KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Health Law

Trump: Creating Crisis Was Necessary To Get Congress To Negotiate On Health Care

President Donald Trump wants Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) to work out a short-term fix for the insurance marketplaces.

Reuters: Trump Declares Obamacare 'Dead,' Urges Democratic Help For Short-Term Fix
U.S. President Donald Trump on Monday declared Obamacare "dead" and "gone," but urged Republicans and Democrats in Congress to craft a short-term fix of healthcare markets under the 7-year-old law that critics say he has effectively sabotaged. "It’s dead. It’s gone. It’s no longer - you shouldn’t even mention. It’s gone," Trump said of former Democratic President Barack Obama's signature 2010 healthcare law that Republicans have repeatedly tried and failed to repeal. (Rampton and Cowan, 10/16)

Los Angeles Times: Trump Calls For Short-Term Obamacare Fix And Reaches Out To Republican Leaders
President Trump threw his weight Monday behind a measure to fix parts of Obamacare, the first time he has voiced approval of a specific legislative approach to do so and an abrupt turnaround on a bipartisan effort to preserve key elements of the healthcare system that he has sought to repeal. Trump’s backing of what he repeatedly referred to as a “short-term fix” to ensure “good healthcare” came during freewheeling remarks in which he sought to mend relations with GOP leaders, even as he kicks a growing list of complicated issues to Congress, including immigration and the Iran nuclear deal. (Mascaro and Bierman, 10/16)

Politico: Trump Said To Want Bipartisan Senate Obamacare Deal
President Donald Trump urged Republican Sen. Lamar Alexander to seek out an Obamacare deal with Democrats — encouragement that might help sway Republicans who are skeptical of a bipartisan agreement. Alexander said Trump told him by phone Oct. 14 he’d like to see a bill that funds the Obamacare cost-sharing subsidies that he abruptly cut off last week. In return, he wants to see “meaningful flexibility for the states in providing more choices,” Alexander (R-Tenn.) said. (Haberkorn, 10/16)

Bloomberg: Trump Urges Obamacare Fix, Senator Says, After Ending Key Plank 
“He called me a week ago and he called me on Saturday,” Alexander said of the effort, which he’s working on with Democratic Senator Patty Murray . “We had a good conversation each time, and he encouraged me to get a result with Senator Murray. He said, ‘I don’t want people to suffer.’ That’s his words.” Trump said Monday that creating a crisis was a necessary step to getting legislation moving. “Republicans are meeting with Democrats because of what I did with the CSRs,” Trump said on Monday at a Cabinet meeting, referring to subsidies to insurers the administration said on Thursday it was cutting off. “If I didn’t cut the CSRs they wouldn’t be meeting, they’d be having lunch and enjoying themselves, all right. They’re right now having emergency meetings to have a short-term fix of health care.” (Tracer, Sink and Litvan, 10/16)

The Hill: Tough Decisions Loom For Dems On ObamaCare 
Congressional Democrats have to decide how badly they want an ObamaCare deal. Senate Republicans are open to renewing the insurer payments that President Trump canceled last week, but, in return, they want to expand a program that allows states to waive Affordable Care Act regulations. That asking price could be hard for Democrats to swallow. (Sullivan, 10/17)

In other news, two Democrats see a way forward that's different than a single-payer system —

The Washington Post: Two Swing-State Democrats Offer Middle Ground On Health Care
A pair of swing-state Democrats are offering new legislation that would create Medicare-style options for non-elderly workers, with a heavy focus on rural areas that have few insurers offering coverage under the Affordable Care Act. The proposal, from Sens. Michael F. Bennet (Colo.) and Tim Kaine (Va.), is politically significant because it tries to build on the existing law rather than the tear-it-all-down proposal of a national health-care system that is being offered by Sen. Bernie Sanders (I-Vt.). (Kane, 10/16)

CMS Letting Plans Adjust Premiums After News That Trump Is Cutting Off Insurer Subsidies

“Insurers in the vast majority of states on the federal exchange submitted rates for the upcoming plan year assuming that CSR payments would not be made, so no rate adjustment is needed,” said spokeswoman Caitlin Oakley. Meanwhile, Bloomberg takes a look at the history of the health plans President Donald Trump is supporting through his executive order.

CQ: Administration Allows Plans To Change Health Exchange Rates
The Trump administration is allowing some insurance companies to change health exchange premiums following the president’s decision to end crucial consumer cost-sharing subsidies. President Donald Trump announced Friday he would end the subsidies, which aid families up to 250 percent of the federal poverty level with copays and deductibles. The subsidies had been at the center of a legal fight between House Republicans and the Obama administration that Trump inherited. (Clason, 10/16)

Bloomberg: The Health Plans Trump Backs Have A Long History Of Disputes 
The short-term medical plans promoted in President Donald Trump’s new executive order on health care have a long history of customer disputes over pre-existing conditions and denied claims -- just the sort of scenarios that were being weeded out by Obamacare. The Affordable Care Act pushes Americans to buy comprehensive long-term coverage; the Obama administration limited short-term plans to three months and prevented them from being extended. The temporary plans are geared toward people who are between jobs or considering retirement. (Larson and Tracer, 10/16)

And in news from the states —

The Philadelphia Inquirer/Philly.com: Pa. Approves Steep 2018 ACA Exchange Percentage Increases, Hopes To Minimize Impact
President Trump’s decision to end payments to insurers that help make health coverage affordable for millions of lower-income Americans under the Affordable Care Act blew up what would have been a year of relatively low rate increases in Pennsylvania. The Pennsylvania Department of Insurance on Monday announced that it had approved average rate increases of 30.6 percent for individual plans to be sold next year both on and off the ACA health insurance exchange. (Brubaker, 10/16)

The Hill: Pennsylvania ObamaCare To See Premiums Spike Amid Trump Pay Cuts 
Insurance premiums for plans sold on Pennsylvania’s ObamaCare exchange will increase by an average of 30.6 percent for 2018, primarily because of President Trump’s decision to stop paying key subsidies, the state’s insurance department said. If Trump had decided to continue making the cost-sharing reduction payments, projections showed a much more modest premium increase of 7.6 percent. (Weixel, 10/16)

The Baltimore Sun: Health Exchange Works To Counter Confusion Over Obamacare
Major last-minute changes at the federal level to the Affordable Care Act and additional rate increases at the state level threaten to undermine enrollment in health insurance this year, but Maryland health exchange officials are sticking to a goal of signing up at least as many people as last year. The exchange, where people who do not get insurance through work can buy coverage, enrolled more than 140,000 people in private plans and about 280,000 in the expanded Medicaid program during the last year’s enrollment period for 2017 insurance coverage. (Cohn, 10/16)

Concord (N.H.) Monitor: Sununu Asks Congress To Act On Health Care
Four days after President Donald Trump ended a key Affordable Care Act subsidy, pitching the individual market into further chaos, Republican Gov. Chris Sununu pressed Congress to authorize the payments themselves. In a joint letter sent to Congressional leaders Tuesday, Sununu and New Hampshire Insurance Commissioner Roger Sevigny asked U.S. House and Senate leaders to restore the funding, known as cost-sharing reduction payments, or CSRs, which reimburse insurers for discounts they are legally required give certain low-income individuals. (DeWitt, 10/17)

New Hampshire Union Leader: NH Officials Call On Congress To Pass Bipartisan Health Care Measure
Gov. Chris Sununu and Insurance Commissioner Roger Sevigny on Monday waded into the national health care debate in a letter to leaders in Congress, urging them to restore cost-sharing reduction payments and pass “the Lower Premiums Through Reinsurance Act of 2017,” a bipartisan measure sponsored by Sen. Susan Collins, R-Maine, and Senator Bill Nelson, D-Fla. The reinsurance program proposed in the legislation would help offset the loss of cost-sharing reduction payments by the federal government, announced last week by President Trump. (10/16)

The CT Mirror: Attacked By Trump, Insurers Tout Economic Impact In CT, Other States
Under attack from President Donald Trump, the nation’s insurers hit back Monday with a report aimed at showing the industry’s impact on the U.S. economy and the economies of every state, including Connecticut where it said health insurers are a $1.15 billion business. The study, released by America’s Health Insurance Plans, or AHIP, said the health insurance industry employs 9,544 people in Connecticut and their average annual salary is $120,366, much higher than in all other states. (Radelat, 10/16)

In Areas Where Hospitals Are 'Economic Anchors,' Repeal Threatens More Than Just Health Care Coverage

Across the country, the health care industry has become a ceaseless job producer. But especially in rural areas where the options are more limited, changing the Affordable Care Act could disrupt already fragile economies.

The New York Times: Deep In Trump Country, A Big Stake In Health Care
Marjorie Swanson was the first in the family to get a job at Baxter Regional Medical Center after moving to this rural Ozark town from Chicago’s South Side in 1995. A year later, her husband was hired by the maintenance department. Six months ago, their daughter snagged a job as a pharmacy technician and shares the night shift with her fiancé, who works in housekeeping. Their son started in 2013 as a biomedical technician, repairing medical equipment. He was introduced to his wife by two nurses there: one who is now his mother-in-law and Beverly Green, an aunt through marriage. (Cohen, 10/16)

Administration News

Drug Czar Nominee Withdraws Following Reports That He Helped Undermine DEA's Power On Opioids

President Donald Trump says in a tweet that Rep. Tom Marino (R-Pa.) withdrew his name from contention to be the next drug czar after a Washington Post and "60 Minutes" report revealed deep ties to the drug industry. Many lawmakers voiced strong objections to the nomination and Sen. Claire McCaskill (D-Mo.) called for a repeal of a controversial law pushed by Marino that hindered the Drug Enforcement Administration's ability to regulate opioids.

Politico: Trump Says Marino Has Withdrawn As Drug Czar Nominee
President Donald Trump on Tuesday announced that Rep. Tom Marino has withdrawn his name from consideration to become the administration's next drug czar, after CBS' "60 Minutes" and The Washington Post reported that the lawmaker championed a law that hobbled federal efforts to combat the abuse of opioids." Rep.Tom Marino has informed me that he is withdrawing his name from consideration as drug czar. Tom is a fine man and a great Congressman!" Trump tweeted on Tuesday morning. (10/17)

CBS News: Tom Marino Out As Trump's Drug Czar Nominee After "60 Minutes" Report
The announcement came following a joint investigation by CBS' "60 Minutes" and The Washington Post on the opioid crisis. The report found that Congress helped disarm the Drug Enforcement Administration during the height of the crisis. Marino, R-Pennsylvania, was the chief advocate for the bill at the center of the investigation. (10/17)

CNN: Trump Tweets That Marino Is Out For Drug Czar
The congressman's withdrawal comes after a joint CBS "60 Minutes" and Washington Post report revealed that Marino took nearly $100,000 from the pharmaceutical lobby while sponsoring a bill that made it easier for drug companies to distribute opioids across American communities and thwart the Drug Enforcement Agency. (10/17)

Stat: McCaskill Seeks To Repeal Law That Hampered DEA Enforcement
Sen. Claire McCaskill (D-Mo.) on Monday said she would introduce legislation to repeal a 2016 law that hampered the Drug Enforcement Administration’s ability to regulate opioid distributors it suspects of misconduct. The new bill would rescind a little-noticed law championed last year by Rep. Tom Marino (R-Pa.), who President Trump has since nominated to serve as “drug czar” and director of the Office of National Drug Control Policy. (Facher, 10/16)

Pharmaceuticals

Pharma Is Still 'Getting Away With Murder,' Trump Says Hinting At Intent To Bring Down Costs

President Donald Trump railed against high drug prices, reiterating a talking point from the campaign, but though he promised to get prices "way down," he offered little detail on how to accomplish that.

The Hill: Trump Promises Action On Drug Prices
President Trump on Monday attacked prescription drug companies and hinted at taking action to bring down rising drug prices. “We are going to get prescription drug prices way down because the world is taking advantage of us,” Trump said during a wide-ranging press conference. (Weixel, 10/16)

In other pharmaceutical news —

The New York Times: Patents For Restasis Are Invalidated, Opening Door To Generics
A federal judge in Texas invalidated four key patents for the dry-eye treatment Restasis on Monday, dealing a blow to its manufacturer, Allergan, which had sought to protect its patents by transferring them to a Native American tribe. The ruling, by United States Circuit Judge William C. Bryson of the Eastern District of Texas, does not mean that generic versions of the drug will be available soon, however. Allergan said that it would appeal the decision, and the Food and Drug Administration has not yet approved copycat versions of the drug. (Thomas, 10/16)

Bloomberg: Drugmakers Are Planning To Start A Phase 2 Trial To Cure Peanut Allergy
Aimmune Therapeutics Inc. is teaming with Regeneron Pharmaceuticals Inc. in hopes of developing a cure for peanut allergies. Aimmune, based in Brisbane, California, specializes in food allergy treatments and has been developing a desensitizing therapy, AR101, to protect peanut allergy sufferers against reactions from accidental exposures. By combining AR101 with Regeneron’s inflammation-inhibiting drug Dupixent, the companies are seeking to increase protection enough so patients stop reacting to peanuts even after treatment ends. (Chen, 10/16)

Medicaid

Walden Says Democrats Are Failing To Negotiate On Funding For Children's Insurance Plan

Democrats have objected to Republicans' plans for securing the money to fund the Children's Health Insurance Program, but Rep. Greg Walden (R-Ore.), who chairs the House Energy and Commerce Committee, says Democrats have not made any counteroffers.

CQ: House Struggling With Dispute Over Children's Health Offsets
Lawmakers are still fighting over how to pay for funding for the Children’s Health Insurance Program two weeks after committees in both chambers approved separate bills. House Energy and Commerce Chairman Greg Walden, R-Ore., called again Monday on his Democratic colleagues to offer suggestions for offsets so the House could pass its committee-approved CHIP bill (HR 3921) and a separate bill to fund community health centers and other public health programs (HR 3922). (Raman, 10/16)

Federal Medicaid Officials Approve Extension Of Kansas' Managed Care Program For One-Year

The Obama administration had denied the extension and said the program did not have sufficient oversight. Kansas officials submitted a corrective action plan and the Trump administration has approved that.

KCUR: Federal Officials Approve One-Year Extension Of KanCare Program 
The federal agency that oversees Medicaid has agreed to a one-year extension of Kansas’ $3.2 billion KanCare program, which provides managed care services to the state’s Medicaid population. In a letter dated Friday, the Centers for Medicare and Medicaid Services said the temporary extension would allow Kansas to continue the privately managed program, which was set to expire on Dec. 31. The Obama administration had denied the state’s request for an extension, saying the program lacked sufficient oversight. CMS’ approval requires Kansas to abide by a corrective action program to address that and other issues. (Margolies, 10/16)

Wichita (Kan.) Eagle: Feds Let Kansas Medicaid Program Continue For 12 Months
When the federal agency initially denied the extension in January, investigators identified a series of shortcomings with the program’s administration, including diminished oversight by the state and a failure to provide beneficiaries with clear and consistent information. The state put in place a corrective action plan to address the findings, which the Centers for Medicare and Medicaid Services accepted in May. As part of the extension, Kansas must continue implementing its corrective action plan. (Shorman, 10/16)

Modern Healthcare: CMS Approves Obama-Rejected Kansas Waiver
The CMS denied the extension request during the Obama administration over concerns that managed-care organizations had inadequate state oversight. The federal agency also said the state hadn't responded to public comments on the waiver, and there wasn't sufficient information about provider networks. (Dickson, 10/16)

Kansas City Star: Federal Officials Approve Extension For Kansas’ $3 Billion KanCare Program
“Our focus on outcomes for patients is resulting in better all-around care for patients across the state,” [Lt. Gov. Jeff] Colyer said in a statement. “We look forward to continuing to take an innovative and conservative approach to healthcare that controls costs and results in better health outcomes for Kansans.” Sean Gatewood, co-administrator of the KanCare Advocates Network, a group that represents patients and healthcare providers, said he was glad that the extension was granted. However, Gatewood said that the “state needs to now work on addressing the foundational problems” with the program over the next year. (Lowry, 10/16)

Women’s Health

Case Of Undocumented Pregnant Girl Part Of Larger Administration Trend To Interfere With Abortions

For the last seven months, the Health and Human Services Department has intervened to prevent abortions sought by girls at federally funded shelters, even in cases of rape and incest and when the teen had a way to pay for the procedure. In other news, Senate Majority Leader Mitch McConnell (R-Ky.) says he'll bring the 20-week abortion ban to the floor, a look at how the administration's birth control mandate will affect consumers and teens speak up for pregnancy prevention programs.

Politico: Undocumented Pregnant Girl In Texas Tests Trump Policy To Stop Abortions
The Trump administration is preventing an undocumented, pregnant teenager detained in a Brownsville refugee shelter from getting an abortion in a policy shift with big implications for hundreds of other pregnant, unaccompanied minors held in such shelters. She is not the first to be stopped, according to advocates who work with undocumented teenagers. (Rayasam, 10/16)

The Hill: McConnell: 20-Week Abortion Ban Will Get Senate Vote 
Senate Majority Leader Mitch McConnell (R-Ky.) said on Monday that the Senate will vote on a 20-week abortion ban, though he didn't specify when the legislation will come up. "It's supported by virtually all of my members, and we expect to have a vote on it at some point," McConnell told reporters during a press conference in the Rose Garden with President Trump. (Carney, 10/16)

Reveal: Just Say Know: Teens Say Pregnancy Prevention Programs Are Worth Keeping
Over the next two years, with a dozen sessions, these students will act out roles focused on how to say no to sex, how to talk to their parents about problems and how to keep healthy and safe. But in July, the U.S. Department of Health and Human Services suddenly pulled the plug on this project and 80 others funded by the government’s Teen Pregnancy Prevention Program, as first reported by Reveal from The Center for Investigative Reporting. (Kay, 10/16)

Public Health And Education

Talking About Guns Can Be Politically Murky Ground For Doctors, But Experts Say It's Necessary

And many doctors already think they should be addressing the topic with patients.

Los Angeles Times: Doctors Urged To Make A Public Commitment To Talk To Their Patients About Guns And Gun Safety
As guardians of health and gatekeepers to the world of medicine, primary care doctors are expected to plunge dauntlessly into the most delicate topics with their patients. Now, in the wake of the worst mass shooting in recent U.S. history, a new campaign is challenging these physicians to talk to their patients about guns. As doctor questions go, it’s right up there with inquiring about risky sexual behavior and a notch stickier than drug or excess alcohol use and obesity. Asking about a patient’s guns strays into prickly political territory. It risks backlash from hard-line gun rights advocates. And in small or rural communities, where guns are often plentiful and medical care is scarce, it may scare a few patients off. (Healy, 10/16)

After Fixing Diversity Problem, Researchers Found Normal Brain Looks Different Than They Thought

The study originally had a disproportionately high number of kids with parents who have an advanced degree. Weighting the data to make it more representative offered insights of what the brain actually looks like. In other public health news: HPV, fertility and sleep.

NPR: What Does A Normal Brain Look Like?
Brain imaging studies have a diversity problem. That's what researchers concluded after they re-analyzed data from a large study that used MRI to measure brain development in children from 3 to 18. Like most brain imaging studies of children, this one included a disproportionate number of kids who have highly educated parents with relatively high household incomes, the team reported Thursday in the journal Nature Communications. (Hamilton, 10/16)

The New York Times: 7 Million American Men Carry Cancer-Causing HPV Virus
The incidence of mouth and throat cancers caused by the human papilloma virus in men has now surpassed the incidence of HPV-related cervical cancers in women, researchers report. The study, in the Annals of Internal Medicine, found that 11 million men and 3.2 million women in the United States had oral HPV infections. Among them, 7 million men and 1.4 million women had strains that can cause cancers of the throat, tongue and other areas of the head and neck. (Bakalar, 10/16)

The New York Times: Raising Concerns About A Widely Used Test To Measure Fertility
Michele K. Bourquin, an account executive from Atlanta, was 36 and divorced when she first looked into freezing her eggs. “I knew I wasn’t getting any younger, and my eggs were aging,” Ms. Bourquin said. So she visited a doctor who gave her a blood test that’s often used to check a woman’s egg supply. It works by looking for anti-Müllerian hormone, or AMH, which is secreted by growing follicles, the sacs that house each egg. (Caron, 10/16)

NPR: How To Fall Asleep And Why We Need More
The National Sleep Foundation recommends an average of eight hours of sleep per night for adults, but sleep scientist Matthew Walker says that too many people are falling short of the mark. "Human beings are the only species that deliberately deprive themselves of sleep for no apparent gain," Walker says. "Many people walk through their lives in an underslept state, not realizing it." (Gross, 10/16)

State Watch

State Highlights: Calif. Gov. Signs Key Health Bills; New York Issues Updated, Emergency Guidance For Home Health Care Employers

Outlets report on news from California, New York, Oregon, Texas, Georgia, Connecticut, Puerto Rico, West Virginia, Ohio, Illinois and Florida.

California Healthline: Governor Inks Support For Some Key Health Bills, Nixes Others
Wielding his pen, Gov. Jerry Brown has reinforced the Affordable Care Act, stood up to pharmaceutical companies and boosted testing for childhood lead poisoning. Facing a Sunday deadline to approve or reject measures passed by the legislature this year, Brown weighed in on some key health care bills, including measures to protect Californians who buy insurance for themselves. (Bartolone and Ibarra, 10/16)

Modern Healthcare: New York Issues Emergency Regs On How It Pays Home Care Workers For 24-Hour Shifts
The state Department of Labor has issued an emergency update to its minimum-wage regulations that reinforces its longstanding guidance to home health care employers to pay workers for just 13 hours of a 24-hour shift. The policy, known as the '13-hour rule,' helps control state spending on home care, which accounts for about 11% of the Medicaid budget. But it conflicts with three New York appellate court decisions issued in April and September that threw the home care industry into a panic. The rulings said home health aides who don't live full time with their elderly or disabled clients should be paid for every hour of a 24-hour shift. (Lewis, 10/16)

The Oregonian: Oregon Voters Will Decide Whether To Overturn $340 Million In Health Care Taxes 
An effort to overturn part of Oregon's $550 million health care tax plan qualified for the ballot on Monday, which means voters will decide whether to keep the taxes in a Jan. 23 special election. State lawmakers passed the taxes earlier this year to raise money so they could balance the state's Medicaid budget and stabilize the individual insurance market. Oregon's health agency faced a budget gap due to reasons including the long-planned ramp down of federal support for states that expanded Medicaid under the Affordable Care Act. (Borrud, 10/16)

The New York Times: On Health, De Blasio Focuses On Crises And Inequality
Four years ago, Bill de Blasio, then the city’s public advocate and a mere mayoral hopeful, took part in a rally in Midtown Manhattan to protest the imminent closing of Long Island College Hospital. Surrounded by dozens of singing and cheering hospital workers, he chanted “No Hospital, No Peace,” and helped block the entrance to the offices of the chancellor of the State University of New York. The police arrested Mr. de Blasio and charged him with disorderly conduct. (Santora, 10/16)

The Washington Post: A 2-Year-Old’s Kidney Transplant Was Put On Hold — After His Donor Father’s Probation Violation
A father in Georgia who had prepared to donate a kidney to his 2-year-old son said last week that he is being forced to wait after a recent stint in county jail. Anthony Dickerson's son, A.J., was born without kidneys, and Dickerson, who is a perfect match, was ready to donate one of his, he told NBC affiliate WXIA in Atlanta. He was arrested days before the planned transplant but released from Gwinnett County Jail this month to undergo surgery. Now, he said, the transplant center at Emory University Hospital has put it on hold — in a case that one expert called befuddling. (Bever, 10/16)

The CT Mirror: Malloy Counters With ‘Lean, No-Frills, No-Nonsense’ Budget
In a bid to end Connecticut’s budget stalemate and persuade legislators to abandon a legally questionable deferral of contributions to the state’s underfunded pension system, Gov. Dannel P. Malloy unveiled his fourth budget proposal for the new biennium Monday. It asks lawmakers to reduce tax increases by accepting deeper cuts to town aid, education and social services. (Phaneuf, Pazniokas and Rabe Thomas, 10/16)

Georgia Health News: An Alarming Trend: Premature Births Go Up In Georgia
Georgia’s preterm birth rate rose in 2016 after years of decrease, a disturbing trend that is mirrored by national data, state officials said Monday. Preterm birth is when a baby is born too early, before 37 weeks of pregnancy have been completed. It’s also called premature birth. (Miller, 10/16)

The Washington Post: Puerto Rican Families Draw Water From Superfund Site
Every 10 minutes or so, a truck or a van pulled up to the exposed spigot of an overgrown well, known as Maguayo #4, that sits not far from a bustling expressway and around the corner from a Krispy Kreme doughnut shop. Fencing around the area had been torn open, and a red and white “Peligro” sign, warning of danger, lay hidden beneath debris and dense vegetation. One after another, people attached a hose to draw water for bathing, washing dishes and, in some cases, drinking. They filled buckets, jugs, soda bottles. (Hernandez and Dennis, 10/16)

Kaiser Health News: On Back Roads Of Appalachia’s Coal Country, Mental Health Services Are As Rare As Jobs
Every other month, Tanya Nelson travels 32 miles from the heart of Appalachia’s coal country for an appointment with the nearest psychiatrist for therapy and to renew prescriptions. But the commute, which should take less than an hour through the winding mountain roads of southern West Virginia, consumes her entire day. Nelson, 29, needs treatment for bipolar disorder, depression and anxiety. But she does not drive, so she must use a van service to keep her appointments. It makes numerous stops along the highway, picking up other travelers, and usually doesn’t return to her home in New Richmond, W.Va., until day’s end. (Connor, 10/17)

Cleveland Plain Dealer: BioEnterprise To Oversee Struggling Global Center For Health Innovation
BioEnterprise, which promotes and nutures healthcare companies and bioscience technologies, will oversee marketing, promotion and tenants at the struggling Global Center for Health Innovation. The nonprofit company was retained Monday by the Cuyahoga County Convention Facilities Development Corp., the nonprofit organization that oversees the Huntington Convention Center and Global Center. (Farkas, 10/16)

Reuters: U.S. Nursing Home Chain Faces Landlord Showdown Over Default
The fate of one of the largest U.S. nursing home operators, HCR ManorCare, will reach a critical court deadline on Thursday in a battle over months of unpaid rent, a growing problem in an industry where eviction would put thousands of elderly out on the street. Many nursing home chains spun off their properties to real estate companies over the last decade to unlock value. Now those landlords need to deal with operators behind on their rent without harming thousands of elderly residents. (Rucinski, 10/16)

Editorials And Opinions

Thoughts And Analysis: Trump On Health Care ... Some Say 'Vandalism' And 'Cruel Sabotage,' But What About His Supporters?

Opinion writers offer a variety of criticisms of President Donald Trump's recent executive order loosening some health insurance restrictions and his decision to stop federal payments to support the Affordable Care Act's cost-sharing reductions.

USA Today: Trumpcare Is Health Care Vandalism Pure And Simple
President Trump isn't afraid to use his bully pulpit, or become an outright bully, to let us know what's important to him. We don’t see moral leadership – quite the contrary. Instead he revels in mocking senators, NFL football players, public officials in disaster zones, morning TV hosts, and news outlets that bring him bad publicity. (Andy Slavitt, 10/16)

The New York Times: What Trump Supporters Hear About Health Care
Since Obamacare became law, it’s been subject to one challenge after another. Some challenges have truly been existential, like the 2012 Supreme Court case and this year’s repeal effort in Congress. Others have had the potential to do damage without undermining the entire law. President Trump’s actions last week are in the second category. (David Leonhardt, 10/16)

St. Louis Post-Dispatch: Trump Undermines His Own Party By Cruelly Sabotaging Affordable Care Act
By scrawling his name a couple of times on Thursday, President Donald Trump added $194 billion to the deficit projection. He increased health care premiums for 12 million working poor and middle-class families by 20 percent and made health insurance unaffordable for 1 million of them. He further undermined the health care marketplaces and legalized cheap, bare-bones insurance sold across state lines. With two executive orders, Trump made the private insurance side of the Affordable Care Act — the part designed for working people — more likely to collapse. Trump would have been smart to recall the Pottery Barn Rule that then-Secretary of State Colin Powell applied to the 2003 Iraq invasion: “You break it, you own it.” (10/16)

Los Angeles Times: Trump Doesn't Know It, But His Attempt To Blow Up Obamacare Could Help California — And Other States
Trump’s lack of understanding of America’s healthcare system appears to be almost infinite, so it’s hardly surprising that he doesn’t grasp the complexities of the cost-sharing reduction payments. But the misunderstandings extend to congressional Republicans, and even Democrats.The truth is that Trump’s action could lead to more Americans receiving subsidized health coverage. It could also produce a windfall for states including California. (Michael Hiltzik, 10/16)

The Des Moines Register: America Still Awaits Trump's 'Great' Health Plan
During the 2016 presidential campaign, Donald Trump repeatedly vowed to “make America great again" if elected. Many voters were never clear on what exactly that meant. After a Republican-controlled Congress failed to repeal the Affordable Care Act this year, the frustrated president said he would work with Democrats to create “great” health care for Americans. When he took steps on Thursday to undermine Obamacare, he again pledged to deliver a “great” plan. (10/16)

Tampa Bay Times: Trump Uses Americans' Health Care As Bargaining Chip
Unable to persuade Congress to kill the Affordable Care Act, President Donald Trump appears determined to do the dirty work himself. The president's unilateral actions are aimed at driving up premiums, steering healthy people away from the federal marketplace and ensuring his inaccurate description of the law as a nightmare comes true. Reducing Americans' access to health care as a political maneuver is a cynical, callous act by a president who once promised better coverage that would be available and affordable to all. (10/16)

The Washington Post: How States Can Save The Obamacare Exchanges
While the president’s decision appears to have been designed to disrupt the Affordable Care Act exchanges, states now have an opportunity to restore order to their insurance markets.Specifically, states can step in to make the subsidy payments themselves — and then turn around and sue the federal government for reimbursement. The law is on their side, and while it might take months or years, the states are highly likely to be repaid in full, plus interest. In the meantime, the backstop provided by the states will encourage insurers to stay on the exchanges rather than rushing to the exits. (Daniel Hemel, 10/16)

The Washington Post: Health Insurance Is Good Not Just For Individuals But For Democracy
For the past seven months, Americans have watched and weighed in as Congress considered the continued existence of the Affordable Care Act (ACA). Last Thursday, the Trump administration announced that the government would stop subsidizing insurers for making premiums and deductibles more affordable for low-income customers. Most of the discussion to date has been about whether these plans are good for families, and if so, which ones. But what if insurance had another value, beyond protecting individuals from financial and health risks? What if it was good for democracy? (Emily Nacol, 10/16)

Bloomberg: Single-Payer Mania Is Actually Helping Republicans
President Donald Trump's two-step gutting of the Affordable Care Act, ending cost-sharing for insurance companies, and allowing them to cover fewer medical conditions should be a political nightmare for Republicans. That’s because the White House has miscalculated, apparently falling for the fantasy that it can sabotage Obamacare and then successfully pin the political blame for lost coverage on President Barack Obama and the Democratic Party. Trump and some other Republicans have developed “Obamacare is imploding” as a talking point, trying to persuade Americans that the Affordable Care Act is collapsing under its own weight. (Albert R. Hunt, 10/16)

CNBC: Medicaid Is The Biggest Winner In Trump's Obamacare Subsidy Cuts
The subsidies offered to low-income individuals to purchase insurance on the individual market and to insurance companies to support this benefit under the ACA, provide the necessary hand up needed to help pull individuals up our prosperity ladder continually. Without this hand, the ladder becomes splintered and broken, forcing those affected to take an inadequate path—after all other options have been exhausted. ... Without the subsidies, Medicaid will remain the best and often only realistic option for many Americans. The recently eliminated ACA subsidies supported working Americans and their families to move up the income ladder with a helping hand. Cutting off the subsidies cuts off the hand. (Jim Rickards, 10/17)

St. Louis Post-Dispatch: Threatened Medicaid, CHIP Programs Are Vital To Our Health Care System
[N]ow looms another quiet threat to these hospitals and our neediest citizens. The Medicaid disproportionate share hospital (DSH) program provides crucial support to hospitals that treat patients whose care is not fully covered by third-parties like Medicaid, and it is essential to keeping hospitals that treat low-income patients open and running. Congress failed to act to renew the DSH program before October 1 allowing massive cuts. Missouri will be hit particularly hard, facing a devastating $2.2 billion in cuts through 2025 after having already passed on nearly $2 billion per year in Medicaid funds for working low-income families. (Judy Baker, 10/16)

Perspectives: Outrage Aimed At The Government's Role In The Opioid Epidemic

A recent investigation by The Washington Post and 60 Minutes has triggered a serious scolding in editorial pages.

The Washington Post: The Government’s Shameful Role In The Opioid Crisis
Multiple, glaring government breakdowns are documented in the revealing investigation of the opioid-overdose epidemic by The Post and CBS’s “60 Minutes.” The report exposed weakening federal enforcement of drug distribution; corrosive industry lobbying that crippled that enforcement; and a dysfunctional Congress and White House at a time when a debilitating scourge swept the country. (10/16)

Viewpoints: How Artificial Intelligence Changes Medical Practice; Birth Control Vs. Religious Liberty

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

Stat: The Rise Of Artificial Intelligence Means Doctors Must Redefine What They Do
This view of post-human medicine may seem repulsive to those who see medicine as uniquely human. Some of that view is grounded in arrogance — surely nothing could ever do what we do as well as us. But as medicine confronts its limitations, modern providers are faced with a paradox: We want the precision and specificity of the machine yet we want to believe that we can still do it all with our hands and eyes and ears. We probably can’t. So we need to start redefining what the human doctor of the 21st century will do. (Bryan Vartabedian, 10/16)

San Antonio Press-Express: Religious Discrimination The Sweet Spot For Undoing Birth Control
After a long history of public debate about women’s access to contraception, a University of Texas/Texas Tribune Poll conducted just last year found the right to use contraception essentially a settled issue. Now the Trump administration’s high-profile action in the name of religious liberty has introduced conflict into an area where before there had been consensus. (Jim Henson and Joshua Blank, 10/16)

Los Angeles Times: Patients Face Tough Choices When A Healthcare Provider Calls It Quits
There are nearly 30 million people with diabetes in the United States. About 90,000 of them were just thrown a curve ball. Johnson & Johnson announced that it’s closing its Animas subsidiary and getting out of the insulin-pump business, leaving the field primarily to a single large competitor, Medtronic, which will control roughly 85% of the market. (David Lazarus, 10/17)

The New York Times: How A Healthy Economy Can Shorten Life Spans
The health of a nation’s economy and the health of its people are connected, but in some surprising ways. At times like these, when the economy is strong and unemployment is low, research has found that death rates rise. At least, in the short term. In the long term, economic growth is good for health. What’s going on? (Austin Frakt, 10/16)