First Edition: December 19, 2018

Kaiser Health News: Taking Surprise Medical Bills To Court
Joaquin Lopez had emergency gallbladder surgery after rushing to an ER last year. He has been haggling with Baptist Memorial Hospital in Memphis over what he owes ever since. The 37-year-old college professor was hit with a nearly $8,000 bill from the out-of-network hospital — that was after the $11,000 he and his insurer had already paid. (Julie Appleby, 12/19)

Kaiser Health News: Hep C And Drug Abuse Often Go Hand In Hand, But Screening For Infection Lags
When people seek help at a drug treatment center for an opioid addiction, concerns about having contracted hepatitis C are generally low on their list. They’ve often reached a crisis point in their lives, said Marie Sutton, the CEO of Imagine Hope, a consulting group that provides staff training and technical assistance to facilitate testing for the liver-damaging virus at more than 30 drug treatment centers in Georgia. (Andrews, 12/19)

Politico: Obamacare’s Secret Base: America’s Middle Class
Millions of middle-class Americans who get health coverage through work have been getting Obamacare benefits for years — whether they know it or not. And millions of older Americans who rack up big drug costs under Medicare get more financial help through Obamacare — whether they know it or not. Now a Texas federal judge who just invalidated the entire health care law has put them at risk — whether they know it or not. (Kenen and Ollstein, 12/19)

Modern Healthcare: Texas ACA Ruling Complicates Politics Of Medicaid Expansion
A Texas federal judge's ruling Friday invalidating the Affordable Care Act could create political headaches for Medicaid expansion supporters in states that are moving to implement or maintain expansion. If it's upheld on appeal, which is highly uncertain, U.S. District Judge Reed O'Connor's decision declaring the entire ACA unconstitutional would eliminate federal authorization and funding for the expansion of Medicaid to low-income adults. That would force states to shoulder the full price of covering people who would not qualify for coverage under pre-ACA criteria, rather than having the federal government pick up 90% of the cost. (Meyer, 12/18)

The Baltimore Sun: Maryland AG Frosh Seeks To Preserve Affordable Care Act And Opposes Acting U.S. Attorney General's Involvement
The Maryland attorney general's office is seeking to preserve its suit sustaining the Affordable Care Act while challenging the legality of Matthew Whitaker's appointment as acting U.S. attorney general. U.S. District Judge Ellen Hollander scheduled a hearing in the case for Wednesday morning in Baltimore. The suit seeks a declaration that the Affordable Care Act — once known as Obamacare — is constitutional, and it aims to uphold provisions protecting people with pre-existing medical conditions when they seek insurance. (Barker, 12/19)

The New York Times: Trump Administration Report On School Safety Plays Down Role Of Guns
Unveiling a report commissioned by President Trump in the aftermath of a mass shooting last winter at a Florida high school, administration officials on Tuesday played down the role of guns in school violence while focusing instead on rescinding Obama-era disciplinary policies, improving mental health services and training school personnel in the use of firearms. The report — by the Federal Commission on School Safety, which consists of four cabinet officials and is led by Education Secretary Betsy DeVos — drew on months of research marked by political conflict and mixed messaging from the administration on how to handle violent events like the Feb. 14 shooting at Marjory Stoneman Douglas High School in Parkland, Fla. Seventeen students and staff members were killed and 17 others were injured in the shooting. (Rogers and Green, 12/18)

The Associated Press: Trump's Safety Panel Seeks To Revoke School Discipline Rules
The panel was asked to study a range of options to bolster security at America's schools, from the regulation of guns to the regulation of violent video games. Yet rather than suggest a series of sweeping changes, the commission issued 100 smaller suggestions that largely avoid strong stances on topics like gun control and whether schools should arm teachers. "Our conclusions in this report do not impose one-size-fits-all solutions for everyone, everywhere," said Education Secretary Betsy DeVos, who led the commission. "The primary responsibility for the physical security of schools and the safety of their students naturally rests with states and local communities." (Binkley, 12/18)

The New York Times: Nearly 40,000 People Died From Guns In U.S. Last Year, Highest In 50 Years
More people died from firearm injuries in the United States last year than in any other year since at least 1968, according to new data from the Centers for Disease Control and Prevention. There were 39,773 gun deaths in 2017, up by more than 1,000 from the year before. Nearly two-thirds were suicides. It was the largest yearly total on record in the C.D.C.’s electronic database, which goes back 50 years, and reflects the sheer number of lives lost. (Mervosh, 12/18)

The New York Times: Thousands Of Migrant Children Could Be Released After Policy Change
The Trump administration announced on Tuesday that it planned to ease onerous security requirements for sponsors of migrant children, meaning that thousands who have been parked in shelters for months could soon be released and reunited with family members. In a major policy reversal, the Department of Health and Human Services, which oversees the care of migrant children through its Office of Refugee Resettlement, said that it would no longer require that all members of a household where a child is to live be fingerprinted. Instead, fingerprints will be required only of the adult who is sponsoring the minor, typically a parent or another relative. (Jordan, 12/18)

Reuters: U.S. Reverses Policy In Move To Speed Release Of Migrant Children
The Department of Health and Human Services (HHS), which cares for children who cross the border alone, said on Tuesday the policy of fingerprinting all adults living with the sponsors enacted in June had increased the time children were in government custody without turning up more red flags. The number of immigrant children in government-run shelters has ballooned to a record 14,700 as of Dec. 17, according to HHS. U.S. laws limit the time migrant juveniles can be detained, so those caught crossing the border without a parent or legal guardian are often released to adult sponsors in the United States. The children are then expected to show up to immigration court to fight their deportation cases. (12/18)

The Washington Post: Democrats Retrace Migrant Girl’s Journey Before Her Death, Denounce Conditions At Border Patrol Stations
Democratic lawmakers who came to the Border Patrol station here Tuesday vowing to investigate the death of a 7-year-old migrant girl emerged from their tour with a litany of accusations but few solutions for helping the agency manage the surge of families that has left agents overwhelmed. The congressional delegation, led by members of the House Hispanic Caucus, described a facility jam-packed with families, lacking sufficient medical care and poorly equipped to care for children. “The only reason this facility is still open as it is now is because these cameras can’t get in,” Rep. Al Green (D-Tex.) told reporters who had to wait outside the station, nearly 90 miles north of the border along Interstate 10. (Miroff, 12/18)

The Associated Press: Officials Baffled By Large Migrant Groups At Remote Crossing
Large numbers of Guatemalan families and unaccompanied children are surrendering to U.S. immigration agents in an extremely remote and dangerous stretch of New Mexico desert, a new smuggling route that has baffled authorities. It is where 7-year-old Jakelin Caal and her father were found Dec. 6 with 161 others near a border crossing in Antelope Wells. ... The U.S. has shifted additional medical personnel and more vehicles to Lordsburg and Antelope Wells to help manage. (Spagat and Long, 12/18)

The New York Times: Suicide Among Veterans Is Rising. But Millions For Outreach Went Unspent By V.A.
Suicide prevention efforts by the Department of Veterans Affairs fell off sharply in the last two years, even though reducing the high suicide rate among veterans is the agency’s top clinical priority, according to a new report. With the department’s top management in turmoil, the suicide prevention effort lacked leadership, planning meetings were repeatedly canceled, millions of dollars budgeted for outreach went unspent, and the television and radio ads that had been broadcast thousands of times across the country in previous years went all but silent. (Philipps, 12/18)

The Washington Post: Trump’s VA Vowed To Stop Veteran Suicide. Its Leaders Failed To Spend Millions Set Aside To Reach Those At Risk. 
As the number of veterans taking their own lives climbed, VA’s media outreach plunged in fiscal years 2017 and 2018 — with fewer social media posts, public service announcements and paid advertisements compared with the agency’s efforts during the Obama administration, auditors said. About 20 veterans die by suicide every day, VA data shows. That’s nearly twice the suicide rate among Americans who did not serve in the military. VA set aside $6.2 million this year alone to advertise its crisis hotline — the centerpiece of its suicide-prevention efforts — online, on billboards, buses and trains, and via local and national radio commercials. But as of September, the agency had spent $57,000 — less than 1 percent of that budget, auditors wrote. (Rein, 12/18)

Politico: Anti-Abortion Groups Demand Ouster Of NIH Chief Over Fetal Tissue
Two influential anti-abortion groups called Tuesday for the ouster of NIH Director Francis Collins over his support for fetal tissue research for medical science. Live Action, March for Life and other conservative groups have been frustrated that the Trump administration has not banned research using fetal tissue donated by women who have had abortions. (Ollstein, 12/18)

The Hill: Anti-Abortion Groups Call On NIH Chief To Resign In Fight Over Fetal Tissue 
“Collins’ actions are inconsistent with the pro-life policies of this administration and with the consensus of Americans who oppose entangling taxpayer dollars with abortion. It is time for his departure,” March for Life President Jeanne Mancini said in a statement. "Director Collins must be replaced with someone who recognizes that children who are killed by abortion should be mourned, not experimented on,” Live Action President Lisa Rose said in her group's statement. (Hellmann, 12/18)

The Washington Post: NIH Official Commits To Continued Funding For Some Fetal Tissue Research
The National Institutes of Health pledged Tuesday at a private meeting of scientists who use fetal tissue that the government’s premier funder of biomedical research would continue to support such work despite a conservative broadside against it. The commitment by a senior official of NIH’s National Institute for Allergy and Infectious Diseases to continue funding for researchers who work for nongovernment labs came at the end of a seven-hour meeting with about 40 researchers from around the country, according to two participants. (Goldstein, 12/18)

Reuters: U.S. Surgeon General Wants Tougher Action To Tackle Teen Vaping Epidemic
U.S. Surgeon General Jerome Adams on Tuesday issued a rare advisory calling for aggressive steps against e-cigarette use among teens, which he said has become an "epidemic". The detailed advisory listed various strategies that states, communities, health professionals and parents can apply to restrict the use of e-cigarettes. (12/18)

The Hill: Surgeon General Calls For More Restrictions To Battle Youth Vaping
"We need to protect our kids from all tobacco products, including all shapes and sizes of e-cigarettes,” Adams said in the advisory. “Everyone can play an important role in protecting our nation’s young people from the risks of e-cigarettes.” The National Institute on Drug Abuse on Monday released data showing that the number of high school seniors who say they used an e-cigarette within the last 30 days spiked by 75 percent since last year, according to the advisory. (Birnbaum, 12/18)

NPR: Vaping 'Epidemic' Among Youths Declared By U.S. Surgeon General
The surgeon general's advisory called on parents and teachers to educate themselves about the variety of e-cigarettes and to talk with children about their dangers. Health professionals should ask about e-cigarettes when screening patients for tobacco use, the advisory said. And local authorities should use strategies, such as bans on indoor vaping and retail restrictions, to discourage vaping by young people. (Stein, 12/18)

The New York Times: Addicted To Vaped Nicotine, Teenagers Have No Clear Path To Quitting
A Harvard addiction medicine specialist is getting calls from distraught parents around the country. A Stanford psychologist is getting calls from rattled school officials around the world. A federal agency has ordered a public hearing on the issue. Alarmed by the addictive nature of nicotine in e-cigarettes and its impact on the developing brain, public health experts are struggling to address a surging new problem: how to help teenagers quit vaping. (Hoffman, 12/18)

The New York Times: How To Help Teenagers Quit Vaping
Nicotine is the addictive chemical that chains both cigarette smokers and vapers, compelling them to repeated use. Its grip is tough to break. Teenagers, whose brains are still developing, are particularly susceptible. Parents and educators are discovering that, unfortunately, there are no established protocols to help teenagers quit vaping. But there are measures parents can take. (Hoffman, 12/18)

The Wall Street Journal: U.S. Weighs Potential Conflicts In Hospital-Accreditation Groups With Consulting Arms
The Trump administration is weighing whether to continue approving hospital and health-accreditation groups that also have consulting arms, following potential conflicts of interest raised in an article in The Wall Street Journal. Among the groups affected could be the Joint Commission, the nation’s largest hospital and health organization accrediting organization. Critics say the commission’s role — accrediting most of the nation’s hospitals while also providing consultants for facilities hoping to be accredited — creates a conflict. The consultants are available through a commission subsidiary. (Armour, 12/18)

Reuters: Judge Mulls Using Monitor To Oversee CVS During Court Process
A federal judge said on Tuesday that he was considering using a court-appointed monitor to make sure CVS Health Corp refrains from fully integrating with insurer Aetna while he examines the companies' settlement with the government. Judge Richard Leon of the U.S. District Court for the District of Columbia held the hearing as part of his review of the antitrust settlement reached with the Justice Department to win approval for the companies' $69 billion merger. (12/18)

The New York Times: Judge Seeks Monitoring Of CVS And Aetna During Antitrust Review
Judge Richard J. Leon, of the United States District Court in the District of Columbia, stopped short of an attempt to block the $69 billion merger, but he reiterated his concerns over the Justice Department’s approval of the combination. He went on to scold the government’s lawyers for being “hostile to the role of the federal courts” in looking after the public’s interest, telling them they “would do well to re-evaluate the tone with which you address this court.” (Baumgaertner, 12/18)

The Wall Street Journal: CVS Urges Judge Not To Halt Integration Of Aetna
CVS has argued that halting all integration would cause irreparable harm to the company and its customers. Instead, it offered four measures it said would help facilitate Judge Leon’s review. Among them, CVS pledged that Aetna would maintain its historical control over pricing of products and services for its insurance customers, and that CVS and Aetna wouldn’t exchange competitively sensitive information for the time being. (Kendall, 12/18)

The Hill: Warren Unveils Bill To Lower Drug Prices By Letting Government Manufacture Them
Sen. Elizabeth Warren (D-Mass.) on Tuesday unveiled a bill aimed at lowering drug prices by allowing the government to step in and manufacture certain drugs that lack competition. The bill from Warren, who is considered a likely 2020 presidential contender, comes as Democrats are putting forward a range of new ideas on how to lower drug prices, a top priority for the public and an issue that President Trump has also highlighted. (Sullivan, 12/18)

Stat: Powerful Democrat Wants Pfizer To Explain Price Hikes For Lyrica 
A powerful Senate Democrat is asking Pfizer to explain why it hiked the price of its nerve pain drug, Lyrica. And if Sen. Ron Wyden (D-Ore.) has his way, more companies will soon be asked to account for their decisions to raise prices. A bottle of 90 Lyrica pills costs over $650 before rebates and discounts. In 2005, it cost $150, according to Elsevier’s Gold Standard Drug Database. (Florko, 12/19)

Stat: Novartis Unit Teams Up With Marijuana Producer, A Milestone For Pharma
In what appears to be a first for marijuana and a major pharmaceutical company, a Novartis subsidiary and a Canadian producer of medical cannabis products have agreed to market them around the world. Tilray Canada announced the agreement on Tuesday with Sandoz, a unit of Swiss-based Novartis that manufactures generic and biosimilar drugs. Under the deal, whose financial terms were not disclosed, Tilray and Sandoz will work together to supply and distribute non-smokable medical cannabis products. The companies will also co-brand and develop other products together. (Cooney, 12/18)

The Wall Street Journal: Pfizer, Glaxo To Combine Consumer-Health Businesses
Pfizer Inc. and GlaxoSmithKline PLC plan to combine their consumer-health units, and eventually spin off the joint venture—creating a global giant selling drugstore staples like Advil and Sensodyne toothpaste. The deal announced Wednesday is an unexpected ending to a yearlong process by Pfizer to shed its consumer business, as it and other pharmaceutical companies focus more on higher-margin prescription-drugs. Glaxo has been pursuing the same focus, though has until now stayed committed to its consumer business, which its chief executive led before her promotion to the top job. (Martuscelli and Roland, 12/19)

The New York Times: Allergan Halts Sales In Europe Of Textured Breast Implants Linked To Rare Cancer
Breast implants made by Allergan that have been linked to an uncommon form of cancer are being taken off the market in Europe, French authorities announced on Tuesday. The implants, which have a textured or slightly roughened surface, rather than a smooth covering, cannot be manufactured or sold in Europe for the time being, and the ones kept on hand at health centers are being recalled. (Grady, 12/18)

The Washington Post: Congressional Report: Drug Companies, DEA, Failed To Stop Flow Of Millions Of Opioid Pills
The distributors of powerful prescription opioids and the Drug Enforcement Administration failed to stop the flow of millions of pills into rural West Virginia despite rampant warning signs that the pills were being diverted for abuse, inertia that contributed to the nation’s opioid epidemic, a congressional report has found. A report from the majority staff of the House Energy and Commerce Committee found that distributors, which fulfill orders for prescription drugs to pharmacies, failed to conduct proper oversight of their customers by not questioning suspicious activity and not properly monitoring the quantity of painkillers that were being shipped to individual pharmacies. (Zezima, 12/19)

The Washington Post: FDA Panel Backs Prescribing Opioid Antidote Alongside Painkillers
Advisers to the Food and Drug Administration recommended Tuesday that labels on prescription opioids urge doctors to simultaneously prescribe the overdose antidote naloxone for at least some of their patients. Several members of two advisory committees, which met jointly, described their 12-to-11 vote as a message to the government that the fast-acting antidote must be made more widely available, at lower cost and with fewer barriers to obtaining it. (Bernstein, 12/18)

The Associated Press: California Doctor Accused Of Prescribing Drugs In 5 Deaths
A Southern California doctor was arrested Tuesday on charges of doling out drugs to patients he didn’t examine and is alleged to have prescribed drugs to five people who died of overdoses as well as an impaired driver who struck and killed a bicyclist, federal prosecutors said. Dr. Dzung Ahn Pham, 57, faces charges of illegally distributing powerful opioids and prosecutors said he prescribed drugs to addicts or people selling them on the street. He prescribed some drugs after receiving text messages requesting specific quantities and doses, prosecutors said. (Melley, 12/18)

The Washington Post: Boyhood At 11 And 12: Navigating A Social Ecosystem That Prizes Alpha Males Over Quirky Kids
At the height of summer, a trio of tween boys walk away from the muggy heat and into the chilled air of their favorite place, the hockey rink. This is where their friendship was formed. It’s where they unleash their aggressions, test their abilities and confront disappointment, and where they saw one of their own through tragedy. It’s where they learned that the claw game is totally rigged but still beg their parents for quarters to see if they can beat it. (McCarthy and Joyce, 12/18)

Politico: Training The EHR To Speak When A Child Can’t
At the UPMC Children’s Hospital in Pittsburgh, scores of babies and older children with head trauma are admitted each year and abuse is the leading cause of death in the ICU. These injured patients are often too young to explain their bruises and fractures, whether accidental or inflicted. If caretakers are responsible, they may not admit it to clinicians, who usually must flag young patients for screening based on their own intuition. (Ravindranath, 12/18)

The New York Times: How Exercise May Make Us Healthier
People who exercise have different proteins moving through their bloodstreams than people who do not, according to an interesting new study of the inner landscapes of sedentary and active people. The proteins in question affect many different aspects of our bodies, from immune response and blood-sugar levels to wound healing, so the new findings may bring us closer to understanding just how exercise enhances our health at a deep, molecular level. (Reynolds, 12/19)

NPR: A Partnership Between Hospital And Campus Helps Students Through A Breakdown
Sometimes a psychiatric crisis can be triggered by something small. For Alexia Phillips, 21, it was a heated argument with a close family member in February 2017. She remembers the fight blew up before she left the house to go to classes at Queens College in Flushing, New York. By midday, Phillips, then a sophomore, says she began to cry loudly and uncontrollably. (Weinstock, 12/18)

The New York Times: Breast-Feeding Tied To Smaller Waist Size In Mother
Breast-feeding for longer than six months may lead to a smaller waist size for the mother, researchers report, and the effect persists for as long as a decade. Their analysis, in The Journal of Women’s Health, used data on 678 women enrolled in two studies who were followed for an average of 11 years after giving birth. (Bakalar, 12/18)

The New York Times: The Hospital’s Gift Of Downtime
Christmas week is a strange time in the hospital. There’s an added melancholy for patients who spend the holidays hospitalized — a sense that their illness, whatever it might be, is so bad they must lie in bed while the world hangs ornaments and roasts chestnuts on open fires. It’s a time when the doctors and nurses on call start to feel the weight of jobs that too often keep them close to computers and far from their families. (Khullar, 12/19)

The Washington Post: D.C. Council Approves Bill Relaxing Restrictions On Southeast Hospital Deal
A deal to build a new hospital east of the Anacostia River appeared to survive — at least temporarily — on Tuesday, as the D.C. Council approved a last-minute measure that proponents say will allow negotiations for the project to move forward. The legislation, most of it drafted by council member Vincent C. Gray (D-Ward 7), stipulated that Howard University’s medical school must have an academic affiliation with either the new hospital or some other medical facility. (Jamison, 12/18)

The Associated Press: State Medical Board Confirms Complaint Records On OSU Doctor
The State Medical Board has acknowledged for the first time that it has confidential records about the investigation of a complaint involving former Ohio State University team doctor Richard Strauss who is accused of widespread sexual misconduct against students decades ago. The documents can't be viewed by the law firm investigating allegations that Strauss abused scores of male student-athletes in the 1980s and 1990s, but still might help guide its inquiry. (12/18)