KHN Morning Briefing

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Kaiser Health News Original Stories

Political Cartoon: 'Short Fuse?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Short Fuse?'" by Nate Beeler, The Columbus Dispatch.

Here's today's health policy haiku:

AT WHAT COST?

Mere casualties
From forcing an "implosion":
Lost navigators.

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Summaries Of The News:

Health Law

Future Of Bipartisan Health Deal Already Shaky As Trump Reverses Course On Support

As news of a deal first broke Tuesday, President Donald Trump initially signaled support for the efforts. But after other Republicans panned the measure he seemed to change his mind. And although Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) expressed confidence in their plan, it will be a tough slog for them to get it through both chambers.

The Associated Press: Senate Health Care Deal In Doubt As Trump Says He's Opposed
A bipartisan Senate deal to curb the growth of health insurance premiums is reeling after President Donald Trump reversed course and opposed the agreement and top congressional Republicans and conservatives gave it a frosty reception. ... In remarks Tuesday in the Rose Garden, Trump called the deal "a very good solution" that would calm insurance markets, giving him time to pursue his goal of scrapping Obama's 2010 Affordable Care Act, the target of Republican derision since it was signed into law. Although top Democrats and some Republicans praised the Alexander-Murray compromise agreement, Trump backed off after a day of criticism from many in the GOP. (Fram and Werner, 10/18)

Bloomberg: Deal To Shore Up Obamacare Faces Big Hurdles, Including Trump 
Trump acknowledged Tuesday that he had encouraged Alexander to reach a deal with Murray, but said he wanted to ultimately see states given blocks of money and be allowed to set up their own programs. “The solution will be for about a year or two years; it’ll get us over this intermediate hump,” Trump told reporters. (Litvan, Edney and Wasson, 10/18)

The Washington Post: Another Last-Ditch Effort To Tackle Obamacare Stalls Within Hours Of Its Release
The measure presented congressional Republicans with an uncomfortable choice between helping sustain coverage for many Americans and making good on a long-standing campaign promise — and paying the consequences — by allowing the ACA to falter. Senate Republican leaders did not immediately endorse the proposal. Influential House Republicans panned the blueprint, and Trump offered conflicting reviews. The discord swiftly cast the plan’s viability into serious doubt. (Sullivan, Eilperin and Goldstein, 10/17)

Politico: Trump Would Have To Broker Obamacare Truce
[G]etting the deal though would require a sustained, focused lobbying effort on Capitol Hill, where Republicans are facing a biting political calculus. They’re still stinging from spending all of this year in a draining but fruitless effort to repeal and replace Obamacare — the law that congressional Republicans have been trying to uproot for seven years. Now, they would have to decide whether the state flexibility concessions Alexander got are enough. (Haberkorn and Cancryn, 10/17)

NPR: Senators Reach Deal To Stabilize ACA Insurance Markets For 2 Years
Murray said she and Alexander had had discussions with more than half the Senate about the bill and she believed the plan would get broad support. Alexander said they'll work to get co-sponsors for the legislation throughout the week so they can bring a bill to McConnell for consideration. McConnell has not said whether he supports the effort. (Kodjak, 10/17)

Modern Healthcare: Bipartisan Deal To Fund Insurer Payments Faces Tough Political Slog 
Senate Minority Leader Chuck Schumer and other Democrats expressed support for the Alexander-Murray agreement, though Democrats have concerns about whether Republicans may try to add provisions to further relax the ACA's consumer protections. There are widespread concerns that Senate Majority Leader Mitch McConnell and other congressional GOP leaders are in no hurry to find a legislative vehicle for passing the market stabilization agreement because they are unenthusiastic about it. In addition, many Republicans want to focus on passing tax cuts and fear getting bogged down in another healthcare debate. (Meyer, 10/17)

The Hill: New Health Deal Falls Flat With GOP 
A bipartisan Senate deal that would extend critical ObamaCare payments to insurers for two years got the cold shoulder from Republicans on Tuesday, suggesting it faces a rocky path to become law. The chairman of the conservative Republican Study Committee in the House dismissed the offering from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) as an affront to GOP promises to repeal President Obama’s signature legislation. (Sullivan, 10/17)

The Hill: McCain, Murkowski Signal Support For Deal On ObamaCare Payments
Two holdouts on the GOP effort to repeal ObamaCare are throwing their support behind a bipartisan deal to extend payments to insurers after President Trump moved to nix them. Republican Sens. John McCain (Ariz.) and Lisa Murkowski (Alaska) on Tuesday both praised the agreement to provide two years of the cost-sharing reduction payments. (Carney, 10/17)

The Wall Street Journal: Senators Reach Deal To Shore Up Health-Insurance Markets
The bill needs 60 votes to pass in the Senate, where Republicans hold 52 seats. The deal is most likely to get a vote in both chambers if it is tethered to another issue. In the Senate, one possibility is that it could be combined with a disaster-relief bill passed by the House last week, lawmakers and aides said. (Armour and Peterson, 10/17)

The Hill: House Freedom Chairman Calls ObamaCare Deal 'Good Start'
The chairman of the powerful House Freedom Caucus said more work needs to be done to get conservatives to support a bipartisan Senate deal to extend critical ObamaCare payments to insurers, but he called it a starting point. “There are elements in the Alexander-Murray plan that we can build on, but much more work needs to be done,” Rep. Mark Meadows (R-N.C) in a statement, but he called it a "good start." (Weixel, 10/17)

The Hill: Heritage Foundation Rips Bipartisan Health Care Deal Ahead Of Trump Speech
A senior fellow for the Heritage Foundation, an influential conservative think tank, ripped a bipartisan deal on Tuesday that would provide funding for key health-care subsidies that President Trump recently announced he would cut off. In a statement issued hours after Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), leaders of the Senate Health Committee, announced that they had agreed on a plan to stabilize insurance markets under the Affordable Care Act, Ed Haislmaier, a senior research fellow in health-care policy for the Heritage Foundation, said the proposal would offer little stability for the unsubsidized insurance market. (Greenwood, 10/17)

The Hill: Trump Blames Dems For ObamaCare Premium Increases 
President Trump on Tuesday blamed Democrats for any premium spikes for ObamaCare plans, even as key senators announced a bipartisan deal aimed at saving the insurance markets from actions taken by the administration. “Any increase in ObamaCare premiums is the fault of the Democrats for giving us a ‘product’ that never had a chance of working,” Trump wrote on Twitter. (Weixel, 10/17)

Alexander-Murray Deal Would Restore Insurer Subsidies For 2 Years, Increase Flexibility For States

“In my view, this agreement avoids chaos,” said Sen. Lamar Alexander (R-Tenn.), who has been leading bipartisan talks with Sen. Patty Murray (D-Wash.).

The New York Times: 2 Senators Strike Deal On Health Subsidies That Trump Cut Off
Two leading senators, hoping to stabilize teetering health insurance markets under the Affordable Care Act, reached a bipartisan deal on Tuesday to fund critical subsidies to insurers that President Trump moved just days ago to cut off. The plan by the senators, Lamar Alexander, Republican of Tennessee, and Patty Murray, Democrat of Washington, would fund the subsidies for two years, a step that would provide at least short-term certainty to insurers. The subsidies, known as cost-sharing reduction payments, reimburse insurance companies for lowering deductibles, co-payments and other out-of-pocket costs for low-income customers. (Kaplan and Pear, 10/17)

The Wall Street Journal: What Democrats And GOP Get In Bipartisan Health-Care Deal
The Alexander-Murray deal addresses the Democrats’ most immediate concern: subsidies known as cost-sharing reduction payments, billions of dollars paid to insurers to limit out-of-pocket costs for low-income consumers. These payments had never been approved by Congress, and President Donald Trump announced last week he would discontinue making them. Democrats and health analysts feared cutting off the payments would send costs soaring in the ACA market and might prompt some insurers to exit. A two-year guarantee will lend the law some measure of stability at a time when Democrats are attempting to ward off repeated GOP efforts to roll it back. ... What do Republicans get? Mr. Alexander, the lead GOP negotiator, said that the deal expands the usefulness of ACA waivers that allow states to sidestep certain ACA rules to remold some aspects of the law, such as how premium subsidies are distributed or how much insurers can be permitted to charge their oldest customers. (Hackman and Wilde Mathews, 10/17)

Bloomberg: Senators Get Deal To Prop Up Obamacare, Keep Subsidies Trump Cut 
The agreement also includes what Democratic Minority Leader Chuck Schumer called “anti-sabotage” provisions. Democrats have accused Trump of deliberately undermining the law, and Trump has said his actions are meant to dismantle it since Republicans in the Senate haven’t been able to pass a repeal bill. Schumer said the Alexander-Murray package got “broad support” during Senate Democrats’ weekly lunch at the Capitol. (Edney, Wasson and Litvan, 10/17)

In other news —

The Hill: GOP Senators Seek To Repeal ObamaCare's Insurance Mandate 
Legislation introduced by two GOP senators would exempt certain people from ObamaCare’s requirement that everyone must purchase health insurance or pay a fine. Sens. Pat Toomey (R-Pa.) and Tom Cotton (R-Ark.) called the law’s individual mandate “cruel” and said they want to exempt working class Americans from the requirement. (Weixel, 10/17)

Among Confusion And Premium Hikes, Insurers Scrambling To Shore Up Customer Base

Companies are predicting a drop off in sign-ups when enrollment season rolls around in just two weeks. Outlets report on marketplace news out of California, New Jersey and Washington, as well.

The Wall Street Journal: Health Insurers Step Up Open Enrollment Push As Window To Sign Up Shrinks
With enrollment for 2018 Affordable Care Act health-insurance plans starting in just two weeks, insurers are bracing for a drop-off among consumers put off by higher rates, confusion about the law’s standing and a shorter window to choose coverage. Companies like Blue Cross Blue Shield of Michigan, Florida Blue and Medica are rushing to shore up their customer base as the future of the 2010 health law continues to be debated on Capitol Hill, where two senators Tuesday announced a tentative deal aimed at bolstering the ACA marketplaces. The insurers are using advertising, letters, emails and other outreach techniques to reassure enrollees about their insurance options under the ACA in 2018. (Wilde Mathews, 10/18)

California Healthline: Questions Loom About Obamacare As Covered California’s Open Enrollment Nears
With open enrollment a little more than two weeks away, President Donald Trump took a one-two punch at the Affordable Care Act. Last week, Trump said he would stop paying key subsidies, known as cost-sharing reductions, which compensate insurers for providing discounts on deductibles and copays. He also signed an executive order aimed at loosening the rules for association health plans — organized by certain types of professional, trade or interest groups — and short-term medical insurance. (10/17)

The Philadelphia Inquirer/Philly.com: New Jersey Regulators Approve Affordable Care Act Rate Increases
Horizon Blue Cross Blue Shield of New Jersey, the state’s largest health insurer, said Tuesday that state regulators had approved average rate increases of 24.3 percent on individual Affordable Care Act plans for next year. The New Jersey Department of Banking and Insurance also approved an average overall increase of 17.1 percent for competitor AmeriHealth New Jersey, a unit of Philadelphia’s Independence Blue Cross, AmeriHealth said. (Brubaker, 10/17)

Seattle Times: Insurance Rates Could Rise 9 To 27 Percent For Some ACA Customers, Washington State Officials Say 
Tens of thousands of Washingtonians buying health insurance through the Affordable Care Act will pay higher rates unless Congress acts, the Washington state insurance commissioner said Tuesday. Commissioner Mike Kreidler said people purchasing a Silver Plan from the Washington Health Benefit Exchange will see rates rise between 9 percent to 27 percent, depending on the insurer, after President Donald Trump’s decision last week to end federal subsidy payments, which are called cost-share reductions, or CSRs. (Blethen, 10/17)

And in other news —

The Wall Street Journal: UnitedHealth Revenue Grows Despite ACA Exit
UnitedHealth Group Inc.’s core insurance and health-services businesses grew in its latest quarter, despite a dent in revenue caused by the company’s decision to pull out of most Affordable Care Act markets. The latest quarterly results from the nation’s largest health insurer come as the market is facing policy changes related to the ACA. President Donald Trump last week signed an executive order seeking to provide lower-cost plans in the individual insurance market, and he has said his administration will end payments to insurers that offset subsidies to low-income consumers. (Prang and Wilde Mathews, 10/17)

KCUR: UnitedHealth Group Says It Will Add 500 Jobs In Kansas 
Officials with the UnitedHealth Group on Tuesday announced they would bring 500 jobs to Kansas. Around 150 of the positions will be at OptumRx's Overland Park facility at 6860 West 115th Street, where renovations have opened up a floor full of cubicles waiting to be filled. "We're very, very deeply committed to Kansas," said John Mahrt, OptumRx's chief operating officer. "Kansas is a fantastic place for our people to live and work." (Janovy, 10/17)

Coverage And Access

'Single-Payer' Is The Hot New Buzz Word. But What Actually Does It Mean?

The Washington Post lays out what exactly a single-payer system looks like. Meanwhile, the issue is becoming a talking point in Minnesota's gubernatorial race.

The Washington Post: Single Payer System: A Healthcare Alternative To Affordable Care Act?
As Republican efforts to repeal and replace the Affordable Care Act continue in the background, some Democrats are starting to eye a new health policy goal: implementing a single-payer system. Sen. Bernie Sanders (I-Vt.) introduced a single-payer bill in mid-September with 16 Democratic co-sponsors — 16 more than he got when he introduced the bill two years earlier. But how is the health-care system funded now, and how would “single-payer” change that? (Soffen, 10/17)

Pioneer Press: MN Governors Race: Support Grows For Single-Payer Health Care
In the midst of the divide and confusion over health insurance’s future, Minnesota Democrats who would be governor are near united in their prescriptions: Universal and single-payer is the way forward. In a recent debate before a union-member crowd, the half-dozen Democratic-Farmer-Labor candidates gave nods to supporting universal health care, meaning everyone would be covered by health insurance. Four of the six proudly said they supported a single-payer health care model, meaning a publicly financed system. Last week, Democrat Rebecca Otto, the state’s auditor, came out with a lengthy Minnesota-based plan to finance health care. (Stassen-Berger, 10/17)

And, not all Democrats want to go as extreme as single-payer —

The Hill: Dems Introduce Public Option For ObamaCare
Sens. Michael Bennet (D-Colo.) and Tim Kaine (D-Va.) on Tuesday introduced a bill to add a government-run “public option” plan to ObamaCare, modeled on Medicare. The plan, part of a long-running debate in the Democratic Party about how far to go in expanding government-run health insurance, would move ObamaCare to the left but does not go as far as Sen. Bernie Sanders's (I-Vt.) "Medicare for all" plan. (Sullivan, 10/17)

Administration News

Former Lilly Executive Is A Leading Candidate For HHS Secretary

Alex Azar, who served as general counsel at the Department of Health and Human Services during the George W. Bush administration, is a top contender for the job, according to reports in The Washington Post and Politico.

The Washington Post: Trump Eyeing Former Drug Firm Executive Alex Azar For Health And Human Services Secretary
Alex Azar, a former pharmaceutical executive and a top health official during the George W. Bush administration, is now the leading candidate to head the Department of Health and Human Services, two Republicans briefed on the matter said Tuesday. Azar served a decade at Lilly USA, the biggest affiliate of Eli Lilly and Co., including five years as president. He directly led a biomedicines division that covered, among other areas, neuroscience, immunology and cardiology, and was also responsible for the company’s sales and marketing operations. (Eilperin and Goldstein, 10/17)

Politico: Trump Leaning Toward Former Pharma Exec For Health Secretary
One official said Trump had signed off on Azar, but another cautioned that the pick wouldn’t be final until the White House makes a formal announcement. A third Trump administration official confirmed that Azar has been shortlisted for the job. Other contenders long seen as top candidates for the job — including Centers for Medicare and Medicaid Services Administrator Seema Verma, and Food and Drug Administration Commissioner Scott Gottlieb — are no longer under consideration, according to multiple sources. (Restuccia, Johnson, Karlin-Smith and Dawsey, 10/17)

And a look at an interesting aspect of NIH duties --

Stat: NIH Library Is A ‘Safe Harbor For Information,’ Director Vows
The National Library of Medicine, built during the height of the Cold War, was designed to protect books, documents, and public information from just about anything — even the fallout of a nuclear disaster. Today the current director thinks the library can be a beacon of transparency and openness in an era full of concerns about threats to public information. NLM Director Patricia Brennan, who heads the $1 billion agency, vows the world’s largest biomedical library will continue to take steps to make data “open and accessible” at a time when the Trump administration has clamped down on making some information available to the public. (Blau, 10/17)

Public Health And Education

Following Investigation, Congress On Edge Over Old Bill That Undermined DEA's Power During Opioid Crisis

The report caused Rep. Tom Marino (R-Pa.) to withdraw his name for the White House drug czar position and has prompted Sen. Claire McCaskill (D-Mo.) to introduce legislation to repeal the law.

The Hill: Newly Controversial Opioid Enforcement Law Under Fire 
Several lawmakers are pushing to repeal or revisit a law critics say enables the flow of deadly and addictive opioids, hours after President Trump’s drug czar nominee withdrew his name amid the controversy. The little-noticed legislation is reportedly undermining the Drug Enforcement Administration’s (DEA) ability to police drug distributors and was heavily influenced by industry lobbying, according to a joint Washington Post and “60 Minutes” investigation published Sunday.  The report was based in part on a high-ranking whistleblower within the DEA. (Roubein, 10/17)

The Washington Post: Congresswoman Requests Hearings On Whether DEA Chief Misled Her About Bill
A Los Angeles congresswoman who co-sponsored a controversial law that has hobbled the Drug Enforcement Administration said Tuesday that the head of the agency personally assured her that the measure would not hamstring law enforcement efforts. Rep. Judy Chu (D-Calif.), an original co-sponsor of the bill, called Tuesday for an investigation into whether the law is harming enforcement against “bad actors” and requested hearings to examine whether she was misled. (Higham and Bernstein, 10/17)

The Washington Post: McCaskill’s False Claim That She ‘Wasn’t Here’ When The DEA Bill Was Passed
In the wake of The Washington Post/“60 minutes” investigation detailing how 2016 legislation passed by Congress weakened the Drug Enforcement Administration’s ability to go after drug distributors, even as opioid-related deaths continue to rise, Sen. McCaskill has led the charge for repealing the law. Already, President Trump’s choice for drug czar, Rep. Tom Marino (R-Pa.), withdrew his nomination after the report exposed his role in spearheading the bill’s passage through Congress. (Kessler, 10/17)

In other news on the epidemic —

The Washington Post: Another Outbreak Related To The Nation’s Opioid Crisis: Hepatitis C
The nation’s opioid epidemic has unleashed a secondary outbreak: the rampant spread of hepatitis C. New cases of the liver disease have nearly tripled nationwide in just a few years, driven largely by the use of needles among drug users in their 20s and 30s, spawning a new generation of hepatitis C patients. Because a treatment that cures the disease costs tens of thousands of dollars, is limited by insurance and Medicaid, and is mostly unavailable to people who are still using illicit drugs, there probably will be financial and public health ramifications for decades to come. (Zezima, 10/17)

Modern Healthcare: Hospitals Move Forward Fighting In Opioid Abuse Despite Lack Of Federal Assistance
President Donald Trump plans to officially declare the opioid epidemic a national emergency by next week, two months after first announcing a pledge to do so. "We are going to have a major announcement, probably next week, on the drug crisis and on the opioid massive problem and I want to get that absolutely right," Trump said during a news conference Monday. Some have criticized the delay in declaring the opioid crisis a national emergency, saying a declaration would immediately release resources to help municipalities and states in their efforts. More than 500,000 people have died from drug overdoses from 2000 to 2015. The deaths are occurring at an average of 91 deaths a day, according to the Centers for Disease Control and Prevention. (Johnson, 10/17)

Iowa Public Radio: Needle Exchanges Urged As More Iowans Inject Heroin
A legislative committee studying Iowa’s opioid epidemic heard testimony today on a serious side effect of increased heroin use in the state. Addicts share needles to shoot heroin, and public health experts say that has contributed to a large increase in hepatitis C cases in Iowa. (Russell, 10/17)

Orlando Sentinel: Amidst Opioid Epidemic, New Medical Codes May Have Muddled Data
The number of babies who were exposed to opioids in the womb jumped by 200 percent in Florida between 2015 and 2016 — to more than 2,500 cases — the biggest spike in the past decade, according to state data. But the number of newborns statewide who were diagnosed with opioid-withdrawal symptoms known as neonatal abstinence syndrome dropped by 68 cases to 1,468, bucking the past decades’ trend of steady increase. (Miller, 10/17)

Google Faces Backlash From Eating Disorder Specialists After Adding Calorie Counts To Maps

The feature showed how many calories a person would burn walking instead of driving to their new location. But experts warned that it could be triggering to those suffering from an eating disorder. In other public health news: obsessive compulsive disorder, diabetes, patients' bigoted remarks, obesity, HIV and dementia.

The New York Times: Google Maps Pulls Calorie-Counting Feature After Criticism
Stephanie Zerwas, the clinical director of the Center of Excellence for Eating Disorders at the University of North Carolina, was trying to find a restaurant in Orlando, Fla., last weekend, so she put the address into Google Maps for directions. She was baffled to see a new feature: The iPhone app told her that walking instead of driving would burn 70 calories. While it was perhaps meant as an incentive to walk, those with eating disorders might instead fixate on the number, a dangerous mind-set that counselors try to minimize, she said. (Victor, 10/17)

NPR: 4 Genes Linked To Obsessive Compulsive Disorder
People who have obsessive-compulsive disorder can get trapped inside a thought. It repeats itself, like a stuck song. Did I lock the door? Is that doorknob clean enough to touch? I better wash my hands again — and again. The biology underpinning this loop remains murky to scientists, but scientists are beginning to sniff out potential genetic factors behind OCD and shed light on how the disorder affects the brain. (Chen, 10/17)

The New York Times: A Diabetes Monitor That Spares The Fingers
For the past year and a half I’ve been buying a medical device from Italy that has improved my life immeasurably. It wasn’t easy: I roped in a good friend who had moved to Milan to buy the device and ship it to me because it wasn’t yet available in the States. And it was expensive: over $1,600 a year. (Zimberoff, 10/17)

Stat: Most Doctors Have Absorbed Bigoted Remarks From Patients, Survey Finds
Most doctors have absorbed racist, sexist, and other bigoted verbal remarks from patients under their care, according to a new national survey. And in interviews, physicians say these ugly incidents, while not frequent, can leave lasting scars. ...A wide-ranging survey of more than 800 U.S. physicians, conducted by WebMD and Medscape in collaboration with STAT, found that 59 percent had heard offensive remarks about a personal characteristic in the past five years — chiefly about a doctor’s youthfulness, gender, race, or ethnicity. As a result, 47 percent had a patient request a different doctor, or ask to be referred to a clinician other than the one their physician selected. (Tedeschi, 10/18)

The Star Tribune: Minnesota's Native American Health Advocates Use Old Games As New Cures For Obesity
Staggering rates of obesity and diabetes among Native Americans have led to shortened life spans. Native adults are twice as likely to be diagnosed with diabetes as is the general population, according to the U.S. Centers for Disease Control and Prevention. Diets worsened when Native Americans were forced to live on reservations and government commodities replaced the nutrient-rich, natural foods they were used to eating. (Shah, 10/17)

Miami Herald: Scripps Scientists Find New Therapy To Suppress HIV
A new therapy for HIV that does not require a lifelong regimen of daily drug cocktails may be on the horizon if early indications from studies on mice prove effective in people, scientists at the Scripps Research Institute in Florida announced Tuesday in the journal, Cell Reports. (Chang, 10/17)

Medicaid

Michigan Officials Bring Home A Message About Impact Of Medicaid Cuts

At a community forum, a diverse group of officials point out how proposals to cut federal funding to Medicaid could play out in Michigan. Also in Medicaid news, Maine voters weigh whether to expand the program there and Indiana hospitals are buying or leasing nursing homes to increase federal funding.

MLive: Proposed Medicaid Cuts 'Devastating' For Vulnerable People, Panel Says
The best way to push back against the president's proposed $700 billion cut to Medicaid funding in 2018 is to emphasize the personal impact of the reductions. That was the message a panel of elected [Michigan] officials brought to people gathered Monday, Oct. 16, at the Community Alliance office in Ypsilanti to learn more about the potential changes to Medicaid. ... The group said the proposed Medicaid cuts would be "devastating" to senior citizens and people with disabilities who rely on Medicaid to fund their long-term medical care. (Slagter, 10/17)

Governing: Maine's Medicaid Vote A Test Of Obamacare Support
The Maine Legislature has voted to expand Medicaid five times in the last five years. But every time the bill reached GOP Gov. Paul LePage's desk, he vetoed it. So advocates of expanding Medicaid decided to go straight to voters. They collected enough signatures to put the issue to voters in November. If passed, the state would become the 33rd to expand Medicaid and signal support for former President Obama's signature health-care law at a time when President Trump is taking major steps to reverse it. (Quinn, 10/17)

Kaiser Health News: Chasing Millions In Medicaid Dollars, Hospitals Buy Up Nursing Homes
Westminster Village North, a nursing home and retirement community in Indianapolis, recently added 25 beds and two kitchens to speed food delivery to residents. It also redesigned patient rooms to ease wheelchair use and added Wi-Fi and flat-screen televisions. This fall, it’s opening a new assisted living unit. “We have seen amazing changes and created a more home-like environment for our residents,” said Shelley Rauch, executive director of the home. (Galewitz, 10/18)

State Watch

State Highlights: $72M Award In J&J Talcum Case Tossed Due To Jurisdiction Problems; Death Toll In Calif. Hep A Outbreak Climbs

Media outlets report on news from Texas, Missouri, California, Massachusetts, Tennessee, Wisconsin and Illinois.

The Associated Press: Appeals Court Tosses $72 Million Award In Talcum Powder Case
A Missouri appeals court on Tuesday that vacated a $72 million award to an Alabama woman who claimed her use of Johnson & Johnson products that contained talcum contributed to her ovarian cancer has thrown the fate of awards in similar cases into doubt. The Missouri Eastern District Court’s ruled that Missouri was not the proper jurisdiction to hear a lawsuit filed by Jacqueline Fox, 62, of Birmingham, Alabama, who claimed the baby powder she used for feminine hygiene for about 25 years contributed to her cancer. (Stafford, 10/17)

San Diego Union-Tribune: Death Toll From San Diego Hepatitis A Outbreak Rises To 19; More Than 500 Cases Confirmed
San Diego’s hepatitis A outbreak added another death Tuesday, pushing the total to 19 as the number of confirmed cases passed 500. Updated numbers released by the county Health and Human Services Agency come as a massive effort around vaccination, sanitation and public education continues to try and stop the largest surge of the viral disease since the vaccine for hepatitis A was approved in the late 1990s. (Sisson, 10/17)

Dallas Morning News: Undocumented Pregnant Teen In Texas Again Sues To Have An Abortion 
After defeat in one federal court, a pregnant minor unauthorized to be in the country has taken her fight to have an abortion to another one, with a new approach. "Jane Doe," a 17-year-old unaccompanied immigrant, is suing the federal agencies responsible for her care to allow her and other unaccompanied immigrant minors to obtain abortions. Doe’s court-appointed guardian, Rochelle Garza, filed the lawsuit Friday in a Washington, D.C., federal court against the heads of the agencies: the Department of Health and Human Services, the Administration for Children and Families and the Office of Refugee Resettlement. (Wang, 10/17)

Nashville Tennessean: Bill Frist Among 6 Inducted Into Tennessee Health Care Hall Of Fame
Former U.S. Sen. Bill Frist was among six health care pioneers inducted Tuesday into the Tennessee Health Care Hall of Fame. He joins Dorothy Lavinia Brown, the first African-American female surgeon in the South; Donald Pinkel, the first director and CEO of St. Jude Children’s Research Hospital; Harry R. Jacobson, former Vanderbilt University Medical Center CEO; Joel Gordon, a veteran health care businessman; and Stanford Moore, aNobel Prize-winning biochemist. (Hubbard, 10/17)

Nashville Tennessean: Nashville Ranks High For Patient-Doctor Language Barrier
People who need physicians who speak a second language are likely to have a harder time finding their language spoken in Nashville than many other cities across the nation. Nashville ranked at number nine in the top 10 metro areas with the greatest disparity between languages spoken by patients and those spoken by physicians, according to a new study from Doximity, a professional social network for physicians and advanced practice clinicians. (Fletcher, 10/17)

Chicago Sun Times: Madigan: Chicago Woman Defrauded Medicaid Out Of Nearly $1M 
A Chicago woman has been charged with defrauding Illinois out of nearly $1 million in Medicaid funding. Santila Terry, 45, was charged Friday with theft, identity theft and vendor fraud, according to a statement from Illinois Attorney General Lisa Madigan’s office. Terry billed Medicaid through her business “Special Therapy Care Chartered” for speech therapy services provided to children enrolled in the state’s Medicaid program, according to the statement. (Owen, 10/17)

Sacramento Bee: Sacramento Mayor Asks County For $53 Million In Homeless Funds
Facing increasing pressure as the number of homeless people surges, Sacramento Mayor Darrell Steinberg asked Sacramento County leaders Tuesday for $53 million to provide services for that population. Steinberg wants to pool the county’s mental health funds – which stem from a state millionaire tax he authored as a legislator – with federal grants obtained by the city to spend a combined $117 million in three years to reduce homelessness. (Branan, 10/17)

Prescription Drug Watch

'I'm Not Interested In Their Money,' Trump Says Of Pharma. But He Took It Anyway.

News outlets report on stories related to pharmaceutical pricing.

Stat: When It Comes To Pharma Money, Trump Was With The Elephant In The Room
President Trump on Monday addressed a well-established tenet of life in Washington: The pharmaceutical industry has loads of money and doesn’t hesitate to spend it on Congress. “They contribute massive amounts of money to political people,” Trump said during an impromptu news conference, turning to Senate Majority Leader Mitch McConnell, who was standing to his side. “I don’t know, Mitch, maybe even to you.” ...Trump was not wrong. In his last race in 2014, McConnell raked in $550,923 from the pharmaceutical and health products industries — more than any other individual lawmaker received that year, according to the Center for Responsive Politics, which analyzes political spending data from the Federal Election Commission. (Swetlitz and Mershon, 10/16)

Stat: What Risks? Consumers Are Tuning Out Side Effect Info In TV Drug Ads
The litany of side effects recited in TV drug ads are designed to alert you to all of the potential risks, big and small. But it turns out these well-intended laundry lists, which are required by regulators, actually have the opposite effect — consumers pay less attention to the most serious side effects and, consequently, focus on the benefits of the drug, according to a new study. In short, regulators may have created a paradox if the marketability of the drugs has increased. (Silverman, 10/12)

ProPublica: Oversized Eyedrops Waste Medicine And Money
If you've ever put in eyedrops, some of them have almost certainly spilled onto your eyelid or cheek. The good news is the mess doesn't necessarily mean you missed. The bad news is that medicine you wiped off your face is wasted by design — and it's well-known to the drug companies that make the drops. (Allen, 10/18)

USA Today: Families Allege Big Pharma Helped Finance Iraq's Mahdi Army Through Bribes
he families of dozens of U.S. troops killed or injured during the war in Iraq filed a federal lawsuit Tuesday against several U.S. and European pharmaceutical and medical supply companies, alleging that the corporations knowingly financed the anti-American militia Mahdi Army through bribes and kickbacks to officials at a government ministry controlled by the group. (Madhani, 10/17)

Stat: Why Do We Need Drug Rebates, Anyway? A Top Lawmaker Wants To Know
Sen. Lamar Alexander has a question: why do we have drug rebates, anyway? “Why do we need rebates?” the Tennessee Republican asked a panel of pharmaceutical industry representatives at a Senate committee hearing. The Health, Education, Labor, and Pensions committee met Tuesday morning for the second of three hearings on drug pricing, and heard testimony from five interest groups representing companies that play different roles in getting medicines to patients. (Swetlitz, 10/17)

Bloomberg: Drug Supply Players Point A Finger Everywhere But Themselves
A day after President Donald Trump renewed his attack on high drug prices, officials from the drug industry’s top lobbying groups sat down at a black cloth-draped table in a Senate hearing room and told lawmakers who’s to blame: the person a few seats over. Drugmakers said in prepared remarks that insurers, pharmacy-benefit managers and hospitals, among others, keep a large chunk of the money Americans spend on medicine and don’t pass on savings to patients. (Edney, 10/17)

USA Today: Cost Of Cold And Flu Season Can Make You Sick
Cold and flu season isn’t just physically painful — it can hurt your wallet too. The average consumer shops for over-the-counter medicine 26 times each year. That’s $338 per household, according to data collected by the Consumer Healthcare Products Association, a trade organization, in 2015, the most recent available. That same year, Americans spent $328 billion on prescription retail drugs, or prescription drugs purchased in pharmacies, according to estimates from the Department of Health and Human Services. (Ell, 10/17)

The Wall Street Journal: Johnson & Johnson Outlook Buoyed By Drug Unit
Johnson & Johnson increased its 2017 sales and adjusted profit guidance for the third quarter in a row, though net income in the quarter fell due to one-time items and amortization related to the company’s Actelion acquisition.J&J, one of the largest health-products companies by revenue based in the U.S., urged lawmakers in Washington to “unite behind” a plan to overhaul the corporate tax system but said its 2017 guidance doesn’t assume there will be tax reform this year. (Rockoff and Lombardo, 10/17)

Stat: Q&A: Will We See More Drug Makers File Antitrust Lawsuits Against Rivals?
Three times in recent weeks, a big drug maker sued another for allegedly using illegal tactics to win valuable contracts with payers. In one lawsuit, Pfizer claimed that Johnson & Johnson violated antitrust law when convincing insurers not to cover its biosimilar version of the Remicade rheumatoid arthritis treatment. Then, Shire alleged Medicare Part D plans refused to cover its Xiidra dry-eye treatment, because Allergan used “bundled discounts” and “exclusive” deals to lock down the market. And Sanofi accused Mylan of thwarting its move to sell an EpiPen rival. Drug makers regularly offer discounts to payers, but the lawsuits are drawing new attention to behind-the-scenes dealings. We spoke with Michael Carrier, a Rutgers University School of Law professor who specializes in antitrust matters in the pharmaceutical industry, about the implications. (Silverman, 10/16)

Stat: Who Will Pay For A $1 Million Drug? Gene Therapies Raise Tough Questions
Gene therapy has the potential to be a one-shot treatment that could reverse blindness, restore blood clotting function to hemophiliacs, or even cure rare diseases outright. But what kind of price tag comes with that promise — and who will pay for it?  The question is no longer academic: On Thursday, Spark Therapeutics won unanimous support from a Food and Drug Administration advisory panel for its gene therapy drug, Luxturna. It seems likely to win FDA approval in the coming months. But the cost will be hefty: Analysts estimate that Luxturna, which has been shown to restore vision in children with an inherited form of blindness, could cost $1 million per patient. (Keshavan, 10/13)

Kaiser Health News: Cascade Of Costs Could Push New Gene Therapy Above $1 Million Per Patient
Outrage over the high cost of cancer care has focused on skyrocketing drug prices, including the $475,000 price tag for the country’s first gene therapy, Novartis’ Kymriah, a leukemia treatment approved in August. But the total costs of Kymriah and the 21 similar drugs in development — known as CAR T-cell therapies — will be far higher than many have imagined, reaching $1 million or more per patient, according to leading cancer experts. The next CAR T-cell drug could be approved as soon as November. (Szabo, 10/17)

Stat: Judge Invalidates Allergan Patents And Criticizes Deal With The Mohawks
In a blow to Allergan (AGN), a federal judge invalidated the patents on its Restasis eye treatment, the latest twist in a captivating controversy over the fate of the best-selling medicine. The ruling brings some of the largest generic drug makers — Mylan and Teva Pharmaceuticals (TEVA) — a big step closer to selling lower-cost versions of a product that generated nearly $1.5 billion in sales last year. For now, though, the companies must first win regulatory approval and, meanwhile, battle in court still more since Allergan plans to appeal. And this will take months to resolve, stretching well into next year. (Silverman, 10/16)

Wisconsin Public Radio: Democrat Seeks Price Transparency On Prescription Drugs
Frustration over prescription drug prices is prompting some states to force pharmaceutical makers to justify the cost of medications. California’s governor recently signed a bill doing just that. And Democratic lawmakers in Wisconsin are pushing a similar measure. A bill introduced by Debra Kolste, D-Janesville, would require advance notification to the state Office of the Commissioner of Insurance and state Department of Health Services anytime the cost of a drug increases more than 25 percent. She said consumers, insurers, the government and the public would like to better understand pharmaceutical pricing. (Mills, 10/16)

The Hill: Battle Over Drug Prices Shifts Back To The States
President Trump has derided pharmaceutical companies as “getting away with murder,” but there’s been little action in Washington to rein in the costs of prescription drugs. Some states are taking matters into their own hands. California passed a new law that requires pharmaceutical companies to explain a drug’s price tag, and other states are considering similar measures. (Roubein, 10/11)

Politifact: Ohio Issue 2 Ballot Initiative Proponents Overstate Impact On EpiPen Prices
Ohio Taxpayers for Lower Drug Prices claims its ballot initiative could lower the price tag for the EpiPen, a popular auto-injector for serious allergic reactions. "We’ve gone from paying about $100 for EpiPens to over $600. And they only hold about one dollar’s worth of medicine," the Aug. 29, 2017, video says. "We don’t have a choice but to pay it and the drug companies know it. Vote yes on Issue 2, the Drug Price Relief Act." (Tobias, 10/13)

Cleveland Plain Dealer: State Report: Issue 2 Savings Impossible To Predict
An analysis by the Ohio Office of Budget and Management finds the state could save some money if Issue 2 passes, but it is impossible to say with certainty or how much. Issue 2 is the ballot initiative that would require the state to pay no more for pharmaceuticals than what the U.S. Department of Veterans Administration does. (Richardson, 10/11)

Viewpoints: It's Time To Stop Drug Companies From 'Gaming The System And Gaming The Rules'

Read recent commentaries about drug-cost issues.

USA Today: Stop Big Pharma From 'Getting Away With Murder'
Few things are more infuriating to consumers than the constant, surging increases in drug prices. Americans under 65 are projected to pay an additional 11.6% this year, while seniors are expected to see increases of 9.9%. These increases follow similar ones in recent years. Price hikes like these, which run well above inflation and wage growth year after year, are a keen indication of how the drug industry lacks market fundamentals. Or, as President Trump put it Monday, prescription drug prices "are out of control" and the big pharmaceutical companies "are getting away with murder." (10/16)

Bloomberg: Here's How Drug Companies Game The Patent System
The Senate Health Committee held a hearing Tuesday morning about why prescription drugs cost so much and what might done to make them more affordable. According to the committee’s website, the witnesses include a lobbyist for the pharmaceutical industry, a lobbyist for the pharmacy industry and a lobbyist for the pharmacy benefits-management industry. (Joe Nocera, 10/17)

USA Today: PhRMA: We’re Working To Protect Patients
Ensuring patient access to medicines that are revolutionizing how we fight disease is critically important. Equally so is understanding when additional safeguards are required to ensure a medicine’s benefits outweigh its risks. In such cases, the Food and Drug Administration may require the biopharmaceutical company that manufactures the medicine to implement additional procedures, called Risk Evaluation and Mitigation Strategies (REMS), to facilitate safe use of the medicine. (James C. Stansel, 10/16)

Forbes: The Cost Of Developing Drugs Is Insane. That Paper That Says Otherwise Is Insanely Bad
You probably know this poem, or at least the story it tells. One man likens the elephant to a wall, another to a spear, a third to a snake, a fourth to a tree. The point is that each sees only part of the animal, and is thereby deceived. Well, here’s how the same thing happened when it came to a new estimate of the cost of developing a new medicine. For years, the pharmaceutical industry has relied on estimates from the Tufts Center for the Study of Drug Development, the most recent of which that puts the cost of bringing a medicine from invention to pharmacy shelves at $2.7 billion. Last month, two cancer researchers grabbed headlines by asserting that estimate is way off. Their number, published in JAMA Internal Medicine: $648 million. In an editorial that ran alongside the new study, journalist Merrill Goozner wrote: “Policymakers can safely take steps to rein in drug prices without fear of jeopardizing innovation.” There are reasons to think that (more on that later), but this paper does not add to them. (Matthew Harper, 10/16)

The Hill: The Future Of Drug Pricing: Value Over Volume
Doctors and hospitals are increasingly being paid not for the quantity of care they provide, but for the outcome or quality of care patients receive. The emerging trend in health care is about rewarding value, rather than volume. This is the future, where there is less focus on the number of tests or treatments a patient receives and more focus on whether a patient’s health is improving. (Jim Greenwood, 10/11)

Stat: Canada Needs A National Registry Of Drug Company Payments To Doctors
The province of Ontario recently took a historic step for Canada by introducing legislation that would shine a light on interactions between drug companies and prescribers. The use of the term “historic” here is not hyperbole, since the extent of payments towards physicians in Canada has never been known. Other countries, such as the United States and France, have been making such information public for a few years now. But Ontario’s bill would provide a wider scope of transparency by including all sorts of prescribers — not just doctors — into the mix, and even bringing in medical device companies. (Nav Persaud, Joel Lexchin and Andrew S. Boozary, 10/17)

The Columbus Dispatch: Ohioans Should Vote No On Issue 2
Tens of millions of dollars are being spent on advertising for and against Issue 2, the “Drug Price Relief Act.” After all this, Ohioans remain confused about this proposed voter-initiated law on the Nov. 7 ballot — a wishful scheme that aims to force the state to buy drugs at unattainable discounts. The muddle is understandable. Ohioans are being told to vote for one thing, but are being sold a bill of goods on another. Its merits shaky, Issue 2 campaigns against a straw man: Big Pharma. (10/18)

Columbus Dispatch: Should Ohioans Support The Drug Price Relief Act? Yes
As a Vietnam veteran and former head of the United States Veterans Administration, I have spent most of my life advocating for veterans. And I’m not stopping now. One of the biggest challenges now facing Ohio families and veterans is posed by the out-of-control pharmaceutical drug industry. This industry has been and continues ripping off Ohio veterans and taxpayers daily by selling our government agencies — including Medicaid — drugs at outrageous prices. (Max Cleland, 10/16)

The Courier: No On Issue 2
High drug costs are a national issue, not just an Ohio one. But voters statewide will get to weigh in on the Ohio Drug Relief Act, Issue 2, on Nov. 7. The run-up to the election, and the outcome, will be closely watched throughout the country.Issue 2, if approved, would create a new law requiring state agencies in Ohio to not pay more for prescription drugs than the federal Department of Veterans Affairs. It also would require state payment of attorney fees and expenses to specific individuals for defense of the law.The issue, which was brought about through an initiative petition signed by nearly 200,000 Ohioans, pits a California health care CEO against Big Pharma in a state which would become the first to directly take on the drug price problem if the issue is approved. (10/18)

Editorials And Opinions

Examining The Alexander-Murray Plan: A Bipartisan Deal On Obamacare? Stop The Presses; It's Not A Bailout

Editorial pages examine the agreement announced yesterday to stabilize the Affordable Care Act's marketplaces after President Donald Trump announced last week that he would end federal payments to fund the law's cost-sharing reductions.

Los Angeles Times: Two Senators Announce A Bipartisan Deal On Obamacare, But Don't Celebrate Yet
n a window into how the U.S. Senate should actually work, two senators — a Republican and a Democrat — announced a bipartisan deal Tuesday to save some provisions of the Affordable Care Act from the Trumpian butcher block. Don’t celebrate quite yet. The window into bipartisan comity is only narrowly cracked open, as yet. The details of the deal are still murky, but plainly it won’t undo some of the damage done to the ACA by the Trump administration over the last nine months. And conservative Republicans are already grousing that it’s too accommodating to a program that has brought health coverage to 20 million Americans. (Michael Hiltzik, 10/17)

Bloomberg: Fresh Hope For Obamacare, And Bipartisanship
After several failed attempts to wreck the U.S. health-insurance system, Congress now has a bipartisan agreement to help shore it up. The deal could still fall apart -- victimized by the president's fickle support and committed opposition from conservatives in Congress -- but it's exactly the kind of rational compromise that Washington needs more of. (10/17)

The Washington Post: Trump Doesn’t Seem To Have Any Idea What He’s Doing On Health Care
President Trump has decided upon a justification for his controversial decision to cancel Obamacare payments to insurers covering policies for low-income Americans: The insurance companies are getting rich off this stuff. As is often the case with Trump, his argument seems plausible on its face but, upon further examination, quickly falls apart. And not only that, but Trump is now lending support to a deal that would actually restore the payments that he says are lining insurance company pockets. (Aaron Blake, 10/17)

Los Angeles Times: Who's To Blame If The ACA Blows Up? Trump, Of Course
President Trump still doesn’t get it: He owns Obamacare now. He’s been hard at work undermining the government-regulated health insurance program —eliminating subsidies to insurance companies, slashing programs to enroll new customers, authorizing bare-bones plans to lure healthy patients out of the insurance pool. But if the system collapses, he insists it won’t be his responsibility. “I think the Democrats will be blamed for the mess,” he said on Monday. (Doyle McManus, 10/18)

Thoughts On The Drug Industry And The Opioid Epidemic: Look No Further Than The Swamp; Examining Enforcement Tools

Opinion writers continue to examine the government's role in the opioid crisis and strategies to curb it.

Chicago Tribune: Drug Industry Swims In Washington’s Swamp
But not so fast. More than most of the controversies that have tested this president, the opioid crisis tragically plagues some of the most desperate communities in Trump’s political base. To voters who turned in good faith to Trump’s promises to “drain the swamp” in Washington, Trump’s drain appeared to be clogged. hat makes this opiate-gate scoop into a scandal is how dramatically it illustrates the corruption and insider deal-making that gives Trump’s swamp-draining talk traction with his rally crowds. (Clarence Page, 10/17)

USA Today: Drug Law Hasn’t Hurt Enforcement
The Ensuring Patient Access and Effective Drug Enforcement Act was a bipartisan, commonsense step forward to improve enforcement efforts and combat the opioid epidemic. At its core, the law supported greater coordination between the Drug Enforcement Administration and drug manufacturers and distributors, pharmacies and doctors. In no way does it diminish DEA’s enforcement tools. (John M. Gray, 10/17)

The Charlotte Observer: Here’s How To Address The Opioid Epidemic
In 2004, my closest friend died of an opioid overdose. Since then I’ve met hundreds of mothers, brothers and daughters who have lost loved ones, too. I’ve spent my entire career treating addiction, and it’s clear that efforts to explain the current crisis and its solutions are missing some vital points. Recently, President Trump commissioned a group to examine how to solve this crisis, and its first suggestion was to declare an emergency. It’s been over 70 days since that report was released, and more than 6,500 people have died since. What will it take for us to act? (Omar Manejwala, 10/17)

Stat: Online Sellers Of Designer Drugs Are A Dark Partner In The Opioid Epidemic
DRC and companies like it sideline the doctor, the pharmaceutical industry, and its regulators from the patient-physician relationship. Over the last few years, the use of new psychoactive substances has increased dramatically. They may represent the future of medicine: the patient-chemical relationship. (Abraham Nussbaum, 10/17)

Viewpoints: In Defense Of Sanctuary Hospitals; Medicare, Medicaid Funding Fairness For Puerto Rico

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

JAMA: Making A Case For Sanctuary Hospitals
In July 2017, Jose de Jesus Martinez, an undocumented immigrant, wept at the bedside of his 16-year-old son Brandon, who was comatose in the intensive care unit of a San Antonio, Texas, hospital after being found in a parked unventilated trailer. Several agents from US Immigration and Customs Enforcement (ICE) entered Brandon’s hospital room and aggressively began questioning Jose. The incident was just one in a recent trend of disturbing actions by ICE agents at or near hospitals and other health care facilities. ... everyone deserves to feel secure when in need of medical care, particularly the most vulnerable members of communities. Under previous government administrations, even ICE recognized that hospitals, like schools and places of worship, were sensitive locations where enforcement actions should not take place unless “exigent circumstances” existed. (Altaf Saadi, Sameer Ahmed and Mitchell H. Katz, 10/16)

Modern Healthcare: Puerto​ Rico​ Deserves​ Fair​ Medicaid​ And​ Medicare​ Funding
The Puerto Rican healthcare system, which serves the 3.4 million people devastated by Hurricane Maria, operates under patently unfair Medicaid and Medicare funding rules. As Americans gear up to help their fellow citizens, it's critical that Congress and the Trump administration correct this injustice. Not only should they offer immediate aid, they should revise the inequitable formulas that systematically shortchange the 69 hospitals and approximately 20 federally qualified health centers with nearly 90 facilities that dot the Caribbean island. (Merrill Goozner, 10/14)

The Washington Post: Congress Wants To Make Americans With Disabilities Second-Class Citizens Again
Led by the hospitality and retail industries, special interests want to shift the burden of [the Americans With Disabilities Act] compliance away from business owners and onto individuals with disabilities. They’re backing a bill that has already passed the House Judiciary Committee, the so-called ADA Education and Reform Act, which would reward businesses that fail to comply with the law. The bill would allow businesses to wait until they are notified of their failure to meet legal obligations before they even have to start removing barriers that prevent Americans with disabilities from leading independent lives. (Sen. Tammy Duckworth, 10/17)

The Des Moines Register: Not Even Death Spares You From Iowa's Budget Cuts
[G]overnment may now be too small for many Iowans, including those with complaints about a nursing home, those seeking a court date or those trying to get someone on the phone to ask questions about their now privatized Medicaid health insurance. And not even death can deliver people from the negative consequences of failing to adequately fund state government. A shortage of forensic pathologists at the Iowa Medical Examiner’s Office is delaying autopsies, which can leave families waiting weeks for their loved one’s remains. This means not only waiting for answers about a death, but also waiting to schedule funerals and burials. (10/17)

Detroit Free Press: Parents Need Honest Answers To Questions About Childhood Vaccines
My heart aches for Rebecca Bredow, the young Metro Detroit mom jailed for violating an Oakland County Circuit Court judge’s order to immunize her son against vaccine-preventable diseases. As I watched Michigan and national media coverage of Rebecca’s case, I saw a young woman who, from all indications, loves her son and is trying to do what is best for him. When Rebecca shared her story with the public, memories came flooding back of my family’s experiences with childhood immunizations. (Veronica McNally, 10/16)

Cleveland Plain Dealer: GOP's Drastic Medicaid Cuts Would Be Devastating For HIV-Positive Ohioans Like Me
I have been living with HIV for 20 years. HIV is a very smart and dangerous virus - it can become out of control in your body quickly, and it can make the common cold a deadly illness. To manage my HIV, I take a daily medication that has the dual benefits of keeping the virus from spreading and boosting my immune system. Missing even one dose of my medication is not an option. ... Medicaid expansion meant that, for the first time since I was diagnosed HIV-positive, I was able to afford all of the treatment I needed in the same month. I no longer had to choose what I would treat from month to month. (Olga Irwin, 10/18)