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Political Cartoon: 'Case In Point?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Case In Point?'" by Steve Sack, The Minneapolis Star Tribune.

Here's today's health policy haiku:


It passed the sniff test …
So the human nose does know!
Who would have guessed that?

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Summaries Of The News:

Health Law

Senate Task Force Considers Ways To Unravel Obamacare Coverage Rules

Key to this discussion is how to handle regulations that require plans to cover a set of essential health benefits as well as preexisting condition protections.

The Hill: Senate GOP Examining Ways To Repeal ObamaCare Insurance Rules 
Senate Republicans are looking into repealing ObamaCare regulations on what services an insurance plan must cover, Sen. John Cornyn (R-Texas) said Thursday. Leaving a meeting of the Senate's healthcare working group, Cornyn was asked if senators are looking at their ability to repeal ObamaCare's essential health benefits. "I'd say yes, we're looking at it," Cornyn replied. (Sullivan, 5/11)

CQ Roll Call: Senate Task Force Discusses Plan To Ease Health Benefit Rules
Senate Republicans in the early stages of revamping a House bill to repeal the 2010 health law met Thursday, reporting progress but no path to consensus in the near future. ... Republicans who are trudging ahead on the daunting task of completing their seven-year quest to repeal the 2010 health law caution that any major legislative activity could take weeks, possibly months. Significant action will have to wait until at least the week of May 22, when the Congressional Budget Office is expected to release its analysis of the bill that narrowly cleared the House last week. (Mershon and Williams, 5/11)

The Associated Press: Senate Conservatives: Ease Obama Health Care Law Protections
Conservative senators are pushing to diminish insurance coverage requirements imposed by President Barack Obama's health care law as Senate Republicans try fashioning legislation overhauling the nation's health care system. Their ideas include erasing Obama consumer protections, such as barring higher premiums for people with pre-existing medical conditions, but allowing states to opt into them. (5/11)

In Repeal-And-Replace Package, Senate Gives New Look To Pegging Tax Credits To Income

The approach - which Politico says would make the insurance subsidies "look a lot like Obamacare" - is billed as a breakthrough in the upper chamber but would likely face difficulties among House conservatives.

Politico: Tax Credits May Provide Rallying Point For Senate Obamacare Repeal
Senate Republicans are working on a potential breakthrough that could help push through an Obamacare repeal bill – by making insurance subsidies look a lot like Obamacare. There’s growing support for the idea of pegging the tax credits in the House repeal bill to income and making aid more generous for poorer people. But those moves — while they may win consensus among Senate moderates — are unlikely to sit well with House conservatives. (Haberkorn, 5/11)

Also in the news —

The Wall Street Journal: What May Happen To Your Medical Tax Deduction
Millions of taxpayers who deduct medical expenses each year are right to be concerned. Congress is attempting to make massive changes to both America’s health-care system and tax code. With those changes in mind, worried readers of Tax Report have written to ask what the impact will be on the one issue that is common to both: the medical-expense tax deduction. (Saunders, 5/12)

Is Rape Considered A Preexisting Condition? The Answer To This - And Other Questions Related To The GOP Health Plan - Aren't Always Simple

Republicans are fielding inquiries on the ramifications of the American Health Care Act.

NPR: House Republicans Defend Health Bill Against Accusations It Hurts Rape Victims
At a town hall meeting in Willingboro, N.J., on Wednesday, U.S. Rep. Tom MacArthur was confronted by angry constituents who demanded to know how the Republican health care bill that he helped write would affect rape victims. A young man named Joseph said he understood that the bill would allow insurance companies to deem rape a pre-existing condition and deny coverage to people who have been raped. (Kodjak, 5/11)

In other news on repeal-and-replace efforts —

Modern Healthcare: GOP Senators Likely To Pass ACA Repeal Bill​ Because Failure Is Not An Option
Senate Majority Leader Mitch McConnell faces a seemingly herculean task in getting at least 50 Republican senators with sharply diverse views to reach consensus on a bill to repeal and replace the Affordable Care Act. After that, he and his lieutenants will have to forge an agreement on the legislation with the generally more conservative House Republicans, who passed their widely panned replacement bill earlier this month. Senate Republicans intend to move the bill through the budget reconciliation process with no Democratic support. No committee hearings are planned. With 52 GOP senators, McConnell can't afford more than two defectors. Vice President Mike Pence could be called on to break a tie vote. (Meyer, 5/12)

The Hill: Portman, Toomey Tasked With Medicaid Talks
Senate Majority Leader Mitch McConnell (R-Ky.) has asked Sens. Pat Toomey (R-Pa.) and Rob Portman (R-Ohio) to discuss a way forward on the issue of Medicaid, according to Senate GOP aides. Portman and Toomey are tasked with discussing how quickly to wind down ObamaCare's Medicaid expansion and how quickly a cap on Medicaid payments should grow. (Sullivan, 5/11)

The Hill: McConnell Promises Women Can Take Part In Healthcare Meetings 
Senate Majority Leader Mitch McConnell (R-Ky.) has provided assurance to GOP colleagues that women will be invited to attend future meetings of a special working group tasked with negotiating healthcare reform. The assurances made in private, backed up by a public statement earlier in the week, have quelled concern in the GOP conference that the rollout of the working group would be derailed by controversy over gender politics. (Bolton, 5/12)

Nashville Tennessean: Tennessee Native: Fix Obamacare, Don't Rip It Apart
An East Tennessee native who was one of the key architects of the Affordable Care Act urged Congress on Thursday to repair what’s wrong with the landmark health care law – and even rebrand it if necessary – but implored lawmakers not to decimate the protections it has provided to millions of Americans. “Don’t strip away the essential health care that people have gotten now,” said Nancy-Ann DeParle, who was a top health care adviser to former President Barack Obama. “That would be a terrible mistake.” (Collins, 5/11)

The Philadelphia Inquirer: 17 Pennsylvania Mayors Say Don't Defund Planned Parenthood
A bipartisan group of 106 mayors from 28 states, including Mayor Kenney and 16 others from Pennsylvania, have signed a letter to congressional leaders opposing efforts to “defund” Planned Parenthood, according to the family planning organization...The House of Representatives last week narrowly voted for a GOP health plan that would dramatically changing health funding and other parts of the Affordable Care Act. The GOP's American Health Care Act, which is expected to face a tough battle in the Senate, would block federal Medicaid payments to Planned Parenthood for a year. (McCullough, 5/11)

The New York Times: Midwestern Manners A Memory At One Iowa Republican’s Town Halls
It is still uncertain whether Republicans in Congress will succeed in undoing the Affordable Care Act, but the debate over repealing it may have already done in Midwestern Nice. It was Tuesday evening, and inside a community college gymnasium, the jeers were hailing down on Representative Rod Blum, a Republican from northeastern Iowa, as he defended his vote for a bill that would reshape health care and repeal much of President Barack Obama’s biggest domestic accomplishment. (Healy, 5/11)

KQED: ‘I’m Andrew Janz And I’m Here To Repeal And Replace Devin Nunes’
Protesters gathered in front of Congressman Devin Nunes’ office in Clovis on Thursday, upset about his vote to support the GOP health care plan and critical of his handling of the investigation into Russian election interference. And, to hear from the first challenger to Nunes in the 2018 midterm election, a 33-year-old Fresno County deputy district attorney making his first run for office. (Rancano, 5/11)

Approval For GOP Health Plan Ticks Up Slightly To 21 Percent

But 75 percent of respondents – and 59 percent of Republicans – say it is a “bad idea” to allow states to opt out of cost-lowering protections for those with preexisting conditions. A separate poll looks at the percent of Americans who are worried about losing access to care.

Politico: Poll: Just 21 Percent Approve Of House’s Obamacare Repeal Bill
Less than a quarter of American voters surveyed in a new poll released Thursday by Quinnipiac University approve of the legislation passed last week by the House of Representatives to repeal and replace the Affordable Care Act. Fifty-six percent of those polled said they disapprove of the legislation, dubbed the American Health Care Act, while just 21 percent said they support it. The support for the legislation represents an improvement over the 17 percent who said they supported the iteration of the bill that failed to pass the House in March. (Nelson, 5/11)

Modern Healthcare: Majority Of Americans Fear They'll Lose Health Insurance
The idea that the government has a responsibility to make sure everyone has access to "affordable, quality healthcare" is highly popular, according to a new survey from Consumer Reports. That's similar to other recent national polls. Consumer Reports conducted a poll from April 6 to 9, with a nationally representative sample and released the results Thursday. It found that 56% of Republicans say the government should make sure everyone can access affordable healthcare, and 78% of all respondents agreed. (Lee, 5/11)

And a look at what the health legislation might mean for you —

Columbus Dispatch: How Would The House GOP Health-Care Plan Affect You?
By rapidly approving a major overhaul last week of the 2010 health-care law known as Obamacare, House Republicans have raised questions among many voters on precisely what kind of coverage they will receive if the Senate approves the same version — unlikely as that might be. The nonpartisan Congressional Budget Office has not analyzed the latest House GOP bill. But in March, the office analyzed a similar measure and concluded the number of Americans without health insurance or government coverage would increase by 24 million by 2026. (Torry, 5/12)

Political Fate Pondered Of Key Role Players In Republican Health Care Bill Wrangling

Reps. Tom MacArthur (R-N.J.), Fred Upton (R-Mich.) and Mark Meadows (R-N.C.) have emerged as national figures during the weeks of negotiations to push a Obamacare replacement bill through the House.

The Philadelphia Inquirer: South Jersey's MacArthur Could Be A GOP Star — If Health-Care Backlash Doesn’t Sink Him
Just a few years ago, Tom MacArthur was virtually unknown in New Jersey politics. A former mayor of Randolph, a North Jersey town of 26,000, he moved to the shore to run for an open congressional seat in 2014. Over the past several weeks, MacArthur burst onto the national scene by brokering a deal with the White House and conservative hard-liners in Congress that revived the GOP’s plan to repeal and replace the Affordable Care Act. (Seidman and Tamari, 5/12)

Politico Pro: MacArthur, Upton Have Senate Buzz After Health Care Roles 
Reps. Tom MacArthur (R-N.J.) and Fred Upton (R-Mich.) are now the men who saved the House GOP’s plan to replace Obamacare. And two years from now, they might be senators — or be out of office entirely. Upton is seriously considering a Senate run, according to Republican operatives close to him, and national Republicans have long seen him as the best candidate to face Democratic Sen. Debbie Stabenow in 2018. Another Republican source said MacArthur would consider challenging under-indictment Democratic Sen. Robert Menendez in 2018, too. (Robillard and Strauss, 5/12)

Roll Call: Western North Carolina Notices Meadows’ Newfound Notoriety
Rep. Mark Meadows has long been a household name in western North Carolina, but his newfound notoriety outside the 11th District has not gone unnoticed by those back home. “If you watch TV at all you know that our congressman is very much a mover and shaker in Washington, D.C.,” South Caldwell High School teacher Tony Crump said, as he introduced Meadows at a masonry competition Thursday for three area high schools. Meadows has been on national cable news a lot more in the past few months. The chairman of the conservative House Freedom Caucus was one of the key figures in the debate over the health care bill that narrowly passed the House last week. (McPherson, 5/12)


As 2018 Marketplace Premiums Appear To Be Heading Up, Trump Suggests He Might Cut Subsidies

The early indications from insurers suggest that premiums for plans sold on the health law's marketplaces will rise on average again next year. Meanwhile, in an interview with the Economist, President Donald Trump talks about the cost-sharing subsidies that the federal government pays insurers to help cover expenses of low-income customers, saying "we don’t have to subsidize" Obamacare. "You know if I ever stop wanting to pay the subsidies, which I will," Trump said. "Anytime I want."

The Wall Street Journal: Kaiser Permanente Chief Pledges To Remain In Affordable Care Act Markets
Kaiser Permanente Chief Executive Bernard Tyson said Thursday that the Affordable Care Act insurance markets are “still very unstable,” but repeated earlier statements that the managed-care system will stick with the markets next year. In remarks at a Wall Street Journal Future of Healthcare event in New York, Mr. Tyson rejected the characterization by Aetna Inc. Chief Executive Mark Bertolini earlier this year that the markets were in a death spiral. “I would not use that term,” Mr. Tyson said, “because we have 20-plus million people getting access to care though the front door. That’s progress.” (Evans, 5/11)

The Hill: Trump Threatens To Stop ObamaCare Payments
President Trump on Thursday threatened to withhold key payments to insurance companies made under ObamaCare, a move that could throw the market into chaos. In an interview with The Economist, Trump said he would cut off the cost-sharing reductions (CSRs) — payments that reimburse insurers for providing discounted out-of-pocket costs to help those with low incomes afford insurance. "[T]here is no Obamacare, it’s dead. Plus we’re subsidizing it and we don’t have to subsidize it. You know if I ever stop wanting to pay the subsidies, which I will," Trump said. "Anytime I want." (Weixel, 5/11)

Fiscal Times: Trump: I Can End Obamacare Health Insurer Subsidies ‘Anytime I Want’
Last Thursday, just a day after House Republicans passed a bill to overhaul the U.S. health care system, President Trump sat down with reporters from The Economist for a wide-ranging interview on his economic policies. The recently released transcript contains numerous eyebrow-raising statements and claims from the president .... But one element of it could very well roil the already turbulent market for individual health insurance plans. ... In the Economist interview, though, Trump went further than he or anyone in his administration has before, suggesting that he might eliminate CSR payments on a whim. (Garver, 5/11)

Judge Gives Cigna Permission To Pull Out Of Proposed Merger With Anthem

The merger had been blocked after federal officials raised objections, but Anthem had sought court approval to keep Cigna from walking away from the proposal.

The Associated Press: Judge Denies Anthem Injunction In Lawsuit Over Cigna Merger
A Delaware judge on Thursday refused Anthem Inc.’s request to extend a temporary ban blocking Cigna Corp. from pulling out of proposed $48 billion merger while Anthem tries to persuade federal officials to drop their objections to the deal. The ruling comes after a federal appeals court last month left in place a decision blocking Blue Cross-Blue Shield insurer Anthem’s bid to buy rival Cigna, saying a bigger company would not be better for consumers. (Chase, 5/11)

Modern Healthcare: Cigna Free To Part Ways With Anthem 
Cigna Corp. has been cleared to walk away from its proposed $54 billion merger agreement with insurer Anthem, a Delaware Chancery Court judge ruled late Thursday. Judge Travis Laster denied Anthem's request to block Cigna from terminating the agreement, but stayed the ruling until noon on Monday to give Anthem time to decide whether it will appeal the decision. Cigna initiallly tried to end its relationship with Anthem in February, but was blocked by a termporaray restraining order. In a statement Thursday, Cigna said, "We look forward to closing this final chapter." Anthem did not return a request for comment. (Livingston, 5/11)

Veterans' Health Care

Non-Sterile Equipment And Missing Tools Halt Surgeries At VA Hospital In Washington

In other veterans' health news, lawmakers move forward with stalled Veterans Affairs legislation while the significant costs of private health care for vets concerns Senate appropriators.

USA Today: Stained, Missing Surgical Tools At Washington VA Hospital Put Veteran Patients In Danger
Investigators found stained surgical equipment and a surgery had to be halted at the Veterans Affairs hospital in Washington Wednesday because staff lacked equipment, indicating patients there are still in danger and prompting the VA’s chief watchdog to immediately notify members of Congress. A patient prepped for vascular surgery in the operating room at the hospital had already been placed under anesthesia when “it was determined that the surgeon did not have a particular sterile instrument to perform the surgery,” VA Inspector General Michael Missal wrote in a letter Wednesday. (Slack, 5/11)

The Washington Post: Lawmakers Reach Deal On Legislation To Make It Easier To Fire VA Employees
Top lawmakers on Capitol Hill have reached a bipartisan deal on legislation to allow the Department of Veterans Affairs to take swift action to fire employees, an overhaul of long-guaranteed civil service protections that President Trump promised he would enact to bring accountability to the troubled agency. The agreement announced Thursday by key senators led by Marco Rubio (R-Fla.) clears a path for passage of a dramatic change that has stalled in Congress for three years following a scandal over waiting times for medical appointments at VA hospitals. (Rein, 5/12)

CQ Roll Call: Costs For Veterans' Private Health Care Worry Appropriators
Senate appropriators at a Thursday hearing highlighted the problems that could emerge with using both discretionary and mandatory funding to provide private medical care for veterans. Their comments came as they also debated the broader issue of how the Department of Veterans Affairs plans to rein in potentially significant costs associated with expanding veterans’ use of doctors and hospitals outside the VA system. (Mejdrich, 5/11)

Women’s Health

Texas Lawmakers Want Abortion Clinics To Be Required To Report Complications To Health Department

Opponents argue that the procedure has a low complication rate.

Texas Tribune: Texas House Moves To Require More Abortion Reporting Data 
Health facilities that perform abortions may soon have to release more detailed data on complications that arise during and after the procedure — another move by GOP lawmakers to crack down on abortions in Texas. House lawmakers voted 94-52 to require hospitals, birthing centers, community health centers and freestanding emergency rooms that perform abortions — not just abortion clinics — to submit complication reports to the Department of State Health Services. (Evans, 5/11)

Austin American-Statesman: Texas House OKs Bill Requiring Reports On Abortion Complications
Revisiting the sorts of abortion battles that have embroiled Texas over recent legislative sessions, the House on Thursday considered a measure that requires facilities providing abortions to report complications related to the procedure. House Bill 2962, by Rep. Giovanni Capriglione, R-Southlake, proposes that every hospital, abortion facility, and medical care facility that provides emergency care assemble a quarterly report on each abortion complication diagnosed or treated at the facility. (Price, 5/11)

Meanwhile, in Illinois —

Reuters: Illinois Lawmakers Delay Bill To Expand Abortion As Veto Looms
Democratic lawmakers in Illinois on Thursday said they have placed on hold a bill that expands state-funded coverage of abortions for low-income residents and state employees but faces a likely veto from the state's Republican governor. The bill, which received final passage in a 33-22 state Senate vote on Wednesday, also aims to keep abortions legal in Illinois if the U.S. Supreme Court follows President Donald Trump's call to overturn its landmark Roe v. Wade ruling that made abortions legal 44 years ago. (Mclaughlin, 5/11)

Chicago Sun Times: Senate Dems Put Hold On Sending Abortion Bill To Rauner's Desk 
Illinois Senate Democrats are temporarily halting a controversial abortion bill from reaching the governor’s desk — calling it a way to protect the bill from Gov. Bruce Rauner’s vowed veto “until he comes to his senses.” The bill would force the Republican governor running for re-election to decide whether to risk angering socially moderate voters by vetoing it, or risk the wrath of conservatives by signing it. (Sfondeles, 5/11)

Public Health And Education

Experts Chide Price For Saying Addiction Medications Don't 'Move The Dial Much'

Using buprenorphine or methadone to treat opioid addiction is considered the standard of care. Meanwhile, Health and Human Services Secretary Tom Price is touring states to talk about the epidemic that's raging through the country, and senators warn President Donald Trump that cutting funding to the drug office will hamper efforts to curb that crisis.

Politico: Addiction Specialists Blast Price Comment On Opioids
Addiction specialists and public health officials on Thursday chided Health and Human Services Secretary Tom Price for belittling the use of medications considered the standard of care for the treatment of opioid addiction. The remarks irked specialists already worried by the Trump administration's law-and-order stance on drug control and its tentative plans, leaked to POLITICO last week, to gut the White House Office of National Drug Control Policy. And ousted Surgeon General Vivek Murthy — fired by President Donald Trump last month — chimed in about the scientific evidence on Twitter. (Allen, 5/11)

Stat: Ousted Surgeon General Rebukes Tom Price Over Comment On Addiction Treatment
Dr. Vivek Murthy, who was ousted last month as surgeon general by the Trump administration, returned to public debate on Thursday to speak out against Secretary of Health and Human Services Tom Price and a comment he made about addiction treatment. Murthy took to Twitter late in the afternoon to support the use of medications to treat addiction. In a string of posts, he said that the approach was scientifically shown to be effective in addressing addiction, a point he said his office made in a report last year. (Facher, 5/11)

NPR: Communities Key To Fighting Opioid Crisis, Says HHS Secretary Tom Price
In March, President Trump called opioid abuse in the U.S. "a total epidemic," and issued an executive order creating a commission focused on combating the opioid crisis. On Wednesday, the White House announced it would appoint Massachusetts Gov. Charlie Baker, North Carolina Gov. Roy Cooper, former Rhode Island Rep. Patrick Kennedy and Harvard Medical School researcher Bertha Madras to the commission, which is headed by New Jersey Gov. Chris Christie. Now, the secretary of health and human services, Tom Price, is touring communities that have been hit especially hard by painkiller and heroin overdoses. (Martin, Brown, Gordemer and Hersher, 5/12)

Stat: Senators Push Back On Trump's Proposed Cuts To Drug Control Office
The Trump administration’s proposal to nearly eliminate funding for White House office tasked with overseeing the nation’s opioid fight is getting fast and firm pushback from the Senate. A bipartisan group of 13 lawmakers, led by Senators Chuck Grassley (R-Iowa) and Dianne Feinstein (D-Calif.), warned President Trump this week that reducing the Office of National Drug Control Policy’s budget by nearly 95 percent would derail the fight against the opioid epidemic, hamper law enforcement efforts, and cost the government money in the long run. (Facher, 5/11)

In other news —

The Wall Street Journal: New York City To Open Crisis Centers
New York City plans to spend $90 million to open two centers where police can bring people with mental illness or substance-abuse issues instead of arresting them. The short-term stay facilities, known as diversion centers, are intended for people who might otherwise be arrested or issued a summons for low-level charges. City officials estimate the two, approximately 20-bed centers, designed largely for stays of up to five days, would serve 2,400 people annually. (Ramey and Kanno-Youngs, 5/11)

Boston Globe: City Of Newton, Newton-Wellesley Hospital Partner In Opioid Fight 
Newton-Wellesley Hospital and the city of Newton say their new partnership will help in the fight against the state’s ongoing opioid abuse epidemic. A new Substance Abuse Disorders Service team at the hospital will expand clinical education and training programs for providers, plus offer treatment for patients with chronic pain and substance use disorders, according to a joint statement. (Hilliard, 5/11)

KCUR: Hy-Vee Announces It Will Sell Naloxone In Missouri Without A Prescription 
Another major pharmacy chain in Missouri now offers naloxone, the potentially lifesaving drug that prevents opioid overdose deaths, to Missourians without a prescription. Hy-Vee announced Wednesday it will now sell the drug to customers in Missouri, Iowa, Wisconsin, and South Dakota. Hy-Vee is the latest major pharmacy chain to carry naloxone without a prescription in Missouri, after Walgreens and CVS made similar announcements last year. The drug is administered in a nasal spray or injection, and can save the life of someone experiencing an opioid overdose. (Woodiel, 5/11)

Fueled By The Opioid Crisis, Hepatitis C Cases Skyrocketing

The Centers for Disease Control and Prevention says access to clean syringes and a limit on Medicaid barriers to curative treatments for hepatitis C can reduce rates of death from the disease and transmission of the virus to others.

Reuters: U.S. Hepatitis C Cases Soar On Spike In Heroin Use
U.S. health officials said new cases of hepatitis C rose nearly 300 percent from 2010 to 2015, despite the availability of cures for the liver disease, fueled by a spike in the use of heroin and other injection drugs, according to a report released on Thursday. (Berkrot, 5/11)

USA Today: Hepatitis C Infections Tripled In Five Years
The trend isn't only destroying families, it's devastating state health care budgets. Sky high hepatitis C drug costs have led states to restrict coverage of drugs to treat it. Free needle exchanges, which minimize the sharing of needles that transmit the disease, also face challenges with funding and opposition among those who believe it encourages drug use. (O'Donnell and DeMio, 5/11)

Bloomberg: New Hepatitis C Infections Soar To 15-Year High, CDC Says 
The number of Americans newly diagnosed with hepatitis C hit a 15-year high in 2015, as the viral disease spread unrelentingly among young adult drug users and detection efforts gained more traction. Infections are growing fastest among Americans in their 20s, because of injection drug use, according to research from the Centers for Disease Control and Prevention. The abuse of heroin and prescription opioids has boomed in the U.S. in recent years, creating a new generation of addicts at risk from needle-sharing. There were 34,000 new infections in 2015, the agency estimated. (Cortez and Bloomfield, 5/11)

Debunking A 19th Century Myth: Humans Actually Have A Great Sense Of Smell

Researchers find that humans' sense of smell is no less than any other mammal.

Los Angeles Times: The Human Nose Has Been Underrated For 150 Years, But Science Is Setting The Record Straight
We’ve been led to believe that our sense of smell is sadly deficient compared with our mammalian cousins such as rodents and dogs. What does the world smell like to a bloodhound, we might wonder. What scents — glorious or gross — can a twitchy little mouse nose detect that are passing right by us. You can stop wondering because it turns out that our sense of smell is not so bad after all. (Netburn, 5/11)

NPR: Humans Are Pretty Great Smellers, Neuroscientist Argues
Smell, the thinking goes, is not our strongest sense. Our lowly noses are eclipsed by our ability to see the world around us, hear the sound of music and feel the touch of a caress. Even animals, we're taught, have a far more acute sense of smell than we do. But one scientist argues the idea of an inferior sense of smell stems from a 19th-century myth. (Harris, 5/11)

The Washington Post: Your Sense Of Smell Is More Powerful Than You Think
In a review published Thursday in the journal Science, John McGann, a professor of psychology at Rutgers University in New Jersey, argued that this is a flawed perception dating back to the 19th century. He blamed pioneering French anatomist Paul Broca, who wrote that, given the comparatively small olfactory organs in the primate brain, “it is no longer the sense of smell that guides the animal.” As for smelling in apes, humans included, “All that exceeded the needs of this humble function became useless.” (Guarino, 5/11)

Medical Attention On Infant At Childbirth Can Sometimes Be At Expense Of Mother's Health

The U.S. has the worst rate of maternal deaths in the developed world, and ProPublica and NPR report that 60 percent are preventable. In other public health news: the "gravity blanket" health claim retracted; bird flu surges; Brazil declares end to Zika emergency; self-checking for skin cancer; and more.

Stat: The 'Gravity Blanket' Raised $3 Million With A Claim To Treat Anxiety — Which Has Now Been Deleted
A “Gravity blanket” on Kickstarter that claimed to use cozy pressure to treat anxiety, post-traumatic stress disorder, and other conditions has been taking the internet by storm, raising more than $3 million. But on Thursday, the company quietly deleted the boldest medical claims on its crowdfunding site — language which violated Kickstarter policy and went against FDA recommendations — after STAT inquired about about its promotional statements. (Thielking, 5/12)

The Washington Post: With Bird Flu Surging, U.S. Needs To Do More To Prevent Possible Pandemic, GAO Says
If the United States were suddenly facing a potential avian influenza pandemic, just one U.S. manufacturer could be counted on to make human pandemic flu vaccine here. And although the chickens that lay the eggs used in the process are themselves susceptible to the virus, until an emergency arises only voluntary and often inadequate measures by poultry producers are in place to protect flocks, according to a new Government Accountability Office report. (Sun, 5/11)

The Washington Post: Brazil Declares End To Zika Emergency After Fall In Cases
Brazil declared an end to its public health emergency over the Zika virus on Thursday, 18 months after a surge in cases drew headlines around the world. The mosquito-borne virus wasn’t considered a major health threat until the 2015 outbreak revealed that Zika can lead to severe birth defects. One of those defects, microcephaly, causes babies to be born with skulls much smaller than expected. (Dilorenzo, 5/11)

Tampa Bay Times: The Essentials Of Skin Cancer Prevention: Self-Checks, Sunscreen And Covering Up 
A 2016 study in the Journal of the American Academy of Dermatology found that women are nine times more likely than men to notice a melanoma, the deadliest form of skin cancer. Melanoma likes to hide in difficult-to-see places like the scalp, between your toes, on the soles of your feet, in the middle of your back — areas that may not get a lot of sun or areas that you might miss, but which a partner might see when you change your shirt, put your feet up or wash your hair. (Maher, 5/11)

Kansas City Star: St. Luke's Heart Study Shows Radiation Reduction 
Cardiologists at St. Luke’s Mid America Heart Institute say they have cut patients’ radiation exposure from a common heart scan by 60 percent by upgrading technology and changing protocols. Randall Thompson, a cardiologist at the institute, presented the findings of an almost eight-year study Sunday at the International Conference on Nuclear Cardiology and Cardiac CT in Vienna, Austria. (Marso, 5/11)

State Watch

State Highlights: Ohio Releases Nursing Home Database In Push For Tighter Control; Wis. Tops List As Best Place For Nurses

Media outlets report on news from Ohio, Wisconsin, California, Colorado, Louisiana, Florida, Illinois, Massachusetts, Texas, Missouri and Georgia.

Columbus Dispatch: State Releases Nursing Home Database In Push For Tighter Regs
As Gov. John Kasich tries to salvage his plan to pay Ohio nursing homes based on the quality of care they provide Medicaid patients, the state today released details showing that the level of service varies widely among Ohio’s 929 facilities. Kasich’s proposal was pulled out of the two-year budget last week by the Ohio House, which pushed managed-care reforms back to 2021. But the governor hopes to persuade the Senate to reinsert his proposal. (Johnson and Candisky, 5/11)

Milwaukee Journal Sentinel: Wisconsin Ranked The Country's Best State For Nurses
Nursing is a challenging, demanding profession, but there's no better state to do it than Wisconsin. WalletHub ranked the Badger State as the best in the country for nurses in a recent study. The website considered 18 factors in its rankings, from job openings per capita and annual salaries to educational opportunities and work environments. (Lewis, 5/11)

Cleveland Plain Dealer: State Officials Cite Low-Performing Nursing Homes In Push For Managed-Care Plans 
Ohio Gov. John Kasich's administration Thursday cited the state's low-performing nursing homes - among the worst in the country in terms of care - in its push for managed-care plans. Kasich's Office of Health Transformation, released a spreadsheet of data on more than 930 nursing homes in Ohio and their ratings from a federal statistical measure, as well as the amounts each receives from Medicaid per day. (Caniglia and Corrigan, 5/11)

Los Angeles Times: Gov. Jerry Brown Urges Republican 'Penance' For Healthcare Vote, Warns Of The Impact On California's Budget
Gov. Jerry Brown on Thursday presented a slightly sunnier view of California’s economy than he offered just four months ago, but nonetheless delivered one of his vintage sermons on the evils of overspending when outlining a new state spending plan. And this time, the man who once trained to be a Jesuit priest singled out the state’s Republican members of the House for their unanimous vote to repeal the Affordable Care Act — a move that alone would result in California losing $18.6 billion in federal funds a decade from now. (Myers, 5/11)

Los Angeles Times: Cedars-Sinai And Torrance Memorial Hospitals Plan To Join Forces
Cedars-Sinai and Torrance Memorial hospitals plan to team up to share resources, collaborate on patient care and provide wider access to clinical trials. Under the proposed partnership, announced this week, the two Los Angeles-area healthcare institutions would keep their separate boards of directors and operate independently under their respective chief executives, each keeping their own employees and making their own staffing decisions. They would, however, affiliate under a new parent organization with a new board of directors. (Easter, 5/11)

Denver Post: Colorado Seniors Rank Fourth In National Health Report
Colorado’s seniors are the fourth-healthiest in the nation, thanks to high levels of physical activity and low levels of obesity, according to new rankings released this week by the United Health Foundation...The report, which is now in its fifth year, looked at the health of people ages 65 and older across the country, using federal and other data sources. Researchers found that Colorado ranks third for the amount of its seniors who are physically active and also scored well at measures for preventing hospital deaths, premature deaths, hospital re-admissions and unnecessary hospitalizations. The state has the second-lowest obesity rate in the country for seniors, at 20 percent. (Ingold, 5/11)

New Orleans Times-Picayune: 'Routine' Colonoscopies Cost Some New Orleans Patients Thousands Of Dollars
In the end, [Cedric] Valeary owed close to $2,500 out-of-pocket for what he thought was a routine, preventive colonoscopy - a procedure that, under federal law, is supposed to cost the patient nothing. Unbeknownst to him and thousands of patients across the country, the cost of a colonoscopy can depend on a host of factors, including lab fees, how long the exam lasted, even what type of anesthesia was used. In some cases, experts say, patients believe they are getting a colonoscopy screening, but wind up being charged for a diagnostic colonoscopy - a test typically performed as the result of abdominal symptoms or a family history of colon cancer. No laws require insurance companies to cover the full amount for such tests. (Lipinski, 5/12)

Chicago Tribune: Shortage Of Caregivers For People With Disabilities Intensifies Statewide 
Lawmakers in Springfield are now considering legislation that would, like the bill sent to the governor last year, raise the minimum wage for the caregivers to $15 an hour. The state Senate passed a bill Wednesday that representatives in the House will consider. With weeks left before the end of the legislative session, and lawmakers still at an impasse over the budget, advocates for people with disabilities say the worker crisis has gone from dire to potentially dangerous. (Healy, 5/11)

Boston Globe: Liberty Mutual Closing Its Research Unit 
Liberty Mutual is shutting down its research arm in Hopkinton that for six decades put it at the forefront of workplace injury prevention, prosthetic limb development, and the push for safer car features, including collapsible steering columns. The company will no longer conduct peer-reviewed research, considered the gold-standard for studies, which extended its reach worldwide. (Fernandes, 5/12)

Texas Tribune: Texas Senate Passes Sandra Bland Act
The Texas Senate on Thursday unanimously approved a bill aimed at protecting people with mental illnesses who are arrested and may harm themselves in jail. The legislation — Senate Bill 1849 — was filed after a high-profile incident in 2015 in which Sandra Bland, a 28-year-old Illinois woman, was found dead in the Waller County jail days after being arrested during a routing traffic stop. (Silver, 5/11)

California Healthline: California Bill Addresses Safety Concerns At Dialysis Clinics
Saying they are concerned about safety in California’s dialysis clinics, a coalition of nurses, technicians, patients and union representatives is backing legislation that would require more staffing and oversight. The bill, introduced by Sen. Ricardo Lara (D-Bell Gardens), would establish minimum staffing ratios, mandate a longer transition time between appointments and require annual inspections of the state’s 562 licensed dialysis clinics. (Gorman, 5/11)

Chicago Sun Times: Chicago Dermatologist Convicted Of Health Care Fraud
A Chicago dermatologist was convicted of health care fraud for billing health insurance programs for falsely reported pre-cancerous treatments. Omeed Memar, a 48-year-old Chicago resident, was convicted Wednesday of eight counts of health care fraud and eight counts of making false statements in a health care matter, according to the U.S. attorney’s office. (Wittich, 5/11)

Health Policy Research

Research Roundup: Wait Times; Telemedicine For Mental Health; Medicaid Waivers

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: Outpatient Office Wait Times And Quality Of Care For Medicaid Patients
We analyzed data on twenty-one million outpatient visits obtained from electronic health record systems, which allowed us to measure time spent in the waiting room beyond the scheduled appointment time. Median wait time was a little more than four minutes. Almost one-fifth of visits had waits longer than twenty minutes, and 10 percent were more than thirty minutes. Waits were shorter for early-morning appointments, for younger patients, and at larger practices. Median wait time was 4.1 minutes for privately insured patients and 4.6 minutes for Medicaid patients. After adjustment for patient and appointment characteristics, Medicaid patients were 20 percent more likely than the privately insured patients to wait longer than twenty minutes, with most of this disparity explained by differences in practices and providers they saw. (Oostrom, Einav and Finkelstein, 5/1)

Health Affairs: Rapid Growth In Mental Health Telemedicine Use Among Rural Medicare Beneficiaries, Wide Variation Across States
[W]e analyzed Medicare fee-for-service claims for the period 2004–14 to understand trends in and recent use of telemedicine for mental health care, also known as telemental health. The study population consisted of rural beneficiaries with a diagnosis of any mental illness or serious mental illness. The number of telemental health visits grew on average 45.1 percent annually, and by 2014 there were 5.3 and 11.8 telemental health visits per 100 rural beneficiaries with any mental illness or serious mental illness, respectively. ... Compared to other beneficiaries with mental illness, beneficiaries who received a telemental health visit were more likely to be younger than sixty-five, be eligible for Medicare because of disability, and live in a relatively poor community. (Mehrotra et al., 5/1)

American Academy of Actuaries: How Changes to Health Insurance Market Rules Would Affect Risk Adjustment
Potential changes to the rules applying to the health insurance market have various implications for risk adjustment. Short of returning to the pre-ACA environment of underwriting and risk rating, risk adjustment would still be necessary to reduce incentives for insurers to avoid high-cost enrollees. Some changes, such as incorporating high-risk pooling and increasing flexibility in cost-sharing requirements, could require only adjustments to the risk adjustment design. Other changes, such as loosening or eliminating the EHB requirements and allowing sales across state lines could greatly complicate the design and effectiveness of a risk adjustment mechanism. If states have flexibility in setting benefit and rating rules, the risk adjustment models and payment transfer factors may need to vary by state. The administration of risk adjustment is complicated. Moving administration of a risk adjustment program from CMS to the states would require a significant investment of state resources. (5/10)

The Kaiser Family Foundation: Proposed Medicaid Section 1115 Waivers In Maine And Wisconsin
Section 1115 Medicaid demonstration waivers provide states with an avenue to test new approaches that further the objectives of the Medicaid program in ways that differ from what states can do under current law. On March 14, 2017, the Centers for Medicare and Medicaid Services (CMS) sent a letter to state governors that signaled a willingness to use Section 1115 authority to “support innovative approaches to increase employment and community engagement” and “align Medicaid and private insurance policies for non-disabled adults.” ... Wisconsin and Maine are seeking waiver authority to make significant changes to Medicaid that would affect non-expansion Medicaid populations. ... Wisconsin and Maine’s proposals include provisions that have not been approved in any state (such as work requirements, drug testing, and time limits). (Musumeci, Hinton and Rudowitz, 5/10)

American Journal of Managed Care: Battling The Chargemaster: A Simple Remedy To Balance Billing For Unavoidable Out-Of-Network Care
Chargemaster abuses from OON [out of network] and emergency care inflict serious financial harm to the most vulnerable while undercutting the functioning of healthcare markets and the creation of valuable insurance products. At the same time, they present straightforward questions of contract law and lead to a simple conclusion: providers are entitled only to collect prevailing negotiated prices for OON services, and patients and payers are under no legal obligation to pay higher chargemaster charges. Applying this interpretation of contract law will prevent providers from hiding behind a convoluted hospital pricing system, will encourage the development of attractive narrow network insurance offerings, and will shield urgently sick people from the dread of medical predation. State legislators ... should pursue court remedies that correct both the immediate and the long-term dynamic harms caused by chargemaster strategies. (Richman et al, 4/28)

Editorials And Opinions

Perspectives On Insurance Markets And Mergers; Preexisting Conditions; Medicaid Reform

Opinion writers explore a variety of health policy issues in play as lawmakers continue to debate changes to the health care system.

The New England Journal Of Medicine: Good Riddance To Big Insurance Mergers
Eighteen months after four of the five largest U.S. health insurers announced multibillion-dollar merger deals, federal judges, siding with the Department of Justice (DOJ), have issued preliminary injunctions halting the two transactions. These decisions will cost the insurers: they spent over $2 billion trying to get the deals done, and the would-be acquirers are due to pay $2.85 billion in breakup fees — and possibly billions more in damages. Moreover, the parties’ conduct has further damaged the public’s view of the insurance industry. (Leemore S. Dafny, 5/11)

The Wall Street Journal: Aetna Says Sayonara To ObamaCare
For all the media think pieces about the nature of truth in the Trump era, Democrats have their own alternative facts about ObamaCare. To undermine the GOP case for repeal and replace, they claim the entitlement is working beautifully. But then what about the latest insurance giant to dump its ObamaCare ballast? (5/11)

Lexington Herald Leader: One Woman’s Cautionary Health Insurance Tale: Living Is A Pre-Existing Condition
Now that a new healthcare bill has passed the House and moved on to the Senate, there is much discussion about the changes proposed. No one knows how the final bill will read, but it looks as if two groups in particular could be subject to significantly higher premiums: those approaching retirement age and those deemed to have preexisting conditions. Remembering my own entry into the individual insurance market in 2003, I shudder to think how this scenario might play out in the lives of millions of Americans. (Susan Owens, 5/10)

The Charlotte Observer: Frightening Times For Families Who Are Fighting Chronic Illness
With the passage of the American Health Care Act by the U.S. House, the United States is one step closer to a country in which people battling chronic illnesses are denied access to the care they need to survive. The ongoing health care debate in Washington has created uncertainty for families fighting chronic diseases. I am the parent of a 21-year-old son who has cystic fibrosis (CF). These are frightening times. (Peter Barry, 5/11)

The Charlotte Observer: What I Meant When I Suggested People With Pre-Existing Conditions Could Move To Another State
About 600,000 North Carolinians were at risk of having zero health insurance options this year when Blue Cross, the only Obamacare option in 95 out of 100 counties, seriously considered pulling out. Humana will pull out of Obamacare nationwide in 2018, and Aetna and CareFirst are on record that Obamacare “is in a death spiral.” While some would have us stick our heads in the sand, House passage of the American Health Care Act was “first base” in a responsible, multiple-step effort with the Senate to repair America’s health care system. (Rep. Robert Pittenger, 5/11)

RealClear Health: Why America Needs A ‘Do-Over’ On Medicaid Reform
One of the most important pieces of the newly passed House health bill is a possible US$800 billion cut over 10 years to Medicaid, the federal program designed to provide insurance coverage to the poor. That bill, entitled the American Health Care Act (AHCA), rolls back part of the expansion of Medicaid that took place under the Affordable Care Act (ACA) by limiting federal contributions toward state coverage of individuals with annual incomes above US$16,643 or families of four with annual incomes above $33,948. With the reduction in federal support, states will now have to decide if they can afford to cover adults with incomes just above the federal poverty line. In addition, the AHCA freezes federal spending per Medicaid beneficiary at its 2016 levels. (Jay Bhattacharya, Anup Malani and Darius Lakdawalla, 5/11)

RealClear Health: Will Senate Republicans Throw Medicaid Under The Bus?
It’s really happening. After the chaos of last week’s House vote, the American Health Care Act (AHCA) is headed to the Senate. Progressives accustomed to watching bills languish in the Senate due to the filibuster can’t afford to be complacent: thanks to budget reconciliation rules and Vice President Mike Pence’s role as tie-breaker, the AHCA only needs 50 votes to pass. In other words, it can pass even if every Democrat and two Republicans vote against it. (Thomas Huelskoetter, 5/12)

Bloomberg: What Democrats Won't Admit About Voters And Health Care
But keep in mind that the American Health Care Act of 2017 does not prevent states from spending whatever is needed to cover pre-existing conditions, if they so choose. The underlying truth is that voters at the state level just aren’t that interested in paying for these benefits, preferring instead to lower taxes, or to spend the money on roads, schools and prisons .In other words, when American voters are given a direct bill for health-care expenditures, they recoil, even when the beneficiaries are in needy or desperate situations. The Democrats are good at tarring the Republicans for indifference to the plight of these people, but less keen to admit that the larger popular indifference plagues their own health-care visions as well. (Tyler Cowen, 5/11)

The Kansas City Star: The Health Care Coverage Gap Is Very Real
With Episcopal Community Services, a nonprofit that has been working to feed the hungry and fight poverty throughout the Kansas City area for 30 years, I meet members of our community every day who are working hard to improve their own lives under very challenging circumstances. Most of these adults fall into the “coverage gap” under existing law: They are too poor to qualify for tax credits to purchase private insurance, and they do not fall into the narrow eligibility categories of existing Medicaid in Kansas and Missouri (poor children, pregnant women with low income, or severely disabled). Or, as Glendening describes them, “able-bodied, childless, working-age adults.” That phrase is used to suggest that those in the coverage gap are not hardworking citizens and are somehow less deserving than other vulnerable citizens. (Beau Heyen, 5/11)

NewsHour: What Medicare Can Teach The GOP About This Basic Rule Of Insurance
Republican efforts to replace Obamacare are delivering many teachable moments, along with a big bucket of stress inflicted on people fearful of losing their health insurance. Will it dawn on GOP House members and President Trump that Americans want guaranteed access to health insurance and do not want to return to the days when they could be denied insurance due to preexisting conditions? One of these teachable moments, yet to be realized, is in plain sight every day in Medicare. It involves the very nature of insurance itself, the fundamentals of which seem to have escaped many critics of Obamacare. (Philip Moeller, 5/10)

Kansas City Star: The U.S. Constitution Mandates National Health Care 
So what exactly is the relationship between our federal government, as framed in our Constitution, and our health care? Although Congress has been debating the topic, it unfortunately merely discusses who gets covered, what gets covered and how expensive it might be. Missing from these debates is a principled discussion about the government’s essential connection to health care. (Thomas Stroik, 5/11)

Lexington Herald Leader: Health Care Is A Public Good, Not A Marketplace Commodity
Most developed countries in the world understand health care to be a public good, provided by government action to ensure all citizens have access to care. America considers health care to exist in the marketplace, a commodity to be purchased by consumers. The result: Many people cannot access health care as they cannot afford to purchase it. (David A. Nash, 5/11)

Milwaukee Journal Sentinel: Moving State Employees To Self-Insurance Program Saves Dollars Without Disrupting Care
The state can save at least $60 million in the next two-year budget by simply changing the way it pays for state employee health benefits. Those savings grow by $22 million more in general purpose revenue if repeal or delay of an Obamacare tax does not occur. These are savings, based on actual bids to the state, that could be used for tax cuts, schools or other government programs.  (John Shiely, 5/11)

Viewpoints: A Multipronged Approach To Taking On Drug Addiction; Prison Is A Bad Fit For People With Mental Illness

A selection of public health opinions from around the country.

Cincinnati Enquirer: Multipronged Approach Needed To Turn Tide In Addiction Fight
Improving the health of our communities is at the very heart of Mercy Health’s mission and there are few greater immediate threats to our communities than the opiate epidemic, which has hit southwest Ohio particularly hard. Thinking about how to tackle this nationwide crisis can be overwhelming, yet it demands a robust, collaborative response. (Michael W. Garfield, 5/11)

Miami Herald: Prison Wrong Place For Darren Rainey, Others With Mental Illness
It is only because of dogged investigative reporting by the Miami Herald that people know of the horrific 2012 death of Florida prison inmate Darren Rainey. Rainey, incarcerated at the Dade Correctional Institution (DCI), was locked by guards in a shower stall for two hours under a torrent of scalding water — reportedly up to 160 degrees. ... But this conversation has been too narrow: The policy makers who sustain our criminal-justice system are also culpable. Rainey was completing a two-year sentence for possession of a small amount of cocaine and had been diagnosed with schizophrenia. What was a mentally ill man with a drug addiction, convicted of a nonviolent crime, doing in prison in the first place? (Howard L. Simon, 5/11)

The New England Journal Of Medicine: The Future Of Transgender Coverage
In tandem with the growing visibility and acceptance of transgender people in the United States, we have seen a rapid increase in insurance coverage for health care services related to gender transition. Despite ongoing court battles over federal nondiscrimination protections for transgender people and uncertainty over the future of the Affordable Care Act (ACA), this trend is likely to continue: Medicare, many state-regulated private plans, some state Medicaid programs, and an increasing number of employer-sponsored plans now cover transition-related care for transgender people. These changes are driven by a growing expert consensus on the medical necessity of gender transition, new legal interpretations prohibiting insurance discrimination against transgender people, and mounting evidence that transgender-inclusive coverage is cost-effective. (Kellan E. Baker, 5/11)

St. Louis Post-Dispatch: SLU School Of Medicine On Probation?
Over 50 percent of doctors suffer from burnout, and we lose more than 400 doctors a year to suicide caused by a toxic work environment. About one-third of resident physicians suffer from burnout. It starts in medical school. Three years ago, the Journal of the American Medical Association-Psychiatry published an article titled “Med student depression, suicide: National response required.” [St. Louis University] has been one of the most active and undeniably the most successful medical school to address this ongoing tragedy, basing medical education on the Jesuit underpinnings of educating and nurturing the whole person: mind, body, spirit and heart. (Keith Frederick and Bob Onder, 5/12)