to only one clinic that performs abortions: the EMW Women's Surgical Center in Louisville. A trial kicking off Wednesday morning in federal court in Louisville will decide whether Kentucky will become the first state without a single such clinic. Republican Gov. Matt Bevin tried to shut down the EMW center earlier this year after his administration told the clinic it was failing to meet state health regulations requiring clinics that provide abortions to have transfer agreements with local hospitals and ambulance services in case of medical emergencies. (McCammon, 9/6)

Boston Globe: Amid Expansion Plans, Steward Health Care Shows No Signs Of Sharing Financial Data
The privately held Boston-based company has failed to submit information about its finances and merger plans, as required by state law, and it hasn’t paid a number of fines imposed for its lack of transparency. It has not officially notified the state about its plans involving two big transactions: the pending acquisition of 18 hospitals outside of Massachusetts owned by IASIS Healthcare of Franklin, Tenn., and the purchase of eight hospitals from Community Health Systems Inc. that closed earlier this year. (Dayal McCluskey, 9/1)

The New York Times: City Hospital System Is Expanding Children’s Mental Health Programs
Recognizing that negative childhood experiences can affect a person’s health long into adulthood, New York City’s public hospital system is expanding its mental health programs for children and adolescents. The programs, which NYC Health & Hospitals plans to announce on Wednesday, are designed to address the challenges facing many of the hospital system’s young patients, such as poverty, violence and substance abuse — circumstances that doctors said make children more likely to need mental health treatment but less likely to get it. (Wang, 9/5)

Atlanta Journal-Constitution: Nursing Home Resident Dies After Found In Ditch In Gilmer County
A North Georgia nursing home resident in a wheelchair was found in a nearby ditch and later died after officials say she fell while leaving the facility after a fire alarm was pulled, unlocking the doors. Dorothy Broome, an 83-year-old resident of Gilmer Nursing Home in Ellijay, was found face down along the southbound lanes of South Main Street last month, according to a police report. (Foreman, 9/5)

The Star Tribune: Blue Cross Payment Cuts Prompt Protest By Minn. Mental Health Providers
Blue Cross and Blue Shield of Minnesota began making the reductions in July as part of an effort to cut overall mental health care spending after a review found that billing for standard one-hour therapy sessions had exceeded national averages over the past two years. As therapists began seeing reimbursements cuts of 15 to 33 percent, word quickly spread within the profession, prompting some therapists to organize a protest outside the insurer’s Eagan headquarters one week from Thursday. (Howatt, 9/6)

Stateline: Cities Look To Public Restrooms To Clean Up Downtowns, Attract Tourists
Denver is one of several U.S. cities using bathrooms not only to clean up areas rife with public urination and defecation, but also to increase tourism and foot traffic. Portland, Oregon, has become famous for its Portland Loo, a stand-alone steel bathroom stall that sits on a city sidewalk and, unlike a traditional port-a-potty, connects to public water and sewer. San Antonio, San Francisco, Seattle, and a host of smaller cities have experimented with similar bathrooms. (Breitenbach, 9/5)

Seattle Times: How Long Will You Live? It Might Depend On Your King County Neighborhood
At first glance, King County looks like a pretty healthy place, with life expectancies among the highest in the nation. But a new analysis that zeros in on individual neighborhoods reveals deep disparities in how long people live and the health problems they face. Men in the affluent, Eastside city of Clyde Hill enjoy an average life span of 86.7 years. The longest-lived neighborhood for women is Bryant, in Northeast Seattle, with an average life expectancy of 88.4 years. But in a south-central Auburn neighborhood with the county’s shortest life spans, average life expectancy is more than 18 years lower for men and more than 14 years lower for women. (Doughton, 9/5)

Milwaukee Journal Sentinel: Fortis Care Facilities Would Get New Operators Under Proposal
The receiver for Fortis Management Holdings is asking for court approval to transfer the operations of 64 of the 65 nursing homes and assisted-living centers previously managed by Fortis to four companies, including North Shore Healthcare in Glendale. Fortis Management, based in Milwaukee, reached an agreement in July with its landlords to have a receiver oversee the company’s operations until management of its skilled-nursing and long-term care facilities could be transferred to new operators. (Boulton, 9/5)

Prescription Drug Watch

Lawmaker: Trump Had Right Rhetoric On Drug Prices, But Pharma Still Has Last Word

News outlets report on stories related to pharmaceutical pricing.

Stat: Q&A: 'More Action And Less Rhetoric' Needed To Bring Down Drug Pricing
In January, it seemed like 2017 would be the year when Congress would finally take steps to rein in pharmaceutical prices. But despite President Trump’s repeated criticism of the drug industry and Democrats’ apparent willingness to work with him on the issue, no major piece of legislation has gained traction. One legislator thinks it’s still possible: Rep. Peter Welch (D-Vt.), who sits on the House Energy & Commerce Committee, which oversees the FDA. Throughout his tenure in Washington, Welch has been outspoken on what he sees as systematic price gouging by drug makers. (Facher, 8/31)

Stat: Pharma Sues Nevada Over Diabetes Drug Transparency Law
Less than two months after Nevada enacted a controversial law requiring more transparency from drug makers over their pricing of diabetes medicines, the pharmaceutical industry is pushing back. In a lawsuit filed last Friday, two large industry trade groups claim the law is an “unprecedented and unconstitutional” action that interferes with well-established patent law by robbing drug makers of their right to protect trade secrets. Consequently, the trade groups also argue the law impedes the ability to successfully to do business in other states by tying penalties to wholesale, or list, prices. (Silverman, 9/5)

Bloomberg: Why Drugs Cost Less In The U.K. Than In The U.S.
Drug prices in the U.K., already among the lowest in the developed world, may drop lower still. The British public-health system has adopted new limits on how much it spends on certain medicines, prompting pharmaceutical companies to sue in a bid to stop the initiative. At a time when U.S. President Donald Trump has pledged to bring down the cost of medicine and health care in the U.S., the U.K.’s experience can offer lessons as well as cautionary tales. (Quinn, 9/4)

Stat: Novartis Charged Much More In The U.S. For Some Drugs Than In Other Countries
In 2014, the most recent year for which data was available, Novartis (NVS) headquarters in Switzerland charged its U.S. subsidiary significantly more for four medicines than what its subsidiaries paid in roughly a dozen other countries. These included several well-to-do nations such as the U.K., Germany, and France. And the difference in pricing ranged anywhere from 45 percent to 176 percent, after adjusting for currency fluctuations and packaging. (Silverman, 9/5)

Stat: Novo Nordisk To Pay $58 Million For Not Complying With An FDA Program
Novo Nordisk (NVO) has agreed to pay more than $58 million to settle allegations that it failed to adequately alert doctors one of its diabetes drugs may be associated with thyroid cancer, a step that was required by regulators at the time its medicine was approved. Specifically, the drug maker failed to comply with a Risk Evaluation and Mitigation Strategy, or REMS, a program that requires companies to develop a plan to educate doctors and monitor distribution of a drug that may cause a very serious side effect. (Silverman, 9/5)

Columbus Dispatch: Outside Experts Assess Ohio's Ballot Issue On Prescription-Drug Prices
Independent legal and medical experts have mixed opinions about Issue 2, the Nov. 7 ballot proposal aimed at reducing prices on prescription drugs for about 4 million Ohioans. Several experts contacted by The Dispatch who are not affiliated with either the proponents or opponents said Issue 2 could result in some savings on prescription drugs but faces signifcant or even insurmountable hurdles. (Johnson and Candisky, 9/4)

The Associated Press: Groups Challenge Explanation Of Drug Price Cap Initiative
Industry groups have filed a court challenge to the South Dakota attorney general's explanation of a ballot question that would cap how much state agencies could pay for prescription drugs. South Dakota Biotech and Washington-based Pharmaceutical Research and Manufacturers of America are asking a judge to direct Attorney General Marty Jackley to modify his explanation. (9/1)

The Wall Street Journal: Germany’s Merck Puts Consumer Drugs Business On The Block
Merck KGaA put its consumer-health unit on the block Tuesday in a move that will focus its health-care activities on the riskier business of developing prescription medicines. Darmstadt, Germany-based Merck is considering options for its consumer-health operations, including a full or partial sale, or strategic partnership, the company said. A final decision hasn’t been made. (Roland, 9/5)

Richmond Times-Dispatch: Independent Pharmacies Emphasize Personal Service As A Way To Compete With Retail Drugstore Giants
Independent, community pharmacies realizing that they can’t compete on drug prices against the CVSs, Walgreens, and Rite Aids of the world or the mail order pharmacies are putting more emphasis on their ability to be more flexible and provide more personal service, including prescription delivery, custom compounding, convenience packaging of prescriptions, and related services such as immunizations, medication counseling and more. (Smith, 9/3)

Bloomberg: With U.S. Generic Drug Market In Chaos, Indian Upstarts Rise
The most recent earnings reports across the generic drug industry read like dispatches from the front lines of a price war, with their U.S. businesses among the biggest casualties. This month, the world’s largest copycat drugmaker, Israel’s Teva Pharmaceutical Industries Ltd., slashed its dividend; U.S. giant Mylan NV lowered its profit target; and India’s Sun Pharmaceutical Industries Ltd. reported its first quarterly loss in at least 12 years. (Altstedter, Hopkins and Modi, 8/30)

Perspectives: Americans Shouldn't Have To Pick Between Affording Food Or Affording Medicine

Read recent commentaries about drug-cost issues.

US News & World Report: Take On Big Pharma And Lower Prescription Drug Prices
The American people are sick and tired of getting ripped off by the pharmaceutical industry which, next to Wall Street, is one of the most powerful and greedy forces in our country. Each and every day my office hears from Americans who cannot afford their prescription drugs. People are having to choose between buying food or buying the medicine they need. Seniors are forced to split their pills in half. Some have lost their homes and declared bankruptcy because of their medical bills. (Sen. Bernie Sanders, 8/30)

Sacramento Bee: Here's Someone To Blame For Drug Prices
They operate in secret. They have no laboratories or research centers, and produce nothing. But they control a critical intersection of our health care system, influencing the price we pay for prescription drugs and skimming off billions of dollars for themselves. (Adrian Wong, 9/1)

Morning Consult: The Pharmaceutical Industry’s Social Contract With Patients
In recent months, the public outcry over drug prices has been somewhat drowned out by the controversy surrounding efforts to reform the Affordable Care Act. Although the administration is still expected to issue an executive order targeting drug pricing soon, the current lull presents an opportunity to evaluate recent efforts to constrain drug prices. In 2016, average prices for all drugs — brand, generic, and specialty — increased by an average of 8.77 percent. Although still a significant increase, 2016 prices increased by less than the over-10-percent increases seen in 2015 and 2014. (Joanna Shepherd, 9/5)

Modern Healthcare: Taxpayers​ Paying​ Twice​ For​ Drugs
Gilead Sciences has a knack for putting itself at the center of the drug pricing debate. The company drew public ire when it priced the hepatitis C drug Sovaldi at $84,000 after buying its developer for $11 billion. Last week, it agreed to pay $11.9 billion for Kite Pharma, whose non-Hodgkin lymphoma treatment will sport a price tag above $500,000. Don't let the wow factors behind this new drug—personalized medicine, a one-time treatment course, potentially curative—mask what's actually driving its price. It's Wall Street, not the cost of developing the drug or its medical value. (Merrill Goozner, 9/4)

Sacramento Bee: Drug Price Bill Is Bad For Business, Patients
California is rightfully known as the birthplace of the biopharmaceutical revolution. Our state continues to be the leading home of innovative companies that are pioneering the new field of precision medicine to develop medications and doses tailored to individual patient’s genes. As a longtime entrepreneur in this sector, I am concerned that Senate Bill 17 will harm our ability to afford the costly and time-consuming process of bringing these therapies to market. (William J. Newell, 9/4)

Morning Consult: When It Comes To The Drug Pricing Debate, Talk Is Cheap
In the last several months, individual companies have begun to take actions in an attempt to address pricing concerns and demonstrate their ability to “self-police” — especially in the face of bad actors that have fueled hatred of the pharmaceutical industry by taking significant price increases on single-source products. ... But the question remains — to what extent have or will these actions actually make a difference in how these companies are perceived by the public and by legislators? (Chrystine Zacherau and April Claassen, 9/6) Here's How Pharmacy Benefit Managers Help Keep Drug Costs Down
There is so much rancor and finger pointing these days over prescription drug prices that consumers are often left to wonder: who is fighting on their behalf? The answer: pharmacy benefit managers. Companies and public programs providing prescription drug coverage hire PBMs for their expertise, and ability to reduce drug costs by negotiating for rebates and discounts from big drug companies and drugstores. (Edmund J. Pezalla, 8/30)

Stat: Gilead Sciences Boxed In By Novartis' Bargain-Bin CAR-T Price Strategy
The Swiss bean counters at Novartis (NVS) decided to be charitable with the pricing of its newly approved cellular therapy for cancer, and now, Gilead Sciences (GILD) is in a tough spot. By setting a $475,000 price for its CAR-T therapy — and indicating it will only charge for the drug if the patient responds — Novartis set a benchmark for the entire class. Gilead, of course, just bought Kite Pharma (KITE) for $12 billion with the expectation of bringing its CAR-T to market. Generating a decent return on that investment will be tougher if Gilead feels pressure to match Novartis’  “bargain” pricing strategy. (Adam Feuersein, 8/30)

Editorials And Opinions

Thoughts On Health Reform: Tough Road To Bipartisan Stabilization Plan; Need For Megadeal

Opinion writers examine prospects for congressional revisions to health care policy.

The New York Times: Dream Of Obamacare Replacement Fades To Bipartisan Patch Job
This week, the Senate will do something it hasn’t done in seven years: hold bipartisan hearings on the future of the Affordable Care Act. Serious and creative ideas will be presented. But don’t expect big policy changes anytime soon. Experts and lobbyists close to the congressional process say that, despite consensus that Obamacare’s markets are too thin and too expensive, very few reforms have any chance of becoming law before insurers begin selling Obamacare plans for next year. (Margot Sanger-Katz, 9/6)

The Washington Post: How We Can Find Common Ground On Health Care
Like so many people across the country, I breathed a sigh of relief when Trumpcare didn’t reach the president’s desk this summer. But legislation isn’t the only way the current administration has tried to undermine families’ health care and raise their costs. In fact, if Congress doesn’t act soon, patients and families will face higher premiums and fewer choices next year as a direct result of President Trump’s attempt to score political points by, as he says, letting the health care in our country “implode.” (Sen. Patty Murray (D-Wash.), 9/5)

Bloomberg: Congress Needs A Megadeal
As Congress returns to work this week, its agenda is crowded with must-pass legislation. To avoid shutting down the government, lawmakers will have to vote for new spending bills. To avoid a debt crisis, they will have to increase the debt limit. To avoid depriving millions of low-income children of health insurance, they will need to reauthorize funding for it. And since the Trump administration on its own seems unwilling to make the Obamacare health-insurance exchanges work more effectively, Congress will need to make some fixes. ... But it will require the kind of deal-making that seems to have disappeared in a hyper-polarized Washington – so “most likely” is far from a sure thing. (Peter R. Orszag, 9/5)

The New York Times: The Real Reason The U.S. Has Employer-Sponsored Health Insurance
The basic structure of the American health care system, in which most people have private insurance through their jobs, might seem historically inevitable, consistent with the capitalistic, individualist ethos of the nation. In truth, it was hardly preordained. In fact, the system is largely a result of one event, World War II, and the wage freezes and tax policy that emerged because of it. Unfortunately, what made sense then may not make as much right now. (Aaron E. Carroll, 9/5)

Viewpoints: Hidden Prices; Opioids' Impact On Economic Growth; The New War On Medicaid

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

Stat: Hidden Prices Make It Hard For Consumers To Track Their Health Care Costs
My father had no idea how much my mother’s treatment would cost, how much of it would be covered by insurance, if there were alternative treatments that would be covered, or how we would pay for treatments that weren’t covered. Forget about negotiating — how could he negotiate about something whose price he didn’t know? No one explained the options for payment. My mother and father had zero control over, or even understanding of, the costs involved. For months following my mother’s diagnosis, they randomly received bills, including one for $20,000 attributed to the initial hospital stay that didn’t include the cost of three specialist visits and the emergency procedure. (Anahita Nakhjiri, 9/5)

Modern Healthcare: Congress Should Reinstate DACA To Promote A Compassionate And Just Society
Over the weekend, I joined more than a dozen Catholic healthcare system leaders in urging President Donald Trump to continue the Deferred Action for Childhood Arrivals (DACA) program. Now that the decision has been made to phase out the program, it is imperative that Congress develop and pass a permanent solution that extends the protections for these Dreamers. As healthcare leaders, we are called to promote and advance the dignity of every human person. Ascension's mission specifically calls us to be "advocates for a compassionate and just society through our actions and our words." The rescission of DACA fails to model a generosity of spirit, especially for those most in need. (Anthony R. Tersigni, 9/5)

Lexington (Ky.) Herald: Jobs Are Here; Ky.’s Workforce Needs Addiction Treatment
Among the many health challenges facing America, none has hit Kentucky harder than opioid addiction. The impact of the opioid crisis on Kentuckians’ health is staggering, with more than 1,400 overdose deaths reported last year. Less obvious, however, is the toll it has taken on the state’s economic growth and development. In Kentucky, the opioid crisis has contributed to a workforce participation challenge that undermines the competitiveness of existing businesses while creating barriers to new investments. (Dave Adkisson, 9/1)

Moyers and Company/Talk Poverty: The War On Medicaid Is Moving To The States
Recent congressional proposals to repeal and replace the Affordable Care Act would have reduced Medicaid enrollment by up to 15 million people, and, despite being defeated, congressional Republicans aren’t done yet: It’s likely they will attempt to gut the program during the upcoming budget debate. Meanwhile, more than half a dozen conservative governors are trying to take a hatchet to the program — at the open invitation of the Trump administration — through a vehicle known as a “Medicaid waiver.” (Greg Kaufmann, 9/5)

Des Moines Register: Iowa Once Sought To Expand Medicaid. Now It Wants To Cut It
States have repeatedly used [Medicaid] waivers to provide needed care to residents in a way that makes sense. But times have changed. Attitudes toward poor people and Medicaid have changed. Iowa has changed. This state now seeks federal permission to deny care to Iowans and avoid paying health providers. House File 653 ... orders the Iowa Department of Human Services to seek a waiver amendment to circumvent the federal government’s “retroactive eligibility provision.” That provision allows for Medicaid payments for health-care services provided in the three months leading up to a person being formally declared eligible for the health insurance. (9/5)

The Washington Post: My Fellow Conservatives Should Protect Medical Marijuana From The Government
I should not need to remind our chief law enforcement officer nor my fellow Republicans that our system of federalism, also known as states’ rights, was designed to resolve just such a fractious issue. Our party still bears a blemish for wielding the “states’ rights” cudgel against civil rights. If we bury state autonomy in order to deny patients an alternative to opioids, and ominously federalize our police, our hypocrisy will deserve the American people’s contempt. (Rep. Dana Rohrabacher (R-Calif.), 9/5)

Cleveland Plain Dealer: Don't Let Federal Cuts Eviscerate Critical Efforts To Prevent Teen Pregnancies
Recent cuts by the U.S. Department of Health and Human Services to the Teen Pregnancy Prevention Program will harm local and national efforts to decrease teen pregnancy and sexually transmitted infection rates. Locally, the Cuyahoga County Board of Health, one of 81 teen pregnancy prevention projects across the United States, and the only one in Ohio, recently learned that its current program period was being cut short; two years ahead of schedule. (Terry Allan and Gloria Agosto Davis, 9/6)

Sacramento Bee: Legislature Should Kill These Bills
In a Capitol controlled by Democrats, many of whom owe their election to union support, the pressure is intense to side with their labor allies. But they should ask themselves whether it’s the proper place for the Legislature to, say, determine that the United Food and Commercial Workers should dictate health policy. That’s essentially what would happen if they approve Assembly Bill 1461 by Assemblyman Tony Thurmond, D-Richmond. The bill is aimed at Blue Apron, which packages meal kits for people who like to cook but don’t have time to shop. The California Department of Public Health regulates the company as a food processor rather than a food handler. Thurmond’s bill would impose additional regulations. (9/5)

Louisville (Ky.) Courier-Journal: UK HealthCare Increasing Transplant Commitment To Louisville
A recent Courier-Journal article raised concerns among many in the community about the future of Jewish Hospital’s transplant program – a program of historic importance with a rich legacy of excellence. The concerns are understandable. What happens, after all, to patients who are waiting for a life-saving transplant when an important program that so many have looked to is shuttered? ... However, it is important to note that for decades, UK HealthCare has provided transplantation services to citizens in Jefferson and surrounding counties. (Roberto Gedaly, 9/4)

Louisville (Ky.) Courier-Journal: Buildings Don’t Perform Organ Transplants – Surgeons Do
The availability of organ transplantion in Louisville has been under scrutiny recently, with concerns raised over whether that availability is threatened because Jewish Hospital is for sale. As Chair of the Department of Surgery and Chief of the Division of Transplantation at the University of Louisville, we would like to clarify a few things. Buildings don’t perform transplants – surgeons do. All of the physicians who support the transplant program are U of L School of Medicine faculty members, and the transplant program remains as strong as ever. (Kelly McMasters and Christopher Jones, 9/4)