First Edition: July 10, 2019

Kaiser Health News: How To Get A Cheaper Prescription Before Leaving The Doctor’s Office
When Mary Kay Gilbert saw her doctor in May for a skin infection on her leg, she wasn’t surprised to receive a prescription for an antibiotic cream.But Gilbert, 54, a nurse and health consultant, was shocked when her physician clicked on the desktop computer and told Gilbert the medicine would cost $30 on her Blue Cross and Blue Shield plan. “I was like, ‘Wow — that’s pretty cool that you know that information,’” she recalled telling the doctor in Edina, Minn. (Galewitz, 7/10)

Kaiser Health News: ‘An Arm And A Leg’: The Full Story Of Insulin And Its Cost ― No Sugarcoating It
One out of every 4 people with Type 1 and 2 diabetes rations insulin. Adeline Umubyeyi is among them. She’s a college grad with a professional job and health insurance who still sometimes goes to bed without dinner — because skipping a meal allows her to skip a dose of her costly insulin. On Episode 5 of “An Arm and a Leg,” meet Umubyeyi and take a 98-year journey with host Dan Weissmann as he traces insulin’s origins. (Weissmann, 7/10)

Kaiser Health News: Watch: High Cost Of Insulin Sends Americans To Canada To Stock Up
Insulin is a vital drug that some 7.4 million Americans must take daily to manage their diabetes. But its price nearly doubled from 2012 to 2016, leaving some patients with no choice but to turn to black-market drugs or traveling to Canada, where insulin can be 90% cheaper. KHN senior correspondent Sarah Varney reports in collaboration with PBS NewsHour about the skyrocketing cost of insulin — and the trend’s deadly consequences. (Varney, 7/10)

The New York Times: Appeals Court Seems Skeptical About Constitutionality Of Obamacare Mandate
A panel of federal appeals court judges on Tuesday sounded likely to uphold a lower-court ruling that a central provision of the Affordable Care Act — the requirement that most people have health insurance — is unconstitutional. But it was harder to discern how the court might come down on a much bigger question: whether the rest of the sprawling health law must fall if the insurance mandate does. In 90 minutes of oral arguments on whether a federal district judge in Texas was correct in striking down the Affordable Care Act in December, two appellate judges appointed by Republican presidents peppered lawyers with blunt questions while the third judge, appointed by President Jimmy Carter, remained silent. (Goodnough, 7/9)

The Washington Post: Appeals Judges Question Whether The ACA Can Stand Without Insurance Penalty
During oral arguments in a case with momentous stakes for consumers and politicians ahead of the 2020 elections, two members of a three-judge panel of the U.S. Court of Appeals for the 5th Circuit grilled lawyers representing Democratic-led states and the U.S. House to explain why the Affordable Care Act remains valid. “If you no longer have the tax, why isn’t it unconstitutional?” asked Judge Jennifer Walker Elrod, who was appointed by President George W. Bush. She and the other GOP appointee, Judge Kurt Engelhardt, named by President Trump last year, repeatedly noted that the law was written without an explicit feature guaranteeing that if one part were ever removed by Congress or the courts, the rest would remain in place. (Goldstein, 7/9)

The Wall Street Journal: Appeals Court Signals Peril For Affordable Care Act
California, leading 20 states defending the health law, argued the insurance mandate raised no constitutional problems because it is no longer enforceable without a penalty, making it more of a wish by Congress that people purchase coverage, not a command. “The individual mandate no longer requires anyone to do anything,” said California Deputy Solicitor General Samuel Siegel. Judges Elrod and Kurt Engelhardt, a Trump appointee, voiced doubts about that argument, saying the ACA still included language that requires people to carry coverage, penalty or not. Congress “left in place the mandatory nature of the mandate,” Judge Elrod said. (Kendall, 7/9)

The Associated Press: Validity Of Obama Health Care Law At Issue In Appeal Hearing
It was less clear after the arguments whether the judges also would invalidate the entire health care law, as the Trump administration favors. The hearing marked the latest development in a 2018 lawsuit by 18 Republican-leaning states claiming that the absence of a tax converts the law into an unconstitutional directive to U.S. citizens to buy a product. A lower court judge ruled in December that it did, and that the entire law must fall as a result. That includes popular provisions such as protection for pre-existing conditions. (McGill and Santana, 7/9)

Politico: Appeals Court Skeptical Obamacare Can Survive
Judge Kurt Engelhardt, a Trump appointee, pointed out that Congress could settle the dispute over the health law’s future by immediately stripping out the individual mandate entirely, eliminating the basis for the lawsuit. He also questioned why the Republican-controlled Senate hasn’t weighed in on the lawsuit.“They’re sort of the 800-pound gorilla who’s not in the room,” Engelhardt said. (Demko, 7/9)

Texas Tribune: Texas Asks Federal Appeals Court To Declare Obamacare Unconstitutional
Most of the unusually large courtroom audience of journalists and interested but unaffiliated attorneys focused on Elrod at the center. By far the most vocal judge of the three, Elrod probed both sides on the issue of standing — whether they have the right to participate in the lawsuit at all. And she appeared highly focused on her court’s options for ordering a remedy, seeming to weigh options for sending the case back to a lower court for further consideration. Engelhardt, who is among the newest appointees to the court, was harsh and occasionally sarcastic, asking more questions of the blue state coalition than he did of the Texas-led team. He seemed skeptical of the standing of both the California-led coalition and the Democratic-majority U.S. House of Representatives, which intervened in the case although the Republican-majority U.S. Senate did not. (Platoff, 7/9)

CNN: Republican-Appointed Judges Appear To Side With Texas Challenge To Obamacare
If the challenge to the Affordable Care Act ... is upheld, it would do what Trump and a GOP-led Congress failed to accomplish in 2017: take down Obamacare. And while Trump has repeatedly said that people with pre-existing conditions, such as cancer and diabetes, would be covered even if the law is struck down, he has not issued any specific plans to do so. (Luhby, Berman and Biskupic, 7/9)

Los Angeles Times: Federal Appeals Court Appears Skeptical Of Obamacare, Putting Future Of Law In Doubt
That would set the stage for another showdown before the Supreme Court, which has twice in the last decade been called upon to rule on the landmark law, often called Obamacare. Such a ruling could also prolong uncertainty over the fate of health coverage for tens of millions of Americans who depend on the law for health insurance and other protections, including the ban on insurers denying coverage to people with preexisting medical conditions. (Levey, 7/9)

CNN: How John Roberts's Signature Opinion Saving Obamacare Can Still Doom It
Chief Justice John Roberts saved Obamacare in 2012 by calling it a tax. Now, his core argument is helping power a Republican-led legal challenge that threatens to sweep away the entire law. ... Roberts, a 2005 appointee of Republican George W. Bush, forged a compromise in 2012 with the four Supreme Court liberal justices to uphold the signature domestic achievement of Obama. In dramatic moves behind the scenes, Roberts shifted multiple times in that landmark Obamacare challenge. After the 2012 case was argued, Roberts was part of a five-justice majority that wanted to strike down the individual insurance mandate. But he became wary of voiding a significant part of the law that was years in the making and reconsidered. (Biskupic, 7/10)

The New York Times: So You Want To Overturn Obamacare. Here Are Some Things That Would Be Headaches.
It’s not just that 21 million people would probably lose health insurance, or that 133 million Americans with pre-existing conditions would lose their protection. Those effects would be the major focus of attention if the Affordable Care Act were to be struck down. But the law was much, much broader, affecting a wide range of health programs, even some areas you might not think of as related to health. Overturning the entire law would mean all of its parts, in theory, would go away at once. (Sanger-Katz, 7/10)

Stat: Top Trump Advisers Hint At Support For Progressive Drug Pricing Idea
A trio of key White House advisors on Tuesday hinted for the first time that they could support a progressive proposal to cap price increases for certain medicines, speaking at a closed-door Capitol Hill briefing of Republican senators. Health secretary Alex Azar joined Joe Grogan, the president’s top policy adviser, to encourage senators to pursue bipartisan legislation on drug pricing and potentially to include one idea from Sen. Ron Wyden (D-Ore.) that would cap some drug price hikes at the rate of inflation, according to senators who attended. (Facher and Florko, 7/10)

The Hill: Trump Officials Seek Plan B On Drug Pricing Rule
The Trump administration suffered a blow when a federal judge blocked a key rule about drug price disclosures just hours before it was scheduled to take effect. U.S. District Judge Amit P. Mehta in Washington, D.C., on Monday sided with a coalition of drug companies and blocked the Trump administration from implementing a policy that would require prescription drug manufacturers to disclose list prices in TV ads. (Weixel, 7/9)

The Hill: GOP Senators Raise Concerns Over Potential Deal To Lower Drug Prices
Republican Senators and Trump administration officials met Tuesday morning to debate a potential deal to lower drug prices, with some attendees raising concerns about a possible agreement with Democrats. Senate Finance Committee Chairman Chuck Grassley (R-Iowa) held the meeting with GOP committee members to discuss a possible agreement that he has been negotiating for months with Sen. Ron Wyden (Ore.), the top Democrat on the panel. (Sullivan, 7/9)

The Associated Press: Trump Revamps Kidney Care To Spur Transplants, Home Dialysis
President Donald Trump is directing the government to revamp the nation's care for kidney disease to give more people with failing kidneys a chance at early transplants and home dialysis. Trump is set to sign an executive order Wednesday aimed at saving lives and millions of Medicare dollars. Senior administration officials tell The Associated Press that the order also is designed to ease financial hardship for living donors and help organizations collecting deceased donations do a better job. (7/10)

The Washington Post: Trump To Order Overhaul Of Organ Transplant And Kidney Dialysis Systems
“These are all good ideas. I’m impressed, very impressed,” said Tommy Thompson, who worked to boost organ donation when he was secretary of health and human services under President George W. Bush. “They are finally modernizing organ procurement.” The executive order the president is expected to unveil Wednesday, first reported by Politico, is one of a series of health- care initiatives Trump is announcing in the run-up to the 2020 presidential election. Several of the Department of Health and Human Services rules have been held up by court fights or budgetary concerns. (Bernstein and Kindy, 7/9)

The Wall Street Journal: Rifts Emerge Over Congressional Move To Curb Surprise Medical Bills
A Congressional plan to tackle surprise medical bills is spurring a furious lobbying campaign and disagreements among Republican lawmakers that could make it difficult to pass the legislation this month. Measures protecting patients from high hospital bills from out-of-network doctors and other health providers has the backing of President Trump, who in May urged lawmakers to take action. Senate Health Committee Chairman Lamar Alexander (R., Tenn.) is hoping the full Senate will vote this month on a plan that would address surprise bills, after his committee approved it in late June. (Armour and Peterson, 7/10)

The Associated Press: California Takes On Surprise Bills, Over Hospital Objections
Lawmakers in Congress and state legislatures across the country have proposed bills to fix problems like this, especially in emergency situations where patients often cannot choose what hospital treats them. While most people agree patients should not have to pay in these situations, there's little agreement on who should. It's a debate now playing out in the California Legislature that's pitting insurance companies and hospitals against each other. A bill by Assemblyman David Chiu, a San Francisco Democrat, would make sure emergency patients never pay more than their copays or deductibles, even if they are treated at an out-of-network hospital. But the bill would cap what hospitals can charge insurance companies, because advocates and some lawmakers view hospitals as a monopoly with too much power over prices. Chiu said his goal is to keep insurance rates from skyrocketing. (Beam, 7/9)

The New York Times: Why Women Getting Abortions Now Are More Likely To Be Poor
Abortion access in America is narrowing. There are fewer clinics, longer drives and more restrictions earlier in pregnancy. But something else is different: The women themselves. Women getting abortions today are far more likely to be poor than those who had the procedure done 20 years ago. Half of all women who got an abortion in 2014 lived in poverty, double the share from 1994, when only about a quarter of the women who had abortions were low-income, according to the Guttmacher Institute, a research group that supports abortion rights and conducts a national survey of abortion patients every six years. (Tavernise, 7/9)

The Associated Press: Abortions Halted At Arkansas Clinic While New Site Sought
Planned Parenthood says it's stopped providing medication-induced abortions at its facility in northwest Arkansas while it seeks a new location, leaving the state for now with two abortion providers. Planned Parenthood Great Plains Chief Executive Officer Brandon Hill said in a court filing over the weekend that the organization stopped providing abortions at its health center in Fayetteville, located 140 miles northwest of Little Rock, while it looks for a new site. (DeMillo, 7/9)

The Associated Press: Most Attackers Made Threats Before Incident, Report Finds
One-third of the attackers who terrorized schools, houses of worship or businesses nationwide last year had a history of serious domestic violence, two-thirds had mental health issues, and nearly all had made threatening or concerning communications that worried others before they struck, according to a U.S. Secret Service report on mass attacks. (Long, 7/9)

Reuters: Most Perpetrators In 2018 Mass Attacks Made Threats: U.S. Secret Service
Two-thirds of the attackers also had a history of mental health issues and half were motivated by workplace or personal grievances, the agency said in a report published by its National Threat Assessment Center. "The violence described in this report is not the result of a single cause or motive," it added. "The findings emphasize, however, that we can identify warning signs prior to an act of violence." (O'Brien, 7/9)

The New York Times: A Gun-Focused Special Session In Virginia Ends Abruptly
In the grim aftermath of the mass shooting in Virginia Beach in May, Gov. Ralph Northam insisted it was time for action. Thoughts and prayers were not enough, he said, as he called for a special session of the Virginia General Assembly to consider a raft of gun control proposals. That special session began on Tuesday around noon. An hour and a half later, it was over. The House and Senate voted along party lines to adjourn until November. (Robertson, 7/9)

The Washington Post: Gun Debate Ends Abruptly In Virginia As GOP-Controlled Legislature Adjourns After 90 Minutes
Gov. Ralph Northam (D) ordered the session in the wake of the May 31 mass shooting at a Virginia Beach municipal building in which 12 people were killed. Lawmakers had filed some 30 bills aimed at restricting gun use or lethality or stiffening penalties for gun law violations. Republican leaders in the state House and Senate said they would refer all bills to the bipartisan Virginia State Crime Commission for study and recommendation, and then reconvene Nov. 18 — after a high-stakes state election in which all 140 legislative seats are on the ballot. (Schneider, Vozzella and Olivo, 7/9)

The Washington Post: Amid Bitter Divisions On Gun Control In Virginia, Moments Of Understanding
One man held an AR-15 semiautomatic rifle and wore a black “Make America Great Again” hat. The other man held a sign with a picture of two arms in an embrace and the caption “The only arms we need” and wore a blue hat that said “Make America Obama Again.” They were caught Tuesday morning outside the Virginia State Capitol between hundreds of anti-gun protesters on one side and a long line of gun rights activists on the other. And they began to talk. (Schneider and Vozzella, 7/9)

The Associated Press: California OKs Benefits To Immigrants In Country Illegally
California has become the first state to offer taxpayer-funded health benefits to young adults living in the country illegally. Democratic Gov. Gavin Newsom signed a bill into law on Tuesday that makes low-income adults age 25 and younger eligible for the state's Medicaid program regardless of their immigration status. (7/9)

NPR: California Approves Law Giving Health Benefits To Undocumented Adults
On Tuesday, Newsom said the state law draws a sharp contrast with Trump's immigration policies. "If you believe in universal health care, you believe in universal health care," Newsom said. "We are the most un-Trump state in America when it comes to health policy." In California, extending health benefits to undocumented immigrants is widely popular. A March survey conducted by the nonpartisan Public Policy Institute of California found that almost two-thirds of state residents support providing coverage to young adults who are not legally authorized to live in the country. (Allyn, 7/10)

Los Angeles Times: Are Democrats Helping Trump By Promising Healthcare To Undocumented Migrants?
With a sharp left turn, Democrats are risking a backlash on an issue of raw emotional and political sensitivity: providing government healthcare to millions of people in the country illegally. Ten of the party’s nearly two dozen presidential candidates stood on a debate stage last month and, without hesitation, raised their hands pledging themselves to the policy shift. Most others in the field have also expressed their support. “This is not about a handout,” said South Bend., Ind., Mayor Pete Buttigieg. “This is an insurance program. We do ourselves no favors by having 11 million undocumented people in our country be unable to access healthcare.” (Barabak and Levey, 7/9)

The New York Times: Border Arrests Drop By 28% In June In First Decline Of The Year
Arrests at the southwestern border dropped by 28 percent in June, according to the Department of Homeland Security, signaling the first time this year that the number of border crossings declined. The department said that 104,344 arrests occurred in June, down from 144,278 in May — the highest monthly total in 13 years. It credited the drop to the security forces Mexico deployed to prevent migrants from reaching the United States border and the expansion of a program that forces migrants to wait in Mexico as their immigration cases are processed. (Kanno-Youngs, 7/9)

The Associated Press: Border Numbers Drop Amid Heat, Mexico Crackdown
The decline comes amid renewed outcry over squalid conditions for migrant children crammed into facilities not meant to hold them longer than 72 hours. Some are kept for weeks because of delays in the system. The monthly border apprehension numbers have become a yardstick by which President Donald Trump measures the success of his administration’s efforts to reduce immigration, his signature issue. The number of families from Central America has risen dramatically under his term despite his hardline policies. (Long, 7/9)

NPR: Drop In Migrant Flow Across U.S.-Mexico Border In June
Still, the number of migrants DHS reported taking into custody remains high. DHS noted that that the total number of apprehensions in the first six months of this year is 140% higher than the same period last year. "We are still in an ongoing border security and humanitarian crisis," the department said in a statement. "We are past the breaking point and in a full-blown emergency. This situation should not be acceptable to any of us." (Burnett and Rose, 7/9)

Stat: Do Doctors Prescribe More Painkillers Because Of Pharma Money? 
Amid ongoing concern that painkillers other than opioids are being misused, a new analysis suggests industry payments to physicians may cause increased prescribing of a class of drugs known as gabapentinoids, which are used to relieve pain and includes the popular Lyrica pill sold by Pfizer (PFE). After combing through a federal database of payments to doctors and running statistical models, the researchers found that physicians receiving food, gifts, and speaking and consulting fees, among other things, were nearly twice as likely to prescribe these medicines instead of lower-cost generic versions. (Silverman, 7/9)

Reuters: Trump Administration Drug Officials Clash Over How To Combat Fentanyl Copycats
Trump administration officials are divided over part of a proposal to crack down on illicit versions of fentanyl, the deadly synthetic painkiller that U.S. President Donald Trump targeted in declaring a national opioid abuse emergency. In an inter-agency dispute that highlights the challenges of curbing opioid abuse, the U.S. Drug Enforcement Administration (DEA) is publicly backing tighter rules for fentanyl analogues, which are slightly altered copycat versions of the powerful drug fueling an explosion in overdoses. (7/9)

The Associated Press: A Peek Into Opioid Users' Brains As They Try To Quit
Lying inside a scanner, the patient watched as pictures appeared one by one: A bicycle. A cupcake. Heroin. Outside, researchers tracked her brain's reactions to the surprise sight of the drug she'd fought to kick. Government scientists are starting to peek into the brains of people caught in the nation's opioid epidemic, to see if medicines proven to treat addiction, like methadone, do more than ease the cravings and withdrawal. Do they also heal a brain damaged by addiction? And which one works best for which patient? (7/9)

The New York Times: C.D.C. Investigates Rare Type Of Paralysis In Children
Last year, health officials confronted a record number of cases of a rare, mysterious neurological condition that caused limb weakness and paralysis in more than 200 children across the country. Officials with the Centers for Disease Control and Prevention said on Tuesday that they were still trying to understand the condition, called acute flaccid myelitis, or A.F.M. And though there have been very few cases so far this year, they urged doctors to be on the lookout because the illness has tended to emerge in late summer and early fall. (Belluck, 7/9)

The New York Times: How Music Can Rev Up A High-Intensity Workout
Cuing up some Calvin Harris or Macklemore during short, intense workouts might change how we feel about the exercise, according to a useful new study of how listening to jaunty music can encourage us to push ourselves harder. The study also found, though, that other types of distractions, such as podcasts, may not have the same effect. High-intensity interval workouts are quite popular at the moment, touted by trainers, coaches, scientists and this column as a way to exercise effectively without investing much time. (Reynolds, 7/10)

The Associated Press: In US Baby Is Born From Dead Donor’s Transplanted Womb
The Cleveland Clinic says it has delivered the first baby in North America after a womb transplant from a dead donor. Uterine transplants have enabled more than a dozen women to give birth, usually with wombs donated from a living donor such as a friend or relative. In December, doctors in Brazil reported the world’s first birth using a deceased donor’s womb. These transplants were pioneered by a Swedish doctor who did the first successful one five years ago. (7/9)

The Wall Street Journal: Rhode Island Looks To Lift Providence’s Failing School District
Brown tap water. Student brawls. Chronically absent teachers. Test scores that rank among the worst in the country. The public school district here is full of deplorable conditions, according to a recent scathing report by the Johns Hopkins Institute for Education Policy. Now the capital city, proud of its downtown renaissance, restaurants and arts scene, faces a painful reckoning as it debates what to do with a failing school system that serves 24,000 children, who are mostly poor and Hispanic. (Brody, 7/10)

Reuters: Air Quality Plummets As Wildfire Smoke Hits Alaska's Most Populous Cities
Smoke and soot from central Alaska wildfires have afflicted the subarctic city of Fairbanks with some of the world's worst air pollution in recent days, forcing many residents indoors and prompting one hospital to set up a "clean air shelter." Fine particulate matter carried by smoke into the Fairbanks North Star Borough over the past two weeks has been measured at concentrations as high as more than double the minimum level deemed hazardous to human health, borough air quality manager Nick Czarnecki said. (7/9)

NPR: Beat Bedbugs With Heat And Hotel Vigilance
Summer is a time of travel and fun. But with every bed an exhausted traveler falls into after a day of sightseeing, the chances of bringing home an unwanted bug increase. Bedbugs don't fly or jump or come in from your garden. They crawl very quickly and are great at hiding in your luggage when you travel and hitching a ride into your home — or hotel room. (Quiros, 7/9)

Los Angeles Times: Ex-USC Gynecologist Sold Sex Videos He Recorded In Foreign Hotel Rooms, Prosecutor Says
A former USC gynecologist charged with sexual abuse of patients also sold photographs and sex videos he took of young women he lured to his hotel rooms while traveling outside the U.S., a prosecutor said Tuesday. The allegation was raised at a downtown Los Angeles court hearing, during which the prosecutor tried to persuade a judge to keep George Tyndall’s bail at nearly $2.1 million, arguing that the doctor charged with sexual misconduct toward 16 former patients was a danger to the public and a flight risk. (Tchekmedyian, 7/9)

The Associated Press: Former USC Gynecologist's Bail Lowered In Sex Assaults Case
A Los Angeles judge reduced bail Tuesday for a former University of Southern California gynecologist accused of sexually assaulting 16 women. Superior Court Judge Teresa Sullivan lowered Dr. George Tyndall's bail from nearly $2.1 million to $1.6 million, which he may be able to post using his condominium as collateral. If he posts bail, he will be confined to house arrest with GPS monitoring. (7/9)

Los Angeles Times: UCLA Employee May Have Spread Measles At Campus Food Court
A UCLA employee who contracted measles may have exposed students and others to the highly contagious disease, according to campus officials. A university employee was diagnosed with measles on Monday. But health officials say he may have infected students when he ate lunch at the Court of Sciences Student Center food court between 9 and 11:30 a.m. on July 2 and 3, according to health officials. (Karlamangla, 7/9)

Los Angeles Times: San Francisco Homeless Count Goes From Bad To Worse, Jumping 30% From 2017
Over the last several months, cities and counties across California have been releasing homeless counts. The results have been grim. San Francisco was no exception. In May, the city released data that showed homelessness had jumped 17%. That was bad enough. Last week, a more complete accounting, known as a point-in-time count, showed the problem was even worse. The count revealed that homelessness in a city that’s become a caricature of wealth inequality in the U.S. had actually increased by about 30% from 2017, when the last count took place. (Oreskes, 7/9)