KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Health Law

Alexander Optimistic About Health Deal Despite Trump's Zig-Zagging And GOP Leaders' Opposition

It was a roller coaster in Washington after Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) released their bipartisan plan to stabilize the Affordable Care Act marketplaces. There are some who are writing off the bill as dead, but Alexander still thinks it will pass in some form by the end of the year.

The New York Times: Trump Pulls Back From Senate Deal To Fund Health Subsidies
President Trump on Wednesday backed away from his endorsement of a bipartisan Senate proposal to stabilize health insurance markets, throwing the legislative effort into doubt even as the chief architect of the deal predicted that it would become law before the end of the year. The latest actions by the White House confused Republicans on Capitol Hill and irked Democrats — but in the end, their effect was not clear. (Kaplan and Pear, 10/18)

The Associated Press: Republican Says He’ll Push Health Deal, Trump Keeps Distance
The authors of a bipartisan plan to calm health insurance markets said Wednesday they’ll push the proposal forward, even as President Donald Trump’s stance ricocheted from supportive to disdainful to arm’s-length and the plan’s fate teetered. “If something can happen, that’s fine,” Trump told reporters at the White House. “But I won’t do anything to enrich the insurance companies because right now the insurance companies are being enriched. They’ve been enriched by Obamacare like nothing anybody has ever seen before.” (Fram, 10/18)

The Wall Street Journal: Trump Signals Opposition To Bipartisan Health-Care Deal
Mr. Trump touched off confusion on Capitol Hill Wednesday morning, tweeting he “can never support bailing out ins co’s who have made fortune w/O’Care,” echoing criticism from conservatives that the deal is a bailout for insurers, a characterization the sponsors dispute. ... Mr. Trump’s comments on Wednesday cheered conservatives, troubled some Republicans who support the bill and left many Democratic lawmakers frustrated. Some Capitol Hill aides said they thought Mr. Trump’s remarks might be a negotiating tactic to get more concessions from Democrats, and GOP lawmakers began looking at potential changes that might ultimately get the president’s backing. (Armour and Peterson, 10/18)

The Washington Post: Trump Appears To Back Further Away From Bipartisan Health-Care Push
President Trump became the subject of an unusual public lobbying campaign over the fate of the Affordable Care Act on Wednesday as Senate Democrats and a key Republican sought to salvage a bipartisan health deal while conservatives pressured the president to disavow the agreement. ... The convoluted campaign, in which Senate Minority Leader Charles E. Schumer (D-N.Y.) insisted that a deal remained in reach even as he blasted the president’s “zigging and zagging,” underscored the unpredictable nature of dealmaking in Trump’s Washington. With constantly shifting alliances, the city’s key political players are jockeying to win the president’s support one issue at a time. (Eilperin and Sullivan, 10/18)

The Hill: 24 Hours Later, Senate Health Deal All But Completely Dead
A Senate healthcare deal to extend critical ObamaCare payments to insurers appears all but completely dead just 24 hours after it was announced. President Trump reversed course Wednesday and said he opposed the deal, while Speaker Paul Ryan’s (R-Wis.) office said the Senate should keep its focus on repealing and replacing President Obama’s signature law. (Sullivan and Roubein, 10/18)

Bloomberg: Deal To Prop Up Obamacare Stalls After Trump’s Mixed Signals
By then, John Thune of South Dakota, the Senate’s No. 3 Republican leader, had told reporters the pact had “stalled” as Senator Orrin Hatch of Utah, the chairman of the Finance Committee, said he opposed the deal. In the House, Speaker Paul Ryan also had signaled his opposition. (Litvan and Wasson, 10/18)

The Hill: Ryan Opposes ObamaCare Payments Deal 
A spokesman for Speaker Paul Ryan (R-Wis.) on Wednesday indicated Ryan won’t support a bipartisan deal to stabilize the ObamaCare insurance markets as opposition to the proposal mounts. "The speaker does not see anything that changes his view that the Senate should keep its focus on repeal and replace of Obamacare,” Doug Andres wrote in an emailed statement. (Roubein, 10/18)

The Hill: Schumer: Trump Doesn't Understand ObamaCare Payments Deal 
Senate Minority Leader Charles Schumer (D-N.Y.) ripped President Trump's comments on a bipartisan deal to extend key ObamaCare payments to insurers, arguing he doesn't understand the agreement.  "Frankly the president doesn't know what he's talking about in the compromise. ... The president ought to know what he's talking about when he tweets about bills. Because on this one he had no understanding of what it's about," Schumer said from the Senate floor. (Carney, 10/18)

The Hill: GOP Senator Floats Changes To Bipartisan ObamaCare Deal 
Sen. Ron Johnson (R-Wis.) is floating changes to a bipartisan deal to stabilize insurance markets that would pull the measure to the right. Johnson said he’s discussed the changes with Sen. Lamar Alexander (R-Tenn.) — the Senate Health Committee chairman who brokered the deal with Sen. Patty Murray (D-Wash.) — and Johnson contends they’re crucial to shoring up support for the bill in the House. (Roubein, 10/18)

The Hill: Alexander: Trump Called Him On ObamaCare Fix Bill 
Senate Health Committee Chairman Lamar Alexander (R-Tenn.) said President Trump called him Wednesday morning expressing optimism about the bipartisan health plan. "He called me to say that, number one, he wanted to be encouraging about the bipartisan agreement that Sen. [Patty] Murray and I announced yesterday," Alexander said at an Axios event Wednesday. (Hellmann, 10/18)

CQ: Draft Details Health Plan As Trump Calls Payments A 'Bailout'
Alexander still expects the legislation to pass by the end of the year. "From my experience here, most of the ideas fail for lack of the idea, and whenever you put a well-formed idea out before this Congress, sooner or later it has a pretty good chance of being adopted," he said. (McIntire, 10/18)

Politico: Obamacare Fix Could End Up In Year-End Package
GOP lawmakers acknowledged they’ll eventually have to contend with shaky insurance markets and an estimated $1 billion hole Trump carved into the health care law last week when he eliminated remaining payments due this year. The money to fund a key insurance subsidy program could be resurrected as part of a year-end spending agreement. Even if the deal struck by Sens. Lamar Alexander and Patty Murray goes nowhere, Republican sources say it's only a matter of time before Congress must find some way of addressing the reeling insurance markets — a vote the GOP sources know will infuriate lawmakers and their base. (Haberkorn and Bade, 10/18)

CQ: Poll: Majority Disapproves Of Ending Health Care Subsidies
Most Americans disapprove of President Donald Trump’s decision to end Obama-era federal subsidies to insurers that lower costs for low- and middle-income families, a new poll found. Fifty-three percent of respondents to an Economist/YouGov poll conducted Oct. 15 and 16 said they disapproved of the executive move, compared to 31 percent who were in favor. Sixteen percent declined to give an opinion. (Connolly, 10/18)

State AGs Ask For Emergency Court Order To Keep Trump From Cutting Off Insurer Subsidies

"It's long past time President Donald Trump learn that he doesn't get to pick and choose which laws he follows," says California Attorney General Xavier Becerra, who is leading the charge in the fight.

The Associated Press: States Ask US Court To Keep Up Health Subsidies Cut By Trump
Top government lawyers representing 19 U.S. states on Wednesday asked a federal judge in California to force the administration of President Donald Trump to make health care subsidy payments that Trump abruptly cut off last week. The monthly payments would normally be scheduled to go out Friday. The states, led by California Attorney General Xavier Becerra, asked a judge in San Francisco for an emergency court order by 4 p.m. Thursday requiring they be paid on time. (Cooper, 10/18)

Los Angeles Times: California And Other States Seek Emergency Order To Stop Trump Administration From Cutting Off Healthcare Subsidies
California Atty. Gen. Xavier Becerra asked a federal court Wednesday to issue an emergency temporary restraining order to block the Trump administration from cutting off cost-sharing subsidies that help reduce the price of healthcare for millions of Americans. A week after California and 17 other states filed a lawsuit challenging the decision on its merits, the same attorneys general requested a restraining order to avoid immediate harm to millions of people who get subsidized healthcare through the Affordable Care Act, Becerra said. (McGreevy, 10/18)

Bloomberg: Democratic Officials Seek Fast Rescue For Obamacare Payments 
[New York Attorney General Eric] Schneiderman, Becerra and the other attorneys general contend the ACA requires those payments be made, even though a U.S. judge in Washington disagreed in a 2016 decision that is currently under appeal. Immediate elimination of the payments would inflict multimillion-dollar losses on carriers and force them to raise premiums, forcing people to go without coverage, according to the AGs. The latest round of payments are to be made this week. (Harris, 10/18)

Meanwhile —

The Hill: Bipartisan Group Of Governors Calls On Congress To Stabilize ObamaCare Markets 
A bipartisan group of 10 governors is calling on Congress to vote on a deal to stabilize ObamaCare’s insurance markets. “We urge Congress to quickly pass legislation to stabilize our private health insurance markets and make quality health insurance more available and affordable,” the governors wrote Wednesday in a letter to House and Senate leaders from both parties. (Roubein, 10/18)

Critics Wield The Term 'Bailout' As Political Weapon. But In Case Of Insurer Subsidies It May Be Misleading.

Media outlets fact check some of the rhetoric swirling around the health care debate.

Cutting Off Insurer Payments Increases Number Of People Who Get Help Through Other Subsidies

Stopping insurer subsidies is like pushing down on one end of a see-saw only to see the other end go up because another of the health law's subsidies would rise for people with low-to-moderate incomes. Meanwhile, a look at how Illinois raced to get ahead of President Donald Trump's move to cut off payments.

The Associated Press: Trump's Health Subsidy Shutdown Could Lead To Free Insurance
If President Donald Trump prevails in shutting down a major "Obamacare" health insurance subsidy, it would have the unintended consequence of making free basic coverage available to more people, and making upper-tier plans more affordable. The unexpected assessment comes from consultants, policy experts, and state officials trying to discern the potential fallout from a Washington health care debate that's becoming harder to follow. (Alonso-Zaldivar, 10/19)

Modern Healthcare: How Illinois Hustled To Protect Obamacare From Trump
Even before President Donald Trump announced plans last week to nix Obamacare subsidies, the Illinois Department of Insurance raced over the summer to get insurers on board with a strategy to minimize the financial pain of such a move. The action in essence allows Illinois—as well as more than two dozen other states adopting the maneuver—to sidestep Trump's recent moves to undo major portions of his predecessor's signature health insurance law. Trump on Oct. 12 ordered the federal government to stop paying the cost-sharing subsidies provided to insurers to defray the cost of covering low-income people. (Schorsch, 10/18)

The Hill: ObamaCare Allies Fear Deal Won’t Mitigate Trump Attacks
ObamaCare supporters are worried that President Trump’s attacks on the law will depress enrollment and confuse consumers, inflicting damage that can’t be fixed even if Congress comes up with a bipartisan health-care deal. Open enrollment begins in less than two weeks, and advocates are bracing for a drop in the number of people signing up amid the Trump administration’s months-long campaign against ObamaCare. (Hellmann, 10/19)

Americans Grappling With Confusion As Enrollment Season Nears

The sign-up period for coverage under the Affordable Care Act begins Nov. 1, but uncertainty only continues to mount.

The Associated Press: Uncertainty Reigns Ahead Of New Health Care Sign-Up Period
Jason Sanford has heard so many rumors about the changing health care landscape that every few weeks he dials a local information desk, seeking just a rough estimate of what his diabetes medication will soon cost him. The answer is the same every time: It's too early to say, even with the next open enrollment period under the Affordable Care Act beginning in two weeks. (10/18)

Health News Florida: Their Only Option: Free Clinics Hear Confusion Ahead Of Obamacare Enrollment
Open enrollment in the Obamacare marketplace begins in less than two weeks but this year some consumers think the law is already dead. From threats to repeal the Affordable Care Act, to news about rising premiums and President Donald Trump's recent decision to do away with some subsidies, people who don't closely follow the issue are getting lost in the headlines and sound bites. (Ochoa, 10/19)

NPR: When States Asked For Insurance Waivers, They Didn't Like The Answers
It was the Friday before a Monday deadline, and federal health officials in Washington, D.C. were working feverishly with their counterparts in Oklahoma to finalize the details of a new state reinsurance program. Emails flew between the Centers for Medicare and Medicaid Services in Washington and Oklahoma's Department of Health. Blue Cross Blue Shield of Oklahoma, the only ACA insurer in the state, was on board. Everything had to be done by Monday, Sept. 25, so the insurance company could set new, presumably lower, health insurance rates for 2018. (Kodjak, 10/19)

In other marketplace news —

Women’s Health

Federal Judge Rules Undocumented Pregnant Girl Can Get An Abortion

Judge Tanya Chutkan ordered the government to move "promptly and without delay." The administration is appealing the ruling.

The Associated Press: Judge Orders Government To Allow Abortion For Immigrant Teen
A federal judge on Wednesday ordered the government to allow a pregnant 17-year-old immigrant, who was detained after entering the country illegally, to undergo an abortion. After a brief hearing that included a testy exchange with government lawyers, Judge Tanya Chutkan ordered the government to move "promptly and without delay" to transport the teenager or allow her to be transported by others to the nearest abortion provider. (10/18)

The Washington Post: Federal Judge Bars Govenrment From Blocking Abortion For Jane Doe, Undocumented Teen Immigrant
Lawyers for the American Civil Liberties Union, which represents the pregnant teen, cheered the judge’s ruling as a major victory for abortion and immigrant rights. “We never should have had to fight this in the first place,” said Brigitte Amiri, a senior ACLU staff attorney who argued the case on Wednesday. “It should never have been something that we needed to go to court over.” (Sacchetti, 10/18)

Los Angeles Times: Judge Rules Detained Teenage Immigrant Must Be Allowed To Have An Abortion
At a hearing Wednesday, a lawyer for Atty. Gen. Jeff Sessions had suggested that because the woman was not legally a U.S. resident, she was not covered by the constitutional right to end her pregnancy. U.S. District Judge Tanya S. Chutkan rebuked the government lawyers at the hearing. Her order directs officials to transport Jane Doe to the clinic of her choice and allow her to obtain an abortion by Saturday. (Lauter, 10/18)

Reveal: Government Must Allow Access To Abortion For Migrant Girl In Custody, Judge Rules
In late September, a Texas court granted her request to get an abortion without her parents’ approval, according to the state’s “judicial bypass” provision. But officials at the Department of Health and Human Services Office of Refugee Resettlement blocked Doe from leaving the South Texas shelter where she’s being held, sending her instead to a religious crisis pregnancy center. The government is required to provide healthcare for immigrant minors in its custody, and has paid to help girls end pregnancies that resulted from incest or rape, an ever-present risk for those crossing north from Central America. (Michels, 10/18)

KCUR: Judge Considers Planned Parenthood Challenge To New Missouri Abortion Restrictions
A Jackson County judge on Wednesday took under advisement Planned Parenthood’s request to block a Missouri law requiring that abortion physicians meet with their patients three days before they undergo the procedure. The law, enacted this summer during a special session of the Missouri Legislature called by Gov. Eric Greitens, is set to take effect Oct. 24. The two Planned Parenthood affiliates in Missouri and two obstetrician-gynecologists at the Washington University School of Medicine in St. Louis sued last week to have the law declared unconstitutional under the Missouri Constitution and sought a temporary restraining order blocking it. (Margolies, 10/18)

Pharmaceuticals

Anthem, Spurning Express Scripts, Will Join With CVS To Start A Drug Plan Business

The new business, which will start in 2020, will be a new pharmacy benefit manager (PBM) company. PBMs serve as intermediaries between drug companies and the prescription plans, but they have come under increasing pressure for not being transparent about how much money they save and how much is passed along to consumers.

Bloomberg: Anthem Breaks With Express Scripts, Will Start Own Drug Plan 
Health insurer Anthem Inc. plans to set up its own pharmacy benefits management unit, signaling a final break with Express Scripts Holding Co. after accusing it of overcharging by billions of dollars. The move means Express Scripts will not only lose its biggest client but also face a new rival. Anthem’s new unit, called IngenioRx, will grow its own business with a “full suite” of services, the insurer said in a statement on Wednesday. (Flanagan and Rausch, 10/18)

Modern Healthcare: Anthem's New PBM To Spark Change Throughout The Industry 
There has been heightened scrutiny on the role PBMs play in the pricing of drugs in recent years. PBMs, which oversee prescription drug benefits for employers and insurers, negotiate drug discounts with pharmaceutical companies, build pharmacy networks and create their own drug benefit plans, are involved in a blame game across the secretive pharmaceutical supply chain. PBMs, drug manufacturers, insurers and wholesale distributors have pointed fingers at each other to try to explain why savings via negotiated rebates aren't ultimately passed to the consumer. (Kacik, 10/18)

Second Version Of Groundbreaking Immunotherapy Treatment Approved By FDA

The therapy is part of a hot new field that uses a patient's own immune system to turn the cells into a "living drug" that attacks disease.

The New York Times: F.D.A. Approves Second Gene-Altering Treatment For Cancer
The Food and Drug Administration on Wednesday approved the second in a radically new class of treatments that genetically reboot a patient’s own immune cells to kill cancer. The new therapy, Yescarta, made by Kite Pharma, was approved for adults with aggressive forms of a blood cancer, non-Hodgkin’s lymphoma, who have undergone two regimens of chemotherapy that failed. (Grady, 10/18)

The Washington Post: Cutting-Edge Immunotherapy Treatment Approved For Another Deadly Cancer
The treatment is for adults with certain types of large B-cell lymphoma who have not responded to or who have relapsed after at least two other kinds of treatment, such as chemotherapy and bone-marrow transplants. The group numbers about 7,500 patients a year in the United States.The one-time infusion, known as CAR T-cell therapy, is made by Kite Pharma, which is based in Santa Monica, Calif., and recently was bought by Gilead Sciences for $11.9 billion. Kite announced Wednesday that the treatment's brand name will be Yescarta and its price will be $373,000. (McGinley, 10/18)

Stat: FDA Approves A Game-Changing Treatment For Blood Cancer
In a six-month trial on 101 patients, 36 percent saw their cancer completely disappear thanks to a single dose of Gilead’s therapy, and 82 percent had their tumors shrink by at least half. But the treatment is not without risks. More than 40 percent of patients suffered anemia during the trial, and common side effects include a dangerous lowering of white blood cell counts and toxicity in the brain. Two patients in the study died of treatment-related complications. (Garde, 10/18)

Medicare

Some Tips To Help Decide Whether Popular Medicare Advantage Plans Are Right For You

These private insurance plan take the place of traditional Medicare and vary in coverage and cost.

CNBC: Here's How To Snag The Best Medicare Advantage Plan
Medicare open enrollment is underway, which means you have until Dec. 7 to sign up for an Advantage Plan or to make changes to the one you already have. If you're uncertain whether one of these plans is right for you, it's important to first understand your options. ... In simple terms, these plans provide coverage from an insurance company and take the place of original Medicare, comprised of Part A (in-patient coverage) and Part B (outpatient care). While regulated by the government, Advantage Plans are administered by insurers and can vary in terms of coverage and cost. (O'Brien, 10/18)

Kaiser Health News: Medicare Vs. Medicare Advantage: How To Choose
As health insurers struggle with shifting government policies and considerable uncertainty, one market remains remarkably stable: Medicare Advantage plans. That’s good news for seniors as they select coverage for the year ahead during Medicare’s annual open enrollment period (this year running from Oct. 15 to Dec. 7). ... Despite Medicare Advantage plans’ increasing popularity, several features — notably, the costs that older adults face in these plans and the extent to which members’ choice of doctors and hospitals is restricted — remain poorly understood. (Graham, 10/19)

And in news on Medicare payment models —

Modern Healthcare: ACOs For Specialty Providers Could Be Key To Medicare Savings
Providers saw promising savings from accountable care organization models over the last year, and recent data has shown the value-based programs could find more success in a relatively untapped area: specialty medicine. The CMS last week quietly released data showing that three ACO programs saved providers millions of dollars. Last year, the Comprehensive End-Stage Renal Disease Care Model saved $75 million, according to the agency. That's more than the $68 million saved by Pioneer ACOs, and the $48 million saved by NextGen ACOs in the same period. Pioneer and NextGen ACOs mainly focused on better coordinating the primary care needs for Medicare patients. (Dickson, 10/18)

Public Health And Education

Rumor Mill Churning About Who Next Drug Czar Will Be After Original Pick Bows Out

Rep. Tom Marino (R-Pa.) withdrew his name from consideration after reports tying him to legislation that undermined the Drug Enforcement Administration's power during the opioid crisis.

Stat: Next In Line As Trump's Drug Czar? Candidate Names Start To Circulate
The Trump administration has gone nine months without a permanent drug czar. But within hours of the announcement that Rep. Tom Marino (R-Pa.) had withdrawn his name from consideration on Tuesday, the D.C. rumor mill was up and running. Potential candidates, according to administration officials, Capitol Hill staffers, and others in the world of drug and addiction treatment policy, include a who’s-who of players in the current battle against the opioid crisis. (Facher, 10/18)

The Associated Press: Former Drug Czar Nominee Marino Defends Role In Opioid Law
President Donald Trump’s former nominee to be the nation’s drug czar is defending his role in writing a law that critics say weakened the government’s authority to stop companies from distributing opioids. Rep. Tom Marino, R-Pa., said he’s proud of his work on the 2016 law, which passed without opposition in the House and Senate and was signed by President Barack Obama. (10/18)

In other news on the opioid epidemic —

Stat: California Wants To Pull Cardinal Health License Over 'Red Flags'
The state of California wants to revoke the wholesale license for a facility run by Cardinal Health, one of the nation’s largest pharmaceutical distributors, for failing to note a series of unusual sales of an opioid painkiller and three other tightly regulated medicines to a pharmacy. Between 2013 and 2015, the Cardinal Health outpost in Valencia, Calif., sold increasingly large quantities of the controlled substances — including Norco, which is a mixture of acetaminophen and hydrocodone — to the pharmacy, which state officials called “red flags.” Another medicine was the Xanax anxiety pill. (Silverman, 10/18)

Stat: Vivitrol, Monthly Shot For Opioid Addiction, Works As Well As Daily Medication
Aonce-a-month shot to treat opioid addiction was as effective in maintaining short-term abstinence from heroin and similar drugs as a more commonly prescribed daily treatment, according to a Norwegian study released Wednesday. The study is believed to be the first to directly compare Vivitrol — administered as a monthly shot — with a combination drug treatment sold under the brand name Suboxone. In the U.S. and many other countries, Suboxone or methadone have been the standard medical treatment for people with an opioid use disorder. (Armstrong, 10/18)

KQED: It’s Treatment Before Trial In Experimental Opioid Court
Federal, county and city court officials are looking hard at Buffalo, N.Y.’s new opioid crisis intervention court as one potential model solution to the epidemic of heroin and opioid overdoses that continue to devastate families and communities across America, taxing local governments, first responders and the nation’s criminal justice system. (Westervelt, 10/18)

The Associated Press: Maryland Congressman Joins Fight Against Opioid Epidemic
Rep. John Delaney, D-Potomac, announced Tuesday that he is co-sponsoring legislation to make it easier for the Drug Enforcement Administration to combat the opioid epidemic. The bill, called the “Opioid Immediate Suspension Order Act of 2017,” was introduced Monday by Rep. Gerry Connolly, D-Virginia. Four Democratic representatives, including Delaney, have co-sponsored the legislation, but no Republicans, according to Connolly’s office. (Jacob, 10/18)

Despite Growing Trend, Doctors Warn Against Women Eating Their Placenta

Proponents have said eating placenta reduces pain, improves mood and energy level, increases milk production, but scientists find any evidence to support those claims lacking. In other public health news: diabetes during pregnancy, other viruses to look out for this flu season, concussions in teenagers, infectious diseases, and postpartum depression.

The New York Times: Lack Of Sleep Tied To Diabetes In Pregnancy
Lack of sleep may raise the risk for gestational diabetes. Gestational diabetes — abnormally high blood sugar that develops during pregnancy — can lead to excessive birth weight, preterm birth or respiratory distress in the baby, among other problems. It can also increase the mother’s risk for Type 2 diabetes later in life. (Bakalar, 10/18)

The Philadelphia Inquirer/Philly.com: The Other Virus That Kills During Flu Season
Most people probably know by now that flu can make fall and winter dangerous for older adults. But another virus that circulates at the same time and causes similar symptoms is now getting more attention as a killer of older people, especially those who are frail, or have chronic health problems or weakened immune systems. ...Long thought to be a threat mostly to infants, respiratory syncytial virus (RSV) is increasingly recognized for its impact on adults. (Burling, 10/18)

The New York Times: Concussions In Teenagers Tied To Multiple Sclerosis Risk
Here’s yet another reason to protect young athletes from head trauma: A large-scale new study found that concussions in adolescents can increase the risk of later developing multiple sclerosis. The risk of multiple sclerosis, or M.S., an autoimmune nervous system disorder with an unknown cause, was especially high if there were more than one head injury. (Reynolds, 10/18)

Bloomberg: Ex-Biogen CEO Raises $500 Million To Conquer Infectious Diseases 
Veteran biotechnology executive George Scangos has been busy since leaving Biogen Inc. and setting up an infectious-disease startup: After founding Vir Biotechnology Inc. in January, he’s done seven deals and raised more than $500 million. That’s one of biggest fundraising rounds for any biotechnology startup this year, particularly for one focused on infectious diseases, an arena that traditionally hasn’t made a lot of money. Vir, which won’t start human trials for about 18 months, is setting its sights on treatments for tricky ailments that have long thwarted researchers, such as drug-resistant tuberculosis, Zika, hepatitis B and HIV. (Chen, 10/18)

State Watch

State Highlights: Md. Website Will Help Consumers Compare Costs For Common Medical Procedures; NYC's Public Hospital System To Get Infusion Of Funding

Media outlets report on news from Maryland, New York, Colorado, Illinois, Pennsylvania, Ohio and Minnesota.

The Washington Post: Maryland To Offer Online Shopping Tool For Common Medical Procedures
The Maryland Health Care Commission, the state’s independent regulatory agency, is unveiling a website on which people scheduling a hip replacement, knee replacement, hysterectomy or vaginal delivery can see price differences among different providers for the same procedure. The site is launching amid rising health-care costs and as some consumers turn to insurance plans with high deductibles. (Itkowitz, 10/18)

The Baltimore Sun: New Website Will Let Maryland Consumers Compare Hospital Rates For The First Time
A new website — wearthecost.org — being launched Thursday by the Maryland Health Care Commission will help consumers compare these types of costs among hospitals and bring more transparency to hospital pricing practices. While patients can request all or some of this data from other agencies and the hospitals themselves, the commission said the website compiles the information all in one place and in an easy-to-navigate, consumer-friendly way. The commission hopes the website will arm users with more information to help them make more informed decisions when choosing a hospital. (McDaniels, 10/19)

The Wall Street Journal: New York City Public Hospital System To Get Relief From State
The head of New York City’s public hospital system said New York Gov. Andrew Cuomo’s administration has agreed to disperse hundreds of millions in aid to the agency, ending a funding dispute that left the hospitals dangerously low on cash. Stanley Brezenoff, interim president and chief executive of NYC Health + Hospitals, said in a letter to agency employees Wednesday that the state had agreed to distribute some $380 million in federal and city funds under the state’s control to the system over the coming months. (Gay, 10/18)

Denver Post: Colorado Spending More On Prison Inmate Health Care, Report Finds
Colorado is spending more per inmate on health care as the state’s prison population ages, according to a national report released Wednesday. The report, from the Pew Charitable Trusts, found that Colorado spent $6,641 per inmate on health care in the 2015 fiscal year. That placed the state in the middle of the pack nationally: 21st  for the highest spending and about $900 per inmate more than the national median. (Ingold, 10/18)

Chicago Tribune: Legislators Want Answers On Illinois' Failure To Screen Babies For Deadly Krabbe Disease 
utraged by a Chicago Tribune report, state Rep. Mary Flowers, D-Chicago, is asking officials from the Illinois Department of Public Health to explain at a legislative hearing next week why they never implemented a 2007 law that mandated screening Illinois babies for a deadly genetic condition. Flowers, chair of the Illinois House Health Care Availability and Access Committee, was a co-sponsor of the law that added Krabbe disease to the state's newborn screening program a decade ago. (Callahan, 10/18)

The Philadelphia Inquirer/Philly.com: Einstein Healthcare Network Credit Downgraded
Moody’s Investor Service downgraded Einstein Healthcare Network’s credit rating by one notch, to just above junk bond status, citing the nonprofit system’s large and unexpected loss of $23 million on an operating basis in the year ended June 30, a decline in liquidity, and uncertain state funding. Einstein said in a statement that it “remains committed to providing high-quality care while balancing the demands of today’s challenging health-care environment. There are initiatives already underway which we believe will put the organization in a stronger financial position moving forward while increasing access to care.” (Brubaker, 10/18)

The Baltimore Sun: Maryland Health Department Gets $7.5 Million To Support Home Visits For Families
A federal grant of almost $7.5 million to the Maryland Department of Health will go to helping teach parenting skills and provide other resources to pregnant women and parents of young children, health department officials said Wednesday. The department will use the funds from the U.S. Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, to support local agencies that make home visits to women and parents through the state’s Maternal, Infant and Early Childhood Home Visiting Program. The goal of the program is to help the families raise children who are physically, socially and emotionally healthy and ready to learn. (Cohn, 10/18)

Pioneer Press: Roseville Care Center At Fault In Resident’s Death, Health Department Says 
The resident was fine when Sunrise Assisted Living staff checked in around 9 p.m. When staff returned around 12:30 a.m., the resident’s neck was wedged between a bed and a transfer pole, and the resident was no longer breathing, according to a report by the Minnesota Health Department. The department determined earlier this month that the Roseville facility was at fault for neglect, having placed the pole too close to the bed. (Chavey, 10/18)

Chicago Sun Times: Suit: Suburban Couple Defrauded Millions From Medicare 
The federal government has filed a lawsuit accusing a south suburban couple of defrauding Medicare out of millions of dollars through false claims by their medical companies. The suit, filed Tuesday in U.S. District Court, accuses Gateway Health Systems Inc. and its owners – 58-year-old Ajibola Ayeni and his wife, Joy H. Turner-Ayeni – of violating the federal False Claims Act by seeking and accepting Medicare payments for fraudulent services, according to a statement from the U.S. attorney’s office. (10/18)

Weekend Reading

Longer Looks: PTSD Or Hate?; In The Wake Of Hurricanes; And Male Fertility

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

The New York Times: A Marine Attacked An Iraqi Restaurant. But Was It A Hate Crime Or PTSD?
The DarSalam Iraqi restaurant, with its steaming plates of falafel and kebab, has for years served as a popular community gathering spot here. The Iraqi family who ran it felt welcome in this eclectic city. But all of that changed one night last spring when a man with a shaved head walked in and took a seat. As other customers chatted, he refused to order, instead staring at photos of the Iraqi countryside on the wall. (Dave Philips, 10/18)

Vox: Harvey And Irma: Pollution, Mold, And Other Lingering Health Risks
In the weeks following Hurricane Irma, parts of Florida have been awash in millions of gallons of sewage. Meanwhile, in Texas, oil refineries and chemical plants have dumped a year’s worth of cancer-causing pollutants into the air following Hurricane Harvey. In both states, doctors are on the lookout for an uptick in respiratory problems, skin infections, and mosquito-borne diseases brought on by the water and mold the storms left behind. (Julia Belluz, 10/16)

The Atlantic: A New Hope For Male Fertility After Cancer Treatment
When Branden Lischner was 18, he got testicular cancer. Between surgery and radiation, which can cause infertility, he saved a sperm sample. But he was so removed from the idea of fatherhood that he soon stopped paying for his banked sperm. Then, in 2013, shortly after he got married, his cancer came back. Lischner only wanted to worry about the surgery to remove his second testicle, but his urologist pushed him to take the time to store sperm. (Rachel Mabe, 10/13)

The New Yorker: How Anti-Trump Psychiatrists Are Mobilizing Behind The Twenty-Fifth Amendment
On October 8th, the outgoing Republican senator Bob Corker sent a tweet calling the White House “an adult day care center.” Corker then told the Times that President Trump’s recklessness could set the nation “on the path to World War III”; he said that most Senate Republicans shared his concerns, as should “anyone who cares about our nation.” Days later, Gabriel Sherman reported in Vanity Fair on the crisis-level discussions among Trump’s aides about how to contain a President who they fear is “unstable” and “unraveling.” According to Sherman’s reporting, the former chief strategist Steve Bannon warned Trump several months ago that “the risk to his presidency wasn’t impeachment, but the 25th Amendment.” That Amendment to the Constitution provides that the Vice-President and a majority of the Cabinet—or, alternatively, a congressionally appointed body—can determine that the President is “unable to discharge the powers and duties of his office” and remove him. (Jeannie Suk Gersen, 10/16)

Politico Magazine: Trump’s Obsessed With His IQ. Here’s What He Should Worry About Instead.
What are we to make of President Donald Trump’s boasts that he has a higher IQ than a member of his Cabinet, Secretary of State Rex Tillerson? Amid reports that Tillerson called Trump a “moron”—a claim Tillerson passed up a chance to deny on Sunday—Trump told Forbes magazine, “I guess we’ll have to compare IQ tests. And I can tell you who is going to win.” White House press secretary Sarah Huckabee Sanders later clarified that Trump “never implied that the secretary of state was not incredibly intelligent”—suggesting that Trump believes his IQ is astronomically high, maybe even the very best. In the past, he has described his IQ as “very high,” “much higher than [that of Presidents Bush and Obama],” “much higher than [the intellectuals’],” and “the highest, asshole!” Before Tillerson, Trump challenged the mayor of London and anyone who said he doesn’t understand global warming to IQ smackdowns. But what would an IQ face-off between Trump and Tillerson—or anyone else—even tell us? Should we care whether our president has a high IQ? (Zach Hambrick, 10/17)

FiveThirtyEight: The Grandfather Of Alt-Science
Arthur B. Robinson, renegade chemist, failed politician, grandpa of the climate skeptics — and maybe, just maybe, our nation’s next scientist-in-chief — padded across the carpet of his homemade lab in a pair of white athletic socks. “This room, everything you see here, was built by my own sons with their own hands, including the concrete,” he said. Robinson raised and home-schooled six children in this tawny valley scratched into the hills near the town of Cave Junction, Oregon. Now his wife is dead and one of his daughters has moved away, but the rest of his kids — two veterinarians, a biochemist and a pair of nuclear engineers — remain nearby. They have a lot to do: Feed the animals; maintain the lab; ward off cougars; publish their popular home-school curriculums; manage Robinson’s repeated, unsuccessful congressional campaigns; and, of course, perform high-stakes research into medicine and biochemistry. (Engber, 10/12)

Editorials And Opinions

Parsing Health Policies And Politics: Examining The Alexander-Murray Obamacare 'Fix'; Why Does It Have To Be So Difficult?

Opinion writers offer a variety of takes on the deal announced this week by Sen. Lamar Alexander (R-Tenn.) and Sen. Patty Murray (D-Wash.) as well as what it can and cannot accomplish. They also take a tough inventory of the politics in play and examine other health policy issues, such as Medicare Advantage networks and the status of the Children's Health Insurance Program reauthorization.

The New York Times: Bipartisan Health Proposal Is Too Late For 2018, But A Salve For 2019
The new bipartisan health proposal is far from a cure-all for Obamacare’s problems, but if it passed it would send health insurers a message they have sought all year: that it’s safe to stay in the marketplaces. Insurers have already signed contracts and are making final arrangements to sell their products in time for next year’s enrollment period, which begins on Nov. 1. (Reed Abelson and Margot Sanger-Katz, 10/19)

Bloomberg: A Congress That Can't Make Anything Easy
Time for another test of whether this Congress can do the easy things -- on health care this time. Republican Senator Lamar Alexander of Tennessee and Democratic Senator Patty Murray of Washington have reached a deal to "fix" the Affordable Care Act -- a seemingly reasonable agreement designed, in very general terms, to help the insurance markets work better while giving states more flexibility to administer things. Both parties have incentives to approve something like this. Democrats care about preserving their big policy win in the original Affordable Care Act; Republicans don't want chaos in health insurance while they control the White House and have majorities in both chambers of Congress. Sure, Republicans in theory would rather repeal and replace Obamacare, but if they didn't realize earlier that they don't actually have any realistic plan for doing so, most of them surely know it now. (Jonathan Bernstein, 10/18)

Bloomberg: Bipartisan Health Care Deal Is Too Late To Fix Much 
A bipartisan proposal to shore up the Affordable Care Act and guarantee the U.S. government keeps helping insurers cover low-income patients would have been something like a best-case scenario for the companies participating in the market -- if it happened several months ago. As it stands, the bill, spearheaded by Senators Patty Murray and Lamar Alexander, has only a small chance of passing. And even if it does pass, it is unlikely to entirely mitigate the Trump administration's active sabotage of the ACA. (Max Nisen, 10/18)

The Washington Post: If Republicans Kill This Health-Care Bill, They’ll Prove Their Cowardice
Bipartisan negotiators announced Tuesday that they had struck a deal to temporarily stabilize Obamacare markets. Republican Sen. Lamar Alexander (Tenn.) agreed to continue paying “cost-sharing reduction” payments that the government promised insurance companies, and Democratic Sen. Patty Murray (Wash.) agreed to relax health-market regulations a bit. Both sides of this deal contain good policy. (10/18)

The Wall Street Journal: Republicans, Stand Up For Health Freedom
While there is plenty of blame to go around for Republicans’ inability to repeal and replace Obama Care, the effort was all but doomed as soon as the GOP chose to fight on the wrong battlefield. Trying to pass a replacement through the budget process known as reconciliation was powerfully attractive, since it would have permitted the Senate to act on ObamaCare with only 51 votes. (Phil Gramm, 10/18)

Chicago Tribune: Breaking The Gridlock On Obamacare
For seven years, congressional Republicans and Democrats battling over Obamacare have agreed on only one thing: They couldn’t agree on anything. As more Americans dropped or skipped coverage because of soaring premiums, lawmakers of the two parties couldn’t — wouldn’t — agree on how to fix the 2010 law. (10/18)

The Wall Street Journal: More Freedom For More Money
That’s the question to ask about this week’s deal between Republican Lamar Alexander and Democrat Patty Murray to appropriate two years of funding for Obama Care’s “cost-sharing” reductions that flow to insurers. The Trump Administration last week cut off these subsidies, which the Obama Administration paid without an appropriation from Congress. A federal judge ruled last year that those payments are illegal. Democrats would also get about $100 million for advertising ObamaCare. (10/18)

The New York Times: Congress, End The Health Care Chaos. You Have 9 Million Kids To Protect.
President Trump and Republicans in Congress have brought chaos to the American health care system by trying to destroy the Affordable Care Act and failing to reauthorize the Children’s Health Insurance Program, which, with bipartisan support for the past 20 years, has provided care for millions of children. Over the next few weeks they can choose to set things right or to destroy them. (10/18)

JAMA Forum: What Do Medicare Advantage Networks Look Like?
The recent, strong growth of Medicare Advantage—private plan alternatives to traditional Medicare—makes understanding the program a priority for policy makers. Of the 57 million Medicare beneficiaries, approximately 33% are now enrolled in Medicare Advantage, an increase from 13% in 2004. Although we know a great deal about Medicare Advantage, there’s one thing we know almost nothing about: the extent and value of plans’ networks of physicians and hospitals at which enrollees can obtain covered care. This is important, because establishment and oversight of networks is a principal way Medicare Advantage plans manage cost and quality, and there has been a trend toward more narrow networks in insurance markets, raising concerns about access and patient cost. (Austin Frakt, 10/18)

Viewpoints: Learning Cybersecurity Lessons From Medical Devices; Big Pharma Should Be Embarrassed -- But Are They?

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

JAMA: Cybersecurity Concerns and Medical Devices: Lessons From a Pacemaker Advisory
Medical devices increasingly include capabilities for wireless communication and remote monitoring systems that relay clinical information from patients to clinicians. For example, many cardiac implantable electrical devices can transmit data regarding arrhythmia burden and heart failure metrics with minimal patient effort. This technology can improve patient care, but also introduces possible risks to data security and patient safety. (Daniel B. Kramer and Kevin Fu, 10/18)

The New York Times: 'Drug Dealers In Lab Coats’
Big Pharma should be writhing in embarrassment this week after The Washington Post and “60 Minutes” reported that pharmaceutical lobbyists had manipulated Congress to hamstring the Drug Enforcement Administration. But the abuse goes far beyond that: The industry systematically manipulated the entire country for 25 years, and its executives are responsible for many of the 64,000 deaths of Americans last year from drugs — more than the number of Americans who died in the Vietnam and Iraq wars combined. The opioid crisis unfolded because greedy people — Latin drug lords and American pharma executives alike — lost their humanity when they saw the astounding profits that could be made. (Nicholas Kristof, 10/18)

The Washington Post: Democrats Are The Real Abortion Extremists
What would America’s abortion policy be if the number of months in the gestation of a human infant were a prime number — say, seven or eleven? This thought experiment is germane to why the abortion issue has been politically toxic, and points to a path toward a less bitter debate. The House has for a third time stepped onto this path. Senate Democrats will, for a third time, block this path when Majority Leader Mitch McConnell (R-Ky.) brings the House bill to the floor, allowing Democrats to demonstrate their extremism and aversion to bipartisan compromise. (George F. Will, 10/18)

JAMA: End-Of-Life Care Among Immigrants Disparities Or Differences In Preferences?
Although describing a “good death” is an existentially challenging exercise, most people, if asked to do so, would note the importance of the presence of friends and family, relief from distressing symptoms, time at home, completing life goals, and other values. Although these goals are likely shared quite widely, how they are prioritized, and how they relate to other goals, may vary among individuals and across cultures. (Michael O. Harhay and Scott D. Halpern, 10/17)

JAMA: Blood Transfusions From Previously Pregnant Women And Mortality: Interpreting The Evidence
The availability of large databases of blood donors and transfusion recipients has facilitated investigation of associations of donor characteristics with recipient outcomes. These databases are available in Sweden-Denmark, Canada, and the Netherlands, using government health data, and in the United States, using a donor-recipient database funded by the National Heart, Lung, and Blood Institute. (Ritchard G. Cable and Gustaf Edgren, 10/17)

JAMA: Better
I was in my first year of medicine residency, still losing my way to radiology, still forgetting the codes I needed to access one room or another, still desperately trying to learn how to keep track of my multiple patients and their multiple problems when I assumed his care. As the intern, it fell to me to examine Mr Jones and write admission orders. As the intern, I’d also been up all night. My new white coat was stained with coffee spilled while sprinting to accomplish one forgotten task or other. My pager was chirping regularly, a constant reminder of the calls I’d yet to return. Tired, anxious, and painfully aware of his nurse’s brisk competence as she quieted a beeping alarm and tugged the bed sheet, I introduced myself. (Jessica Gregg, 10/17)