KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Political Cartoon: 'Leg It Out?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Leg It Out?'" by Mike Luckovich, Atlanta Journal-Constitution.

Here's today's health policy haiku:

WHEN IT SEEMS TO GOOD TO BE TRUE ...

History of fraud
And abuse plague health plans that
President Trump touts.

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Summaries Of The News:

Health Law

McConnell Open To Vote On Health Plan, But Says 'We Need A Bill The President Will Actually Sign'

Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) introduced legislation last week to stabilize the Affordable Care Act's marketplaces, but despite support from a large number of lawmakers, President Donald Trump has run hot and cold on the measure.

The New York Times: McConnell Signals Willingness To Hold Vote On Health Deal If Trump Approves
Senator Mitch McConnell of Kentucky, the majority leader, said on Sunday that he would be willing to bring a bipartisan proposal to stabilize health insurance markets up for debate if President Trump signaled his support. “If there’s a need for some kind of interim step here to stabilize the market, we need a bill the president will actually sign,” Mr. McConnell said on CNN’s “State of the Union.” “And I’m not certain yet what the president is looking for here, but I’ll be happy to bring a bill to the floor if I know President Trump would sign it.” (Fandos, 10/22)

Politico Pro: Trump Stokes Hopes Of Obamacare Repeal — Setting Up Senate For Another Failure
Repeatedly claiming that Republicans have the votes to repeal major parts of Obamacare early next year, Trump is stoking expectations that the GOP can fulfill its seven-year pledge before the 2018 midterm elections — a promise that Republicans once again might not be able to keep. The Senate, Trump says, will have the 50 votes needed to enact the bill known as Graham-Cassidy, the last of a series of repeal bids that went down in flames this summer and fall. (Haberkorn, 10/20)

The Hill: Schumer Calls On McConnell To Send Bipartisan Health Care Bill To Floor This Week 
Senate Minority Leader Charles Schumer (D-N.Y.) called on Senate Majority Leader Mitch McConnell (R-Ky.) Sunday to bring a bipartisan short-term ObamaCare stabilization deal to the Senate floor this week, despite uncertain support from President Trump. "This is a good compromise. It took months to work out. It has a majority. It has 60 senators supporting it, we have all 48 Democrats, 12 Republicans. I would urge Senator McConnell to put it on the floor immediately, this week," Schumer told NBC's Chuck Todd on "Meet the Press" on Sunday. (Manchester, 10/22)

Politico: Schumer: Bipartisan Health Care Bill 'Has A Majority'
Senate Minority Leader Chuck Schumer said Sunday that the Alexander-Murray bipartisan health care bill has support from a majority of senators, and he urged Senate Majority Leader Mitch McConnell to bring it to the floor "immediately." “This is a good compromise. It took months to work out. It has a majority. It has 60 senators supporting it. We have all 48 Democrats, 12 Republicans," Schumer (D-N.Y.) said on "Meet the Press" on NBC. "I would urge Senator McConnell to put it on the floor immediately, this week. It will pass and it will pass by a large number of votes.” (Morin, 10/22)

The Associated Press: Top Dems Nix White House Demands To Alter Health Care Deal
Top Senate Democrats rejected White House demands Friday to add provisions weakening the Obama health care law to a bipartisan deal on steadying unsettled insurance markets. The compromise already faced an uphill path and this was the latest blow. Senate Minority Leader Chuck Schumer, D-N.Y., said the Trump administration was involved in the negotiations that produced the accord and "should support it instead of floating other ideas that would further the sabotage both parties are trying to reverse." (Fram, 10/20)

The Hill: Mulvaney: 'Good Chance' To Get ObamaCare Deal
White House budget chief Mick Mulvaney said Sunday there is a "good chance" to get a deal on ObamaCare insurer payments. During an interview on CBS's "Face The Nation," Mulvaney was asked about President Trump's position on the bipartisan health-care deal. (Savransky, 10/22)

IRS Will Enforce Health Coverage Requirement Under ACA

Despite the individual mandate being a primary target for Republicans, the Trump administration says it will reject tax returns that do not have complete information about health care coverage filled in. Meanwhile, GOP lawmakers are trying to weaken the mandate through legislation.

The New York Times: I.R.S. Says It Will Reject Tax Returns That Lack Health Insurance Disclosure
Despite President Trump’s pronouncements, not only is Obamacare not dead, there are signs that his administration is keeping it alive. In the latest signal that the Affordable Care Act is still law, the Internal Revenue Service said this week that it is taking steps to enforce the most controversial provision: the tax penalty people face if they refuse to obtain health insurance. (Abelson, 10/20)

The Hill: GOP Redoubles Efforts To End ObamaCare Mandate
The GOP is redoubling its efforts to eliminate ObamaCare’s individual mandate, a step that would be yet another blow to the health-care law. They are doing so even as key Senate Republicans seek a bipartisan deal that could strengthen the law by extending critical payments to insurers that help low-income people afford their copays and deductibles. (Weixel, 10/22)

Change In Auto-Enrollment Policy May Trap Millions Of Consumers Into Plans They Don't Want

Under the Obama administration, consumers were auto-enrolled in their plans, but then sent a notice that they can and should shop around for better or cheaper coverage. This year, the auto-enrollment process won't happen until it's too late to make a change. Meanwhile, groups are launching outreach efforts as open enrollment season nears.

The Washington Post: ACA Enrollment Schedule May Lock Millions Into Unwanted Health Plans
Millions of Americans with insurance through the Affordable Care Act could find themselves locked into health plans they do not want for the coming year because of the Trump administration’s schedule for the enrollment season that starts in less than two weeks. The complication arises when people who already have health plans under the law are automatically re-enrolled in the same plan. In the past, a few million consumers each year have been auto-enrolled and then were sent government notices encouraging them to check whether they could find better or more affordable coverage. (Goldstein, 10/20)

The Wall Street Journal: Health Advocates Gear Up For Open Enrollment
Consumer groups and some state officials, facing new pressure to show the Affordable Care Act remains in place after President Donald Trump declared it dead, have begun launching urgent outreach programs to sign people up for health coverage during the coming open-enrollment period. The ACA’s fifth open-enrollment season, which this year runs Nov. 1 through Dec. 15, may be lackluster compared with previous years because the administration has cut the time period in half and cut about $116 million in funding for outreach and advertising. As a result, advocacy groups are mounting on-the-ground efforts aimed at telling consumers they can still get coverage and subsidies despite recent efforts to undo the law. (Armour and Hackman, 10/22)

Los Angeles Times: Obamacare Enrollment Starts Nov. 1. Here's What You Need To Know
Choosing the right health insurance plan can be a cumbersome process, and this year’s political back-and-forth over Obamacare has made it seem even more confusing. For months, executive orders and congressional debates have swirled around the law, officially called the Affordable Care Act. President Donald Trump has declared the law “dead” — but it’s still in effect, and open enrollment for plans on the Obamacare exchange begins Nov. 1. (Schencker, 10/20)

Meanwhile, in the states —

The Philadelphia Inquirer/Philly.com: As Trump Undercuts Affordable Care Act, Democrats Go On Offense In Pa., N.J.
After years of absorbing attacks over the Affordable Care Act, its rocky roll-out and early flaws, Democrats are on the offensive. With Republicans now holding the White House and Congress, and President Trump taking steps to undercut the law, Democrats are pounding GOP incumbents over the results, particularly in the Philadelphia area. A potent example came earlier last week, when Pennsylvania and New Jersey regulators approved steep rate increases in the states’ insurance markets for individuals, a response, officials and insurers both said, to Trump’s decision to end roughly $7 billion in federal payments intended to hold down costs. (Tamari, 10/20)

Nashville Tennessean: Nashville, Here Are Your Affordable Care Act Options
Cigna and Oscar Health are the only two insurance companies offering Affordable Care Act health plans in Nashville next year. While it might seem like options are limited, it’s worth bearing in mind that Nashville was at risk of having no carriers offering 2018 plans. Thanks in part to the leadership of government officials, Middle Tennessee is fortunate to have two, given the turmoil in healthcare today. (Tolbert, 10/22)

The Baltimore Sun: Maryland Insurance Administration To Consider Insurance Rate Hikes After Trump Cuts Obamacare Subsidies
The Maryland Insurance Administration will hold a public hearing Monday to consider new premium rate hikes proposed by health insurance companies in response to the Trump Administration’s decision to eliminate subsidies that help low-income people pay out-of-pocket expenses. CareFirst BlueCross BlueShield and Kaiser Permanente of the Mid-Atlantic States have requested permission to further increase rates on individual plans sold under Obamacare before enrollment opens on Nov. 1. (McDaniels, 10/20)

Concord Monitor: Alexander-Murray Bill Could Help N.H. Reinsurance Program
In September, the Commissioner of the New Hampshire Insurance Department, Roger Sevigny, sent the chairman of the U.S. Senate health committee, Lamar Alexander, a request for action. With premiums on New Hampshire’s individual insurance market predicted to rise amid a new swell of patients and rising treatment costs, Sevigny’s department was pursuing what they called a viable solution: a state-wide reinsurance program. ... This week, Alexander delivered. Included in the Tennessee Republican’s health care bill are changes to Section 1332, which would allow New Hampshire to use savings from the federal funds it usually receives for tax credits and insurance subsidies to instead be invested into the reinsurance program. (DeWitt, 10/20)

Trump's Promise Of Inexpensive Health Plans Comes With A Dark Underbelly

The plans President Donald Trump is touting have a long history of vulnerabilities to fraud and abuse. The problems are described in dozens of court cases and enforcement actions taken over more than a decade by federal and state officials who regulate those types of plans. Meanwhile, the case against Trump's move to cut off subsidies goes to court on Monday.

The New York Times: Cheaper Health Plans Promoted By Trump Have A History Of Fraud
In signing a recent executive order, President Trump promised that millions of Americans could soon obtain “great, great health care” through inexpensive plans that offer consumers options they had been denied under the Affordable Care Act. But these health plans, created for small businesses, have a darker side: They have a long history of fraud and abuse that have left employers and employees with hundreds of millions of dollars in unpaid medical bills. (Pear, 10/21)

Georgia Health News: ‘Catastrophic’ Policies Part Of Sweeteners In Latest Health Care Bill
For most people, the biggest attraction in the bipartisan health care bill in the Senate is the renewal of federal cost-sharing payments to insurers, which President Trump recently cut off.  ...The Senate bill would expand the use of so-called “catastrophic’’ health plans for individuals. Currently only young adults up to age 30 or those who qualify for “hardship waivers’’ can buy them. (Miller, 10/22)

Administration News

Court Grants HHS Time To Release Pregnant Girl So She Can Obtain An Abortion Outside Its Custody

The court blocked an earlier ruling to allow the girl to get an abortion immediately. Now the government has 11 days to release the girl into outside custody, or the matter will return to the courts.

The New York Times: Undocumented 17-Year-Old Must Delay Abortion, Court Rules
The decision by the United States Court of Appeals for the District of Columbia Circuit could put her health at risk, doctors say, especially now that she is about 15 weeks pregnant. “While first-trimester abortion is over 10 times safer than childbirth, the risks gradually increase in the second trimester to those of childbirth,” Dr. Nancy L. Stanwood, the chief of family planning at the Yale School of Medicine, said in an email. Forcing her to wait, she added, “harms her physical health, period.” (Caron, 10/21)

The Associated Press: Immigrant Teen Seeking Abortion Asks Court To Reconsider
Attorneys for a pregnant teen being held in a Texas immigration facility are asking a federal appeals court to reconsider its decision not to order the government to let her obtain an abortion. Lawyers for the 17-year-old on Sunday asked the U.S. Court of Appeals for the District of Columbia to hold another hearing before all the judges on the court. (10/23)

Politico: Teen In Immigration Detention Takes Abortion Fight To Full Appeals Court
"Every additional day she must remain pregnant against her will places a severe strain on J.D., both physically and emotionally. Every additional week the government delays her abortion increases the risks associated with the procedure," the teen's attorneys wrote in the petition for en banc review filed with the D.C. Circuit just after 10 P.M. Eastern Time Sunday. "In a matter of weeks, J.D. will no longer be able to get an abortion at all, and the government will have forced J.D. to have a child against her will." (Gerstein and Rayasam, 10/22)

WBUR: Appeals Court Sets Terms For Abortion For Teen Immigrant
"If a sponsor is secured and J.D. is released from HHS custody to the sponsor, HHS agrees that J.D. then will be lawfully able, if she chooses, to obtain an abortion on her own pursuant to the relevant state law," the judges wrote. But they added if a sponsor is not secured and the minor is not released to a sponsor by Oct. 31, then the matter will return to the courts. (Gonzales, 10/20)

Top EPA Official's Industry-Friendly Moves Undermine Regulations To Protect Public Health

Nancy Beck's efforts to roll back certain rules is part of a broad initiative by the Trump administration to change the way the federal government evaluates health and environmental risks associated with hazardous chemicals.

The New York Times: Why Has The E.P.A. Shifted On Toxic Chemicals? An Industry Insider Helps Call The Shots
For years, the Environmental Protection Agency has struggled to prevent an ingredient once used in stain-resistant carpets and nonstick pans from contaminating drinking water. The chemical, perfluorooctanoic acid, or PFOA, has been linked to kidney cancer, birth defects, immune system disorders and other serious health problems. So scientists and administrators in the E.P.A.’s Office of Water were alarmed in late May when a top Trump administration appointee insisted upon the rewriting of a rule to make it harder to track the health consequences of the chemical, and therefore regulate it. (Lipton, 10/21)

Capitol Hill Watch

States Fret As Congress Dilly Dallies Over CHIP Funding Renewal

Politico takes a look at where things stand and what will happen if funding for the popular program dries up.

Politico: States May Roll Back Children’s Health Coverage Without Money From Congress
Federal funds for the Children’s Health Insurance Program (CHIP) expired Sept. 30, leaving states to come up with short-term fixes to keep their programs going. CHIP, now in its 20th year, primarily covers children from low-income families who earn too much to qualify for Medicaid. The program has long had bipartisan support, but lawmakers — consumed by the fight over Obamacare — blew past a key funding deadline and have been slow to extend new money. (Pradhan and Frostenson, 10/23)

Medicaid

As Medicaid Director Announces Departure, Kansas Delays Details On New Program

Gov. Sam Brownback had promised that state officials would release plans for a new version of the privatized Medicaid program last Friday but that was delayed, and officials surprised reporters with news that the medicaid director was leaving. In other news, Oklahoma doctors likely to feel the pinch of the state budget crisis and Michigan next spring will institute a wellness program.

Wichita (Kan.) Eagle: Kansas Medicaid Director Departing; KanCare Proposal Release Delayed
The state Medicaid director is departing as Kansas prepares to move toward the next version of its privatized program, called KanCare. Mike Randol announced Friday he is leaving, said Angela de Rocha, a KanCare spokeswoman. De Rocha was unable to provide a departure date. The governor’s office said earlier in the week that the state would release its proposal Friday for the next version of KanCare, which serves more than 400,000 people. But de Rocha said the rollout had been delayed for a week. She said the delay was related to legal issues and not to Randol’s departure. (Shorman, 10/20)

The Oklahoman: Oklahoma Doctors Plan For Medicaid Cuts, Staff Layoffs After Budget Remains Stalled
The state faces a $215 million budget deficit after the Oklahoma Supreme Court struck down the $1.50-per-pack cigarette fee. Gov. Mary Fallin called a special session to address the situation, but the Legislature isn't meeting due to lack of consensus on a plan. About $70 million of the missing funds were intended for the Oklahoma Health Care Authority, which administers SoonerCare, the state's Medicaid program. Part of the agency's plan to fill that budget gap includes a 9 percent cut to most providers who accept Medicaid, which would save the state about $28 million — but cost it $40 million in federal funds linked to state appropriations. (Wingerter, 10/23)

Veterans' Health Care

Lawmakers Mull Making VA Choice Program Permanent

The legislation, which the House Veterans' Affairs Committee will discuss Tuesday, would also simplify the program. VA Choice allows veterans to seek care outside the VA system and was created in the wake of the wait-time scandal that plagued the agency.

Modern Healthcare: House​ To​ Examine​ Bill​ That​ Would​ Speed​ Payment​ From​ VA​ Choice​ Program
The House Veterans' Affairs Committee wants to make permanent a program that allows former servicemen to receive care from private providers and speed up payments to participating hospitals. The VA Choice program has been marred by administrative and financing woes since it was enacted via legislation in 2014. The program was created in response to a scandal where some veterans died while waiting months for appointments at VA facilities. Congress and President Donald Trump had to intervene earlier this year to save the program as it was on the verge of running out of money. Despite an emergency infusion of $2.1 billion, the program is still expected to be tapped out by December. (Dickson, 10/21)

In other news —

The Associated Press: More Officers Receive Training To Help Veterans In Crisis
More police officers in Delaware are being trained to help military veterans going through a mental health crisis. The News Journal of Wilmington reported Sunday that a new unit has been formed within the New Castle County Police Department. The Veterans Response Team includes officers who served in the military. It will complement the department’s already existing Crisis Intervention Team. (10/23)

Public Health And Education

In Wake Of Opioid Crisis, An HIV Epidemic Is Brewing -- In Trump Country

And officials say they're not prepared to handle it. In other news, lawmakers want information on a newly controversial law that undermined the DEA's power amid the opioid crisis and health insurers get a slap on the wrist for their role in the epidemic.

Politico: From Opioids To HIV — A Public Health Threat In Trump Country
The next HIV epidemic in America is likely brewing in rural areas suffering under the nationwide opioid crisis, with many of the highest risk communities in deep red states that voted for President Donald Trump. Federal and state health officials say they are unprepared for such an outbreak, and don’t have the programs or the funding to deal with a surge in HIV cases. And given how little screening for HIV there is in some rural counties, they worry it may have already begun. (Ehley, 10/21)

The Washington Post: Senators Demand Information On Drug Law Affecting DEA
More than 30 U.S. senators demanded information Friday on the 2016 law that stripped the Drug Enforcement Administration of its most potent weapon against companies suspected of spilling hundreds of millions of addictive painkillers onto the black market. Thirty-one Democrats and two independents noted that the same law required the DEA and the Department of Health and Human Services to compile a report for Congress on the law’s impact by April 16. Six months later, no report has been submitted. (Bernstein and Higham, 10/20)

Stat: At Opioids Commission Meeting, Insurance Industry Gets A Scolding
Patrick Kennedy, it seemed, had been waiting for a public opportunity to speak directly to the nation’s health insurers. “The historic treatment of addiction and mental illness has been a separate and unequal process,” the former Rhode Island congressman and a member of the president’s opioid commission told a group of insurance executives on Friday. “All of you, as insurers and payers, have treated mental health and addiction as if it’s something other than the rest of medicine.” (Facher, 10/20)

ProPublica: Pressure On Insurance Companies To Consider Role In Opioid Crisis
Rep. Elijah Cummings, D-Md., the ranking member of the House Committee on Oversight and Government Reform, wrote to the companies after an article by ProPublica and The New York Times found that insurance companies sometimes favor cheaper, more addictive opioids over less addictive, but more expensive, alternatives. (Ornstein, 10/22)

And in the states —

Richmond Times-Dispatch: With New Surgical Program, Bon Secours Reduces Opioid Use By 80 Percent
Some patients at Bon Secours Richmond Health System’s St. Mary’s Hospital are now going home two days earlier than they did a year ago after surgery, and are less likely to use opioids for their post-surgical pain. The changes come in light of St. Mary’s Enhanced Recovery Program, launched in August 2016, which has changed the protocols for patients receiving open and laparoscopic colorectal surgery. (O'Connor, 10/22)

The CT Mirror: For Babies With Opioid Withdrawal, A Mom-Centered Approach
In the United States, the number of NAS births grew nearly five-fold between 2000 and 2012 — reaching a total of nearly 22,000 infants. As the number of cases has grown, health care providers across Connecticut and the country have started to focus more on the syndrome, especially since no national standard of care currently exists for screening and treating NAS. (Rigg, 10/23)

Ex-HHS Secretary's Wife Defends Comments About Quarantining HIV Patients As 'Provocative,' 'Rhetorical'

Georgia State Rep. Betty Price (R) made the comments during a meeting about her state's high rate of HIV cases.

The Washington Post: Georgia Lawmaker, Wife Of Ex-HHS Secretary, Says Her Remarks About Quarantining HIV Patients Were Misunderstood
A state lawmaker who has drawn criticism after asking about the legality of quarantining people with HIV has said her comments were misunderstood and intended to be “provocative” and “rhetorical” in a broader conversation about curtailing the virus. Georgia State Rep. Betty Price (R) made the statement Tuesday, at a study committee meeting on barriers to adequate health care. Committee members had been discussing, she later said, why Georgia ranks second in the nation when it came to new HIV cases. (Hui and Wang, 10/22)

The Hill: Price’s Wife On HIV Quarantine Remark: I Was Just Being ‘Provocative’
“What are we legally able to do, and I don’t want to say the quarantine word, but I guess I just said it,” Price says. “Is there an ability, since I would guess that public dollars are expended heavily in prophylaxis and treatment of this condition. So we have a public interest in curtailing the spread. What would you advise, or are there any methods legally that we could do that would curtail the spread?” (Conradis, 10/22)

Politico: Price's Wife Defends AIDS Quarantine Remark As 'Provocative'
On Saturday, Price stressed she has worked in public health for years and had made the comments during a discussion of why there were so many people in Georgia who were not getting treatment and posed a risk of spreading the virus to others. Georgia has one of the highest rates of new HIV infections in the country. (10/22)

Stat: Lawmaker, Wife Of Tom Price, Asks About 'Quarantine' Of People With HIV
Georgia was home to nearly 50,000 people diagnosed with HIV in 2014, and had the second highest rate of new diagnoses among all states the following year, according to the Centers for Disease Control and Prevention. Wortley’s presentation noted that gay black men in metro Atlanta have by far the highest rates of HIV diagnoses in Georgia. AIDS researchers have compared the severity of Atlanta’s epidemic to that of some nations in Africa. (Blau, 10/20)

Fertility Industry Is Booming, But With It Comes Tricky Ethical, Legal Questions

It's an era where people can have a checklist for their perfect baby, and companies can charge high prices to give them just that. But despite the ethical and legal morass the promise of all that brings, the industry remains largely self-regulated.

The Washington Post: Discounts, Guarantees And The Search For ‘Good’ Genes: The Booming Fertility Business
When Julie Schlomer got the news that she was finally pregnant at the age of 43, her thoughts turned to the other mothers. There were three of them in all, complete strangers, but they shared an extraordinary bond made possible by 21st-century medicine and marketing. They were all carrying half-siblings. Under a cost-saving program offered by Rockville-based Shady Grove Fertility, the women split 21 eggs harvested from a single donor — blue-eyed, dark-haired, with a master’s degree in teaching. Each had the eggs fertilized with her partner’s sperm and transferred to her womb. (Cha, 10/21)

Stat: Genetic Testing Of Embryos Is Creating An Ethical Morass
The issue also pokes at a broader puzzle ethicists and experts are trying to reckon with as genetic testing moves out of the lab and further into the hands of consumers. People have access to more information about their own genes — or, in this case, about the genes of their potential offspring — than ever before. But having that information doesn’t necessarily mean it can be used to inform real-life decisions. A test can tell prospective parents that their embryo has an abnormal number of chromosomes in its cells, for example, but it cannot tell them what kind of developmental delays their child might have, or whether transferring that embryo into a womb will lead to a pregnancy at all. Families and physicians are gazing into five-day-old cells like crystal balls, seeking enlightenment about what might happen over a lifetime. Plus, the tests can be wrong. (Joseph, 10/23)

Raising Taxes On Cigarettes Is Working, Which Is Why Industry Is Swarming On State Capitols

“I’d never seen this amount of money being poured into a session in my 17 years here," says the American Cancer Society's Kristin Page-Nei of the failed effort in Montana to increase the state's cigarette tax. In other public health news: peanut allergies, labor, memory training, ankle replacements, UTIs, and more.

The Washington Post: Cigarette Taxes Are The Best Way To Cut Smoking, Scaring Big Tobacco
For more than a decade, Kristin Page-Nei begged Montana lawmakers to raise cigarette prices. As a health advocate for the American Cancer Society, she watched year after year as other states increased their cigarette taxes and lowered their smoking rates. “What they’re doing is saving lives,” she kept saying. Finally, this spring, she helped persuade state senators to raise cigarette taxes for the first time in 12 years. Then came the tobacco lobbyists. (Wan, 10/21)

Stat: A New Peanut Allergy Vaccine Failed In A Trial, But The Company Wants It Approved Anyway
An experimental vaccine meant to combat peanut allergy came up short on Friday in a large clinical trial, but the company developing it blames the failure on a surprising placebo effect — and believes it still might win Food and Drug Administration approval. The treatment, called Viaskin Peanut, is a patch designed to gradually train a patient’s immune system to tolerate peanuts. In a trial on more than 300 children with peanut allergies, about 35 percent of patients responded to Viaskin, but the overall results didn’t beat placebo by enough to meet the study’s primary goal. (Garde, 10/20)

The New York Times: During Labor, Lie Down
Many doctors recommend that women in labor sit upright or walk to speed things along. But a randomized trial suggests the best bet may be to lie on your side. British researchers randomly assigned 3,093 first-time mothers with a low-dose epidural in the second stage of labor to either an upright position (walking, kneeling, standing or sitting up straight) or to a lying-down position (up to 30 degrees inclination). (Bakalar, 10/20)

Reuters: Epidurals May Not Slow Down Birthing Process.
Giving pregnant women epidural spinal anesthesia to ease their pain during the late stages of labor and delivery may not prolong the birthing process, a new experiment suggests. “Many obstetric providers believe that the numbness and weakness in a woman’s legs from epidural medications may affect a woman’s ability to push out a baby,” said senior study author Philip Hess, an anesthesiology researcher at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston. (10/22)

NPR: Brain Training Can Improve Memory, But Won't Make You A Genius
When it comes to brain training, some workouts seem to work better than others. A comparison of the two most common training methods scientists use to improve memory and attention found that one was twice as effective as the other. The more effective method also changed brain activity in a part of the brain involved in high-level thinking. (Hamilton, 10/23)

Bloomberg: Americans Are Retiring Later, Dying Sooner And Sicker In-Between 
Data released last week suggest Americans’ health is declining and millions of middle-age workers face the prospect of shorter, and less active, retirements than their parents enjoyed. Here are the stats: The U.S. age-adjusted mortality rate—a measure of the number of deaths per year—rose 1.2 percent from 2014 to 2015, according to the Society of Actuaries. That’s the first year-over-year increase since 2005, and only the second rise greater than 1 percent since 1980. (Steverman, 10/23)

The Washington Post: Total Ankle Replacement Becomes More Common As Treatment Improves
Once disparaged as borderline quackery, the total ankle replacement is gaining acceptance as a treatment for crippling arthritis and serious injuries. For years, doctors discouraged patients from getting the procedure — called ankle arthroplasty — because of persistent controversy over the earliest techniques, which involved cementing metal ankle reconstruction devices to bone. Sometimes the parts loosened prematurely or caused infections, leaving patients in worse shape than before. (Pianin, 10/22)

NPR: Water Helps Reduce Risk Of Recurring Urinary Tract Infection
Urinary tract infections cause painful urination and are unfortunately widespread. Scientists estimate that somewhere between 40 percent to more than 50 percent of women will get a UTI in their lifetime, and one in four will get a repeat infection. Left untreated, they can lead to kidney problems. (Jochem, 10/20)

Columbus Dispatch: Should A Disability Affect Who Gets Organ Transplants?
A 2008 survey by researchers at Stanford University found that 85 percent of pediatric transplant centers consider neuro-developmental status in the eligibility process at least some of the time, [Courtney] Hansen said. And in the same study, 62 percent of the centers said eligibility decisions based on disability tended to be made informally, making discrimination difficult to show. (Price, 10/22)

State Watch

State Highlights: Calif.'s Gubernatorial Candidates Split Over Single-Payer; FDA Working In Puerto Rico To Avert Medical Device Shortages

Media outlets report on news from California, Puerto Rico, California, Florida, Maryland and Kansas.

Los Angeles Times: Democrats Running For California Governor Debate Over Bringing Single-Payer Healthcare To The State
The top four Democrats running for California governor stood onstage for the first major candidate forum Sunday, splintering over single-payer healthcare but little else. The divide on healthcare mirrored the conflict within the Democratic Party both nationally and in California, with progressives — including those who backed Vermont Sen. Bernie Sanders for president — aggressively pushing for universal healthcare while moderates and establishment party members want to plot a more deliberative, cautious course. (Willon, 10/22)

Sacramento Bee: Candidates For California Governor Debate Universal Health Care
The two leading Democrats for California governor on Sunday split over how to achieve universal health care, with Lt. Gov. Gavin Newsom defending his support for a government-run, single-payer system and former Los Angeles Mayor Antonio Villaraigosa dismissing as “pie in the sky” plans that don’t include viable financing methods. (Cadelago, 10/22)

Stat: In Puerto Rico, Hurricane Damage Still Disrupting Medical-Device Manufacturing
Food and Drug Administration Commissioner Scott Gottlieb announced  Friday that the agency is “working closely” with about 10 companies that manufacture medical devices in Puerto Rico to “prevent medical device product shortages.” Since Hurricane Maria devastated the island in mid-September, many, including the FDA, have been worried about the impact on Puerto Rico’s pharmaceutical manufacturing industry. Medical device companies have received comparatively less attention, although Gottlieb’s announcement emphasized that the agency has been working “equally hard” to assist those companies. (Swetlitz, 10/20)

Miami Herald: State May Waive Fees As Kids Face Losing Insurance After Irma
With more than 4,000 families facing the loss of their state-subidized KidCare health insurance in the wake of Hurricane Irma, Florida regulators have reversed course and now say they are prepared to seek federal help. Florida Healthy Kids, the agency that operates the KidCare insurance program, told the Herald/Times Friday that it will call a special board meeting next week to explore asking the federal government for a waiver to help families still financially stressed from the hurricane. (Klas, 10/20)

California Healthline: One Nurse Per 4,000 Pupils = Not The Healthiest Arrangement
During a 15-minute recess, the elementary school students trooped from the playground toward nurse Catherin Crofton’s office — one with a bloody nose, a second with a scraped knee and a third with a headache. Kids quickly filled a row of chairs. Staffers brought paper towels for the bleeders and tried to comfort the crying. “We’re here for first aid, emergency, counseling,” said Crofton of the Mount Diablo Unified School District. “There is always something to do.” (Ibarra, 10/23)

The Baltimore Sun: Church Groups Enlisted In End-Of-Life Medical Planning Initiative 
Doug Wilson, an elder at West Baltimore’s Kingdom Life Church, recalled the steps he took after he was diagnosed with throat cancer. Before going into the University of Maryland Medical Center, he put down, in writing, the steps he wanted taken during and after his seven-hour surgery. ...Sunday’s class was the first in a series sponsored by the Maryland Faith Health Network. The class, like others to follow at other congregations, was funded by the Maryland State Department of Health. The initiative will continue until about 500 religious congregants hear the talk and receive informational documents. (Kelly, 10/22)

KCUR: Hallmark Opens First Hospital Gift Shop At KU Hospital
Hallmark Cards and The University of Kansas Health System on Friday unveiled a first-of-its-kind Hallmark Gold Crown hospital gift shop. "It's very important to us at Hallmark and at Hallmark Gold Crown that we present an opportunity to be a store of the community," said  Jennifer Seyller, a vice  president of retail sales at Hallmark. (Taylor, 10/20)

Editorials And Opinions

Perspectives On Health Debate: What Changed On Subsidies? The Need For Stability Now

Opinion writers take a look at some of the health law issues that are front and center today.

Los Angeles Times: Why Did Trump Make The Obamacare Reimbursement Payments He Claims Are Illegal And Unconstitutional?
The ACA requires insurers to reduce deductibles and co-pays for low-income buyers on the individual insurance market, and it requires the government to reimburse the insurers for those reductions; but because the ACA didn’t specifically provide an appropriation for the payments, congressional Republicans have maintained that they can’t be made. In other words, the payments are mandated by law, and also illegal (and unconstitutional). President Trump cited this argument on Oct. 12, when he said through his press office that “the government cannot lawfully make the cost-sharing reduction payments.”... But that raises an important question: If the payments are illegal, why did the Trump administration make them every month after it took office, from February through September? (Michael Hiltzik, 10/20)

Modern Healthcare: Washington Needs To Stabilize The Markets To Move Forward On Healthcare
After a season of healthcare policy fits and starts, now is the time for Washington to take a collective deep breath and assess what we learned and how we as a nation can do better. I say "we" because if the objective is truly a high-performing, affordable health system for all Americans, then everyone has a role to play—patients, providers, purchasers, health plans and policymakers of every stripe. ... Market stabilization is central to long-term success. (Ceci Connolly, 10/21)

Huffington Post: 24 Senators Back Latest Health Care Proposal, Offering Hope It Could Pass
Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) on Thursday formally introduced their proposal to shore up the Affordable Care Act’s private insurance markets. And in a show of the proposal’s bipartisan strength, they announced the bill now has 24 sponsors, with precisely 12 from each party. It will take that kind of support to push the proposal through Congress, given many Republicans’ feelings about anything related to “Obamacare,” not to mention the contradictory statements President Donald Trump has made lately. (Jonathan Cohn, 10/19)

Axios: Keeping The Alexander-Murray Health Care Bill In Context
As the debate unfolds about the bipartisan bill by Senators Lamar Alexander and Patty Murray to repair the Affordable Care Act marketplaces, the public could be just as confused as they have been about the ACA's marketplaces. That's why it's important to debate it in the right context: It's aimed at an urgent problem affecting a relatively small sliver of the health insurance system, not all of the ACA and not the entire health system. The bottom line: It's a limited measure that will never give conservatives or liberals everything they want. (Drew Altman, 10/23)

Sacramento Bee: Trump Is Punishing Real Families On Health Care
After failure to repeal and replace Obamacare comes retribution, but not against White House staff or U.S. senators. Instead, President Donald Trump is punishing millions of American families by jacking up premiums and letting skimpy health plans flood the marketplace. (Daniel Zingale, 10/20)

Reuters: Blame The Constitution For Trump’s Undemocratic Executive Orders
The president is required by Article Two of the Constitution to “take care that the laws be faithfully executed.” So are his efforts to undermine the Affordable Care Act unconstitutional? Particularly since Congress, which is empowered to write American laws, declined to make similar changes to the Obama-era health law when Trump urged legislators to do so, most of the framers of the Constitution would presumably be appalled by these actions. (Scott Lemieux, 10/18)

Viewpoints: Administration's 'Brazen' Argument On Abortion; Bolster The Fight Against Opioids

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

The New York Times: Abortion Ideologues Subvert A Woman’s Rights
Late Friday, a federal appeals court in Washington ruled that the teenager must be allowed to have an abortion, but it gave the federal government until Oct. 31 to find her a sponsor so that the government itself does not have to arrange for the procedure. The ruling came hours after the court heard the case, in which the Department of Health and Human Services’ Office of Refugee Resettlement said that if it released her to see a doctor it would “facilitate” an abortion, an action it said would contradict its interest in “promoting child birth and fetal life.” The government argued that barring an abortion doesn’t place an “undue burden” on her rights because she can always go home to get one — to a Central American country that criminalizes abortion and to parents who are abusive. This argument is as weak as it is ideologically brazen. (10/20)

Modern Healthcare: Help The Addicted, Not The Conflicted
Special interests and their Washington lobbyists are undermining the campaign to combat opioid abuse, an epidemic that is now taking the lives of nearly 100 Americans a day. Until we put the victims of this national tragedy front and center, the conflicted voices of soulless opioid manufacturers and the opaque treatment world, which is filled with sketchy rehab clinics and questionable alternative therapies, will continue to cloud the debate and prevent effective action. (Merrill Goozner, 10/21)

The Wall Street Journal: Big (And Hurting) Media On Drugs
Obviously opioid abuse is a challenge today, as is adequately treating patient pain, though, 20 years later, the problem is still sometimes misstated. But one thing is certain: Unless the Washington Post and CBS ’s “60 Minutes” have discovered a new, physics-defying form of quantum action at a distance, their splashy exposé last weekend identified neither the cause nor any solution. (Holman W. Jenkins Jr., 10/20)

Stat: Psychological First Aid Must Be Part Of Disaster Relief
The danger of these disasters lies not only in the tremendous loss of life and property, but also in the psychological toll they take on survivors. When disaster strikes, mental health support should be a top priority. Amidst the chaos, though, it often isn’t. Sadness, shock, anxiety, and fear are normal stress responses for those who live through a natural disaster. For many of them, these feelings fade away. For others, though, they persist, affecting their quality of life and ability to function. Survivors of natural disasters are at risk for developing post-traumatic stress disorder (PTSD), anxiety, depression, and other mental health issues. (Alani Gregory, 10/20)

Sacramento Bee: California Now Has Fairer Laws On HIV
Gov. Jerry Brown signed Senate Bill 239 into law, putting California at the forefront of states modernizing HIV laws. These laws – which criminalize otherwise legal conduct of people living with HIV and increase criminal penalties based on a person’s HIV-positive status – were passed at the height of the AIDS crisis, when the public perceived HIV as a death sentence, and there was no effective treatment. (Ayako Miyashita, 10/20)

Cleveland.com: What You Might Not Know About Medicaid
Ohio Medicaid spends about $48,000 per minute. While that number sounds dramatic, it's important to understand the context of how costs grow in Medicaid, otherwise we are limited to the politics of the moment, oversimplifying one of the most significant investments made in our society. Medicaid provides a critical safety net. While many believe Medicaid is a program only for the poor, the majority of the spending, over half, goes to the disabled and the elderly. In fact, Medicaid provides more resources for the regular health care needs of the aging population than does Medicare. (Loren Anthes, 10/22)