KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Health Law

Administration To Allow Moral, Religious Exemptions To Birth Control Mandate

More than 55 million women have access to birth control without copayments because of the contraceptive coverage mandate in the Affordable Care Act.

The New York Times: Trump Administration Set To Roll Back Birth Control Mandate
The Trump administration is poised to roll back the federal requirement for employers to include birth control coverage in their health insurance plans, vastly expanding exemptions for those that cite moral or religious objections. The new rules, which could be issued as soon as Friday, fulfill a campaign promise by President Trump and are sure to touch off a round of lawsuits on the issue. (Pear, 10/5)

The Washington Post: Trump Administration To Narrow Affordable Care Act’s Contraception Mandate
The action, according to a Republican briefed Thursday on the regulation, will allow a much broader group of employers and insurers to exempt themselves from covering contraceptives such as birth control pills on religious or moral grounds. It represents the latest twist in a seesawing legal and ideological fight that has surrounded this aspect of the 2010 health-care law nearly from the start. (Wan and Eilperin, 10/6)

Trump Continues To Chip Away At ACA Despite Congress' Failure To Repeal Law

In a rare move, President Donald Trump weighed in on a decision concerning Iowa's attempts to stabilize its marketplace, telling CMS to deny its request. Supporters of the Affordable Care Act see the president’s opposition even to changes sought by conservative states as part of a broader campaign to undermine the law. Meanwhile, a left-leaning study finds that at least 20 states blame the administration for the uncertainty in the marketplaces.

The Washington Post: As ACA Enrollment Nears, Administration Keeps Cutting Federal Support Of The Law
For months, officials in Republican-controlled Iowa had sought federal permission to revitalize their ailing health-insurance marketplace. Then President Trump read about the request in a newspaper story and called the federal director weighing the application. Trump’s message in late August was clear, according to individuals who spoke on the condition of anonymity to discuss private conversations: Tell Iowa no. (Eilperin, 10/5)

The Hill: Trump Told HHS To Deny Request To Fix Iowa ObamaCare Market: Report
President Trump told the head of the Centers for Medicare and Medicaid Seema Varma to deny a request from the Republican-controlled state of Iowa to fix their health-care marketplace, according to The Washington Post. According to the Post, Iowa officials sought for months to get federal permission to fix health insurance markets in their state, but they were shut down by Trump administration officials. (Manchester, 10/5)

Politico Pro: Democrats Accuse Trump Of ‘Sabotage’ On Obamacare Sign-Ups
Obamacare's first open enrollment season under the Trump administration is expected to be a flop — and even the law's most ardent supporters are worried there's little they can do to change that. With less than a month before sign-up begins, the federal government has gutted outreach and marketing, slashed funding to outside enrollment groups and left state officials in the dark on key details. (Demko and Cancryn, 10/5)

The Hill: Many States Blame Trump, GOP For ObamaCare Premium Increases 
Twenty states attribute ObamaCare premium increases next year to uncertainty caused by the Trump administration and Republicans in Congress, according to a new report released Thursday. The report from pro-ObamaCare group Protect Our Care analyzed the 28 states where final, state-approved rates are public and found that 20 specifically cited uncertainty at the federal level for at least part of the reason for increases. (Hellmann, 10/5)

Des Moines Register: Iowa's Stopgap Health Insurance Plan Not Dead Yet, Leaders Say
Iowa officials said Thursday evening they still hadn’t heard whether the Trump administration will approve or deny a “stopgap” plan to stabilize the state’s health insurance market, despite a national report that the president told his administrators to reject it. The Washington Post reported that President Trump told a top human-services administrator in August to reject Iowa’s plan. The proposal was made by Iowa Insurance Commissioner Doug Ommen, who is a fellow Republican. It would redirect Affordable Care Act money in a way that Ommen says would encourage more young, healthy Iowans to buy individual insurance policies and would ease risks to insurance carriers. (Leys, 10/5)

And in other health law news —

The Philadelphia Inquirer/ It's Getting Harder To Sign Up For ACA Health Insurance. Here Are 9 Things To Do About It.
More than 426,000 people in Pennsylvania and 295,000 in New Jersey signed up for health-care coverage this year through Affordable Care Act marketplaces. Gov. Wolf recently bragged that the uninsured rate in Pennsylvania is lower than it’s ever been, thanks to the law better known as Obamacare. New Jersey is touting similar results. And in Washington, the latest effort to “repeal and replace” the ACA was defeated without even a vote. (Quann, 10/4)

Nashville Tennessean: Vanderbilt University Medical Center Absent From 2018 Obamacare Plans
Vanderbilt University Medical Center is not covered under any individual Obamacare insurance plan in the greater Nashville area for 2018, insurance representatives said Thursday. The academic medical center is not in-network with either Cigna or Oscar Health, the two insurers selling plans on the federally run-exchange in Davidson, Cheatham, Montgomery, Robertson, Rutherford, Sumner, Trousdale, Williamson, and Wilson counties. It's also not available in the companies' off-exchange plans. (Fletcher, 10/5)

Capitol Hill Watch

House Passes Budget Including Deep, But Non-Binding, Cuts To Medicaid

The purpose of the budget is to set the stage for Republicans' tax overhaul plan.

The Associated Press: House Passes GOP Budget In Key Step For Upcoming Tax Debate
The House on Thursday passed a $4.1 trillion budget plan that promises deep cuts to social programs while paving the way for Republicans to rewrite the tax code later this year. The 2018 House GOP budget reprises a controversial plan to turn Medicare into a voucher-like program for future retirees as well as the party’s efforts to repeal the “Obamacare” health law. Republicans controlling Congress have no plans to actually implement those cuts while they pursue their tax overhaul. (Taylor, 10/5)

In other news from Capitol Hill —

The Hill: Graham Brings 20-Week Abortion Ban To Senate With 45 Co-Sponsors 
Sen. Lindsey Graham (R-S.C.) introduced a 20-week abortion ban in the Senate on Thursday with the support of 45 GOP senators, two days after a similar bill passed the House.  The "Pain-Capable Unborn Child Protection Act," which faces long odds in the upper chamber, would make it illegal for any person to perform or attempt an abortion after 20 weeks of pregnancy with the possibility of five years in prison, fines or both. (Hellmann, 10/5)

Stat: Senator Aims To Block Maneuvers Like Allergan's Patent Deal With Mohawks
Angered by a controversial Allergan patent maneuver, Sen. Claire McCaskill (D-Mo.) on Thursday introduced a bill that prohibits tribal sovereign immunity from being used to block certain types of patent challenges. Her move comes after Allergan transferred six patents for its best-selling Restasis eye treatment last month to a Mohawk tribe, which has sovereign immunity and is now attempting to use its status to block patent challenges filed by several generic drug makers. (Silverman, 10/5)

Ardent Abortion Opponent Tim Murphy To Step Down Amid Abortion Scandal

Originally Rep. Tim Murphy had said he was not going to seek reelection, but he faced increasing backlash from reporting that he asked a woman he was romantically involved with to terminate a pregnancy.

The Washington Post: Rep. Tim Murphy Resigns From Congress After Allegedly Asking Woman To Have Abortion
“Upon further discussion with my family, I have made the decision to resign my position” effective Oct. 21, Murphy wrote in a letter to House Speaker Paul D. Ryan. “I am grateful for the opportunity to have served the people of southwestern Pennsylvania and to have worked with the talented and dedicated men and women of the United States Congress.” In a statement Thursday, Ryan (R-Wis.) thanked Murphy “for his many years of tireless work on mental health issues here in Congress and his service to the country as a naval reserve officer.” (DeBonis, 10/5)

Politico: Tim Murphy Resigns From Congress
The Pennsylvania Republican’s about-face came after House GOP leaders and senior Republicans upped the pressure on Murphy to step down. Republican sources familiar with Murphy’s thinking said the married father of one child initially believed he could weather a story in the Pittsburgh Post Gazette, revealing he had sent a series of text messages to his girlfriend — a psychologist half his age — encouraging her to have an abortion. Murphy has been a strongly anti-abortion lawmaker during his 15 years in Congress. (Bade and Sherman, 10/5)


After Missing Deadline For Children's Insurance, Congress Now Mired In Funding Disputes

Lawmakers in both the Senate and House have bills to renew the Children's Health Insurance Program, but Democrats and Republicans have very different ideas about how to fund that.

CQ: Offsets Remain An Obstacle In Children's Health Coverage Bills
The Senate Finance and House Energy and Commerce committees both approved their versions of bills to renew funding for the Children’s Health Insurance Program Wednesday, but questions remain about what offsets, if any, will make it into law. The House markup Wednesday night was contentious, with all the Democrats there voting against the bill due to issues with offsets. The House GOP bill would pay for the funding by making changes to Medicaid third-party liability, lottery winning calculations and Medicare premium adjustments for higher-income persons. Democrats offered an amendment, which was rejected 22-28, that included their alternatives for funding the CHIP bill (HR 3921). (Raman, 10/5)

Stateline: States Scramble To Overcome Congress’ Failure To Move On CHIP
With the U.S. Senate distracted last month by another Hail Mary attempt by Republicans to repeal and replace the Affordable Care Act, Congress didn’t get around to reauthorizing CHIP by the Sept. 30 deadline. And that has left states contemplating how to keep the program running when the federal funding runs out — if they can keep it going at all. “The clock is ticking,” Joan Alker, executive director of the Center for Children and Families at Georgetown University, said. “The longer this goes on, the bigger troubles states are in and more consequences we will see.” (Ollove, 10/6)

Politico Pro: IPAB Repeal Could Complicate Funding For Children's Health Insurance
House Republicans are trying to tie together bills to fund the Children’s Health Insurance Program with repeal of the Independent Payment Advisory Board, a still-dormant Medicare cost-cutting panel created by Obamacare. But attaching repeal of any Obamacare provision could complicate funding CHIP, which has broad support among both parties. (Haberkorn, 10/5)

In other state Medicaid news —

Georgia Health News: Audit At Community Health Indicates Risky Data Policies In Medicaid
Auditors have found that Georgia’s Department of Community Health “exposes itself to unnecessary risk of error, misuse, fraud or loss of data’’ that could significantly affect the reliability of claims and payment processing of Medicaid benefits. The audit findings were reported in a document at the DCH board’s September Audit Committee meeting, obtained by Georgia Health News under the Georgia Open Records Act. (Miller, 10/5)

The Associated Press: State Estimates 90,000 Medicaid Eligible Are Uninsured
A new [Virginia] state report says there are about 90,000 Virginians who are eligible for publicly funded health care programs for the poor and disabled but have not signed up. The Virginia Department of Medical Assistance Services recently reported to the General Assembly that it estimates there were 28,000 adults who were eligible for Medicaid in 2015 that were not signed up for the program. DMAS said about 60,000 eligible children were not signed up for Medicaid or the state’s program for children known as FAMIS. (10/6)


Idaho And Utah Seniors Paying Highest Average Premiums For Medicare Drug Plans

The average premium for beneficiaries in that region is more than $10 higher than the national average. In other Medicare news, a new study finds that beneficiaries using Medicare Advantage plans typically have access to less than half of the doctors in their community, and a congressional advisory group urges the repeal of a key provision in the bipartisan law that is revamping Medicare payments to doctors.

Idaho Statesman: We’re No. 1? Idaho Seniors To Pay Highest Medicare Rx Premiums
Idahoans will pay the highest average premium in the U.S. next year for Medicare Part D, the prescription drug plan for seniors. Next year’s premiums will average $65.52 for plans in Idaho and Utah, a combined market for Medicare Part D. The outsized premiums were spotted by the health insurance comparison website Health Pocket, which analyzed publicly available information from the Centers for Medicare and Medicaid. (Dutton, 10/5)

The Philadelphia Inquirer/ More Than A Third Of Medicare Advantage Subscribers Have Limited Physician Choices, Study Finds
A typical senior with a Medicare Advantage plan has access to just 43 percent of physicians in his or her county, a new analysis by the Kaiser Family Foundation has found. Kaiser on Thursday released what it said was the first study to compare the size of networks available without extra fees to Medicare Advantage subscribers, said lead author Gretchen Jacobson, a health economist and expert in Medicare, the government insurance program for seniors and the disabled. (Burling, 10/5)

Modern Healthcare: MedPAC Urges Repeal Of MIPS
The Medicare Payment Advisory Commission is pushing for the immediate repeal and replacement of a Medicare payment system that aims to improve the quality of patient care. To avoid penalties under MACRA, physicians must follow one of two payment tracks: the Merit-based Incentive Payment System (MIPS), or advanced alternative payment models like accountable care organizations. MedPAC wants to junk MIPS as it feels that it's too much of a burden for physicians and won't push them to truly improve care. (Dickson, 10/5)


Pharmaceutical Factories Try To Keep Running As Puerto Rico Infrastructure Struggles From Hurricane Damage

The Food and Drug Administration says that it is monitoring potential shortages of key medications manufactured on the devastated island. Other health fallout facing Puerto Ricans include mental health concerns, a lack of insurance coverage and not enough clean and drinkable water.

Bloomberg: Drugmakers In Storm-Battered Puerto Rico Must Now Ride Out Recovery
Drugmakers rode out Hurricane Maria in Puerto Rico, but keeping plants running while the devastated island picks up the pieces is likely to be tougher. Tax breaks and incentives made Puerto Rico the Caribbean’s economic powerhouse two decades ago, helping attract dozens of drug and device makers that built state-of-the-art manufacturing facilities. (Cortez and Hopkins, 10/4)

The Associated Press: Mental Health Concerns Arise In Puerto Rico Aftermath Of Hurricane Maria
Locked out of his home and with nowhere else to go, Wilfredo Ortiz Marrero rode out Hurricane Maria inside a Jeep, which was lifted off its wheels by floodwaters in the parking lot. He then endured days without enough food or running water. The lights are back on at his residence for low-income elderly people in the San Juan suburb of Trujillo Alto, and food has started arriving, but he still waits as long as he can each night to leave the company of others in the lobby. Alone in his room, he sometimes starts to shake. “You get really depressed,” he said Wednesday. (Melia and Coto, 10/5)

The Hill: Feds Activate Emergency Prescription Program For Uninsured Puerto Ricans
The Health and Human Services Department has activated a program that will pay for prescription medications for uninsured Puerto Ricans impacted by Hurricane Maria. The Emergency Prescription Assistance Program allows uninsured patients to get a 30-day supply at participating pharmacies with renewals every 30 days while the program is active. (Hellmann, 10/5)

McClatchy: Much Of Puerto Rico Has No Running Water
In households across Puerto Rico, water has become a precious commodity. ...And its scarcity means that for many Puerto Ricans, their bodies, their homes and their clothes are not as clean as they would like. (Johnson, 10/5)

New Trial Ordered In Battle Over Cholesterol Drug In Win For Sanofi, Regeneron Over Amgen

A federal appeals court reverses a sales ban on Sanofi and Regeneron's pricey cholesterol medicine Praluent. In other pharmaceutical industry news, the FDA considers looser safety protocols on compounded drugs.

Stat: Sanofi And Regeneron Score A Big Win Over Amgen In The Cholesterol Wars
Sanofi and Regeneron Pharmaceuticals won a notable victory on Thursday when a federal appeals court reversed a ban on the sale of their pricey cholesterol medicine and ordered a new trial to decide a bitter patent dispute with Amgen, their only rival in a potentially lucrative market. The appeals court permanently removed an injunction that had actually been suspended several months ago. It would have prevented Sanofi and Regeneron from marketing Praluent, a newer type of cholesterol medicine. The injunction was initially granted by a lower court after a jury last year found their drug infringed on patents held by Amgen, which sells a competing treatment called Repatha. (Silverman, 10/5)

CQ: FDA Opens Door To Loosening Drug Safety Protocols
The Food and Drug Administration says it is writing new guidance to allow so-called “office use compounding,” in which pharmacies create compounded drugs for doctors, without a prescription, for them to have at the ready in their offices. Drug compounding is a service pharmacies provide to patients who cannot take mass-produced products because of allergies or other reasons. (Zeller, 10/10)

Public Health And Education

Officials Attribute Innovative Partnership Between Las Vegas Police, Firefighters With Saving Countless Lives In Shooting

Fire departments traditionally have waited on the sidelines of shooting scenes until police declare it safe for medics to go in and treat victims, but in Las Vegas they took a different approach.

The Washington Post: Armed With A New Approach, Police And Medics Stormed Through The Las Vegas Gunfire, Saving Lives
Joe Geeb didn’t know if there was one shooter, or 30. When the call for a “mass casualty incident” blasted through the radio Sunday night, the Clark County fire captain had no idea what was happening on the Las Vegas Strip, but he immediately began thinking about how he would run toward the bullets, the mayhem and the carnage while everyone else was running away. (Bui, 10/5)

The New York Times: How To Stop Bleeding And Save A Life
In the commotion immediately after the Las Vegas shooting that killed nearly 60 people on Sunday, medical workers outnumbered by victims pressed bystanders into service to help with emergency first aid. Just as bystander CPR has become standard, public health agencies are working to increase awareness of bystander first aid. Because trauma victims often die of blood loss, rather than the injury itself, stopping the bleeding is the top priority. (Rabin, 10/5)

Los Angeles Times: California Residents Can Apply For Aid For Medical Bills, Funeral Expenses After Las Vegas Attacks
Californians who were injured in the Las Vegas attack may be able to get some monetary relief. The California Victim Compensation Board, a state program that offers monetary support for victims of violent crimes, has released a single application process to allow people to apply for compensation from California as well as from Nevada's program, said Julie Nauman, the board's executive director. (Kohli, 10/5)

How San Diego's Hepatitis A Outbreak May Have Had Its Roots In A Baseball Game

Stat takes a look at how San Diego's outbreak has been brewing for a while.

Stat: Hepatitis A In San Diego: An Outbreak Waiting To Happen
The hepatitis A outbreak now roiling this well-heeled, coastal city may have had its roots in a baseball game — when the city cleaned up for the 2016 All-Star Game by pushing its homeless out of the touristy areas downtown and into increasingly congested encampments and narrow freeway onramps just east of downtown. The lines of tents stretched for blocks. At the same time, the city was locking and removing bathrooms to help control the rampant drug and prostitution trade they’d spawned. Hepatitis A is transmitted through contact with feces from an infected person, and in close, unsanitary conditions, the highly contagious virus can spread explosively. So it was only a matter of time, experts say, before cases would surge among the homeless. (McFarling, 10/6)

Los Angeles Times: California's Deadly Hepatitis A Outbreak Could Last Years, Official Says
California’s outbreak of hepatitis A, already the nation’s second largest in the last 20 years, could continue for many months, even years, health officials said Thursday. At least 569 people have been infected and 17 have died of the virus since November in San Diego, Santa Cruz and Los Angeles counties, where local outbreaks have been declared. Dr. Monique Foster, a medical epidemiologist with the Division of Viral Hepatitis at the U.S. Centers for Disease Control and Prevention, told reporters Thursday that California’s outbreak could linger even with the right prevention efforts. (Karlamangla, 10/5)

Sacramento Bee: Sacramento County Scrambles To Prevent Hep A Outbreak
As health officials work to control a hepatitis outbreak in Southern California, Sacramento County and City officials are trying to get ahead of the crisis. ... After declaring an outbreak in San Diego County in April, health officials started distributing the vaccine to the homeless since they are the most at-risk because of poor hygiene and sanitary conditions. (Sullivan and Lillis, 10/5)

In Latest Setback, Painkiller-Maker Agrees To Pay $500K In Suit Over Marketing Tactics

Massachusetts brought the lawsuit on claims that the company "aggressively marketed its product and made illegal payments to providers to boost sales."

Stat: Insys To Pay $500,000 To Massachusetts For Illegal Marketing Of Painkiller
Insys Therapeutics (INSY) agreed on Thursday to pay $500,000 to Massachusetts to resolve charges of illegally marketing its highly addictive Subsys painkiller and paying kickbacks to doctors to write prescriptions. Between 2012 and 2014, state officials charged that Insys marketed Subsys for patients whose pain is caused by an ailment other than cancer, even though the medicine was only approved by regulators for treating cancer pain. And Insys made misleading statements suggesting that Subsys was appropriate for combating mild pain, even while citing a study that found the drug was only appropriate for “moderate to severe” pain. (Silverman, 10/5)

In other news on the opioid crisis —

CQ: Health Officials Call For Resources To Address Opioids
Top Trump administration health officials appearing before a Senate committee Thursday called for sustained resources to address prescription opioid and heroin abuse, although the president's budget request called for cuts in many health programs. The officials emphasized to senators on the Health, Education, Labor and Pensions Committee the importance of insurance coverage to securing treatment and expressed a desire for Congress and the administration to agree on more appropriations to promote anti-opioid programs. (Siddons, 10/5)

The Philadelphia Inquirer/ Pa. To Fund Opioid Overdose Antidote For First Responders
Gov. Wolf said Thursday that Pennsylvania would supply 120,000 doses of the opioid overdose reversal medication naloxone to first responders. The budget includes $5 million for bulk purchases of Narcan Nasal Spray, a consumer-brand version of the emergency antidote, administration officials said. Narcan is made by Adapt Pharma Inc., an Irish company with U.S. headquarters in Radnor. Unlike the generic, which emergency room physicians and paramedics administer by injection, the nasal spray is intended for use by people with minimal medical training, including police, ambulance crews, and friends and families of people at risk of an overdose. (Sapatkin, 10/5)

Nashville Tennessean: Opioid Epidemic Getting Worse Instead Of Better, Officials Warn
A top public health official warned Thursday the nation’s opioid epidemic is showing no signs of abating. “It is one of the few public health problems that is getting worse instead of better,” said Dr. Debra Houry, director of the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control. Houry and public health officials testifying at a Senate hearing described an addiction crisis that has spiraled so out of control that it is far beyond the scope of any particular agency to address. (Collins, 10/5)

Gene Therapy Staves Off Fatal Brain Disease In What Was Thought Of As An Impossibility

The treatment had never really been tried on diseases such as ALD, a rare, fatal disorder. In other public health news: neanderthal DNA in humans, cancer and obesity, MRSA and sports, and traumatized children.

The New York Times: In A First, Gene Therapy Halts A Fatal Brain Disease
For the first time, doctors have used gene therapy to stave off a fatal degenerative brain disease, an achievement that some experts had thought impossible. The key to making the therapy work? One of medicine’s greatest villains: HIV. The patients were children who had inherited a mutated gene causing a rare disorder, adrenoleukodystrophy, or ALD. Nerve cells in the brain die, and in a few short years, children lose the ability to walk or talk. (Kolata, 10/5)

Los Angeles Times: As Much As 2.6% Of Your DNA Is From Neanderthals. This Is What It's Doing
Modern humans are a little more Neanderthal than we thought. A highly detailed genetic analysis of a Neanderthal woman who lived about 52,000 years ago suggests that our extinct evolutionary cousins still influence our risk of having a heart attack, developing an eating disorder and suffering from schizophrenia. Altogether, scientists now estimate that somewhere between 1.8% and 2.6% of the DNA in most people alive today was inherited from Neanderthals, according to a report published Thursday in the journal Science. (Healy, 10/5)

NPR: Neanderthal DNA Can Affect Skin Tone And Hair Color
Neanderthals died out some 30,000 years ago, but their genes live on within many of us. DNA from our shorter, stockier cousins may be influencing skin tone, ease of tanning, hair color and sleeping patterns of those of present-day Europeans, according to a study from the Max Planck Institute for Evolutionary Anthropology published Thursday in the American Journal of Human Genetics. (Jochem, 10/5)

Columbus Dispatch: CDC: 13 Types Of Cancer Linked To Obesity, Overweight
The report released by the Centers for Disease Control and Prevention this week shows that the overall rate of a dozen cancers associated with being overweight or obese rose by seven percent from 2005 to 2014. Meanwhile, cancers not associated with high weight were down 13 percent. (Viviano, 10/5)

The New York Times: The Never-Ending Battle Against Sport’s Hidden Foe
The first thing Colgate University did was purchase a sophisticated $14,000 machine that used ozone gas, not water or detergent, to disinfect all its athletes’ gear. An ice hockey player had come down with a staph infection, and Colgate, fearing the severe and sometimes fatal form of it known as MRSA, was not going to take any chances. The university didn’t stop at gassing gear. (Pennington, 10/6)

WBUR: For Traumatized Children, An Offer Of Help From The Muppets
Sesame is better known for teaching preschoolers letters and numbers. But those familiar furry characters are also taking on tougher topics, says Jeanette Betancourt of Sesame Workshop. ... The new trauma material focuses on simple coping skills for what many in the field call "big feelings" — like anger, anxiety and sadness. (Kamenetz 10/6)

State Watch

NYC Public Hospitals Will Not Fill Many Vacancies Because Of Federal Funding Cutbacks

State and city officials are working to sort out how to deal with a $2.6 billion reduction in federal funds for all state hospitals. Also, Politico examines the impact of the growing number of closures of rural hospitals, and voters in Oregon are likely to be asked to approve a new tax on health providers.

The Wall Street Journal: New York City Public Hospitals Take Measures To Conserve Cash
The head of New York City’s public hospital system says he will leave more jobs unfilled at the 11 hospitals he oversees to cope with a cash-flow crisis that emerged after the state withheld millions in aid. City and state officials have sparred over the funding in recent days as health-care dollars from Washington become scarce. (Gay and West, 10/5)

Politico: Rural Hospitals Are Dying And Pregnant Women Are Paying The Price
As Congress debates repealing and replacing the Affordable Care Act, rural hospitals are in a kind of purgatory, unsure about their Medicaid budgets and the private health insurance that sustains them. At least 81 rural hospitals have shut down across the country since 2010, according the North Carolina Rural Health Research and Policy Analysis Center at UNC. The pace of closures has been increasing since the Great Recession, but the current health care policy limbo—which leaves hospitals and insurers unable to predict their income—exacerbates the problem. (Rab, 10/3)

The Oregonian: Repeal Of Oregon Health Care Tax Appears Headed For January Ballot 
Opponents of a new tax on health insurance providers and hospitals on Thursday submitted what they said are enough signatures to put the issue on the ballot. If enough valid signatures were collected, voters will be asked in a Jan. 23, 2018 special election if they want the taxes to take effect. A "yes" vote would maintain the tax on insurance premiums that lawmakers approved in June. Supporters -- including labor groups and organizations that make money by providing Medicaid services -- say money raised by the bill will help keep 350,000 poor Oregonians on the state's Medicaid program.  They say the money will also help stabilize the insurance market by establishing a reinsurance program. (Friedman, 10/5)

The CT Mirror: Hospital Lawsuit No Longer An Obstacle To New CT Budget Deal
Gov. Dannel P. Malloy’s administration clarified its position Thursday on a new taxing arrangement with Connecticut’s hospital industry — removing a key stumbling block to a new state budget in the process. The administration said it remains open to the tax changes — which would leverage major new federal aid for Connecticut and its hospitals — even though an industry lawsuit against the state remains unresolved. (Phaneuf, 10/5)

State Highlights: Second USC Med School Dean Out After Old Harassment Claim Emerges; Bureaucracy Undermines Ill. Screening Law

Media outlets report on news from California, Illinois, Washington and Kansas.

Los Angeles Times: USC Medical School Dean Out Amid Revelations Of Sexual Harassment Claim, $135,000 Settlement With Researcher
After the dean of USC’s medical school resigned last year amid long-running complaints about his drinking and boorish treatment of colleagues, university leaders assured students and faculty that his successor would be worthy of respect. The man USC chose, however, had a black mark on his own personnel record: A finding by the university 15 years ago that he had behaved inappropriately toward a female medical school fellow. (Parvini, Ryan and Pringle, 10/5)

Chicago Tribune: How Illinois Bureaucracy Robbed Parents Of A Chance To Save Their Children From A Deadly Disease
The state's newborn screening program was supposed to be immune from the budget pressures weighing on state officials as the Great Recession took hold. Screening newborns in Illinois is funded by a testing fee charged to hospitals for each baby born. The legislature directed Public Health to raise that fee to cover the new testing for Krabbe disease and other lysosomal disorders. But the state took so long to change the rules to allow a $19 increase for each baby — an extra $3 million a year — that the money didn't start accumulating until January 2010. (Callahan, 10/4)

Chicago Tribune: Edward-Elmhurst Health Cutting $50 Million, Eliminating 234 Positions 
West suburban hospital system Edward-Elmhurst Health has laid off 84 employees as part of plans to slash $50 million in costs. In all, the system is cutting 234 positions, mostly by not filling vacant spots. Of the 84 people who lost their jobs, 36 were in management, said spokesman Keith Hartenberger. The system had nearly 9,000 employees before the layoffs. (Schencker, 10/5)

San Jose Mercury News: California To Crack Down On Disabled Placard Fraud
Gaming a program for drivers with disabilities is about to get much harder under a new California law set to take effect in January, starting with one common-sense measure: using federal data to help determine which disabled parking permit-holders have died. Senate Bill 611, by Sen. Jerry Hill, D-San Mateo, came in response to an April state audit revealing that as many as 35,000 parking placards issued to Californians whom the Social Security Death Master File listed as deceased were still in use. (Murphy, 10/5)

Chicago Tribune: How To Train Nursing Students? Schools Turn To Fake Patients
UM’s five-story, 41,000-square foot Simulation Hospital, which opened Thursday on its Coral Gables campus, is part of a growing trend of colleges building simulation centers to provide real-life experiences to students. Community colleges and vocational schools also use simulators for emergency medical technician, paramedic and medical assistant programs. Broward College opened a 66,000-square foot Health Sciences Simulation Center in 2014. Florida International University, west of Miami, opened a 16,000-square foot facility in 2010. Nova Southeastern University recently opened a new simulation center on its main Davie campus. Simulation labs are standard in other South Florida nursing programs as well. (Travis, 10/5)

Seattle Times: Washington State Family Sues Medical Center For Refusing Services To Transgender Son 
The federal lawsuit, filed in U.S. District Court in Seattle, appears to be the first of its kind in Washington state, said ACLU staff attorney Lisa Nowlin. The ACLU contends that PeaceHealth’s blanket policy of refusing to pay for transgender medical services discriminates on the basis of sex and gender identity, violating the Affordable Care Act (ACA), which prohibits such discrimination. The lawsuit also claims PeaceHealth violated the state law against discrimination. (Young, 10/5)

San Jose Mercury News: San Leandro May Ban Flavored Tobacco Products
Flavored cigarettes, cigarillos and electronic cigarettes may soon be banned in San Leandro. The San Leandro City Council, by a 4-3 vote, approved the proposed ban Monday, following nearly two hours of public comment from city retailers and anti-smoking advocates. (Moriki, 10/5)

KCUR: KU Scientist Snags Another Big Award For Work On Antibiotic Resistance
A University of Kansas scientist who won a prestigious award last year for her work on antibiotic resistance has chalked up another major achievement. The National Institutes of Health announced Thursday morning that it’s awarding nearly $2.3 million to Joanna Slusky and her lab to further their work on combating the problem of antibiotic resistant infections. Slusky, 38, and her lab are taking a novel approach to the problem. Instead of trying to come up with new antibiotics, their focus is on efflux pumps, or the proteins within bacteria that push out antibiotics as well as toxic substances. The idea is to disable the pumps. (Margolies, 10/5)

San Jose Mercury News: Cities In Santa Clara County Scramble To Ban Marijuana Sales Ahead Of Jan. 1
Twenty years after California voters legalized marijuana for medicinal use, they took the next big step at the ballot box last November by deciding it’s OK to toke for fun too. But while 57 percent of the state’s voters embraced the recreational use of pot by approving Proposition 64, South Bay cities are sitting back and waiting for the smoke to clear before amending their local laws to let the once forbidden weed openly flourish. (Sarwari, 10/5)

Editorials And Opinions

Viewpoints: Backtracking On Medicare Costs; Single-Payer Could Jeopardize Obamacare

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

Bloomberg: Trump Slows Efforts To Cut Health-Care Costs
In April 2016 the federal Medicare program began an experiment to save money on the half-million hip and knee replacements it pays for each year. In 67 cities, Medicare capped the payments it makes to hospitals for joint surgeries and the months of follow-up care they require. ... The idea is to lower costs over time by giving hospitals incentives to be more efficient, which would ultimately boost their bottom lines. ... Now, the new payment arrangement will be optional for hospitals in half of the cities where it previously was mandatory. That change will increase Medicare costs by $90 million over the next three years, according to the agency. (John Tozzi, 10/5)

Los Angeles Times: A Single-Payer Litmus Test Won't Help The Progressive Agenda
Obamacare is still with us. The latest Republican repeal effort has failed, and the enrollment period begins Nov. 1. A bipartisan Senate bill to address its problems could be voted on sometime this fall. Meanwhile, many Democrats are embracing a single-payer “Medicare for all” system as the next step in healthcare reform. But making single-payer the top priority now could jeopardize the gains made since passage of the Affordable Care Act, which is still being sabotaged by the Trump administration. (Tom Epstein, 10/5)

Boston Globe: Protect Free Access To Birth Control
Republicans on the national level will continue their egregious attack on women’s health, making the political resistance by states more important than ever. Barriers to birth control disproportionately hurt the poor, and it’s up to Massachusetts lawmakers to pass legislation like the ACCESS bill to protect them. (10/6)

Des Moines Register: Iowa Anti-Abortion Strategy: Force Women To Wait So The State Can Indoctrinate Them
The 18-year-old high school student didn’t need to hear the fetal heartbeat. She had heard enough about the challenges of becoming a teen mom from her own mother. She didn’t need to see the sonogram or to be asked again about it. She didn’t need more adoption-promotion literature or warnings of potential psychological downsides to abortions. She was determined to make a better life for herself than her mother had been able to. And after waiting four days for the appointment, she wanted to get on with the abortion. But on May 5, the long arm of the state of Iowa reached out to block her. On that day, former Gov. Terry Branstad signed a law, effective immediately, requiring anyone seeking an abortion to wait three more days and make more than two clinic trips to get one. (Rekha Basu, 10/5)

Los Angeles Times: Guns, Like Cigarettes, Are Legal Products That Kill People. That's Not OK
This week it’s guns, with at least 59 people dead and hundreds injured after the worst mass shooting in modern U.S. history. But the focus just as easily could be on cigarettes, or junk food, or sugary beverages. No reasonable person disputes that all these products can be dangerous, whether we’re talking about firearm casualties, lung cancer, diabetes or heart disease. The issue is how, or if, the makers of these products should be held accountable for the trouble they cause. (David Lazarus, 10/6)

The Washington Post: Talking About Mental Health After Mass Shootings Is A Cop-Out
“He was a sick man, a demented man,” said President Trump, trying to explain the latest mass shooting in the United States. We hear this view expressed routinely, after every new incident. But it is a dodge, a distortion of the facts and a cop-out as to the necessary response. There is no evidence that the Las Vegas shooter was insane. (I prefer not to use his name and give him publicity, even posthumously.) He did not have a history of mental illness that we know of, nor had he been reported for behavior that would suggest any such condition. (Fareed Zakaria, 10/5)

The New York Times: America Is Surprisingly Reliant On Foreign Medical Graduates
[M]any people think the United States health care system has a lot of problems. So it seems reasonable to think of policy changes that make things better, not worse. Making it harder for immigrants to come here to practice medicine would fail that test. The American system relies to a surprising extent on foreign medical graduates, most of whom are citizens of other countries when they arrive. (Aaron E. Carroll, 10/6)

Miami Herald: To Avoid Another Tragedy, Skilled Nursing Homes Need Priority During And After Hurricanes
The aftermath of Hurricane Irma has sparked many conversations about senior health and disaster preparation, and whether skilled nursing facilities should be prioritized when it comes to restoration of power and recovery efforts. ... If we are to ask skilled nursing facilities to adopt these hospital best practices for staffing during times of natural disaster, then skilled nursing facilities should also be categorized as top priority when it comes to restoration of power and recovery efforts. With more complex patients in our care that may be unable to evacuate, it is crucial – lifesaving even – that we be designated as “critical facilities”, immediately after hospitals, in restoration efforts. (Elaine Bloom, 10/6)

Des Moines Register: Do Iowa Lawmakers Think They Will Never Grow Old?
The Republican-controlled Iowa Legislature cut funding for direct-care workforce programs from about $500,000 to $188,000 for the current fiscal year. More than $100,000 was slashed for Iowa CareGivers, a nonprofit organization dedicated to cultivating a quality, caregiver workforce in this state. The money previously appropriated was used for mentoring programs, partnerships with community colleges, workforce training, stakeholder forums, public awareness and other efforts to recruit and retain direct-care workers. (10/5)

Bloomberg: Go Ahead, Order That Cheesesteak
In the latest science shocker, researchers discovered that a number of people around the world are eating foods such as cheese, butter and full-fat yogurt without doing deadly harm to their bodies. This was treated as health heresy, yet this study’s findings weren’t all that out of line with previous research on moderate consumption of so-called saturated fats, found primarily in animal products. (Faye Flam, 10/4)

Bloomberg: What Humans Can Learn From Sleep-Deprived Fruit Flies
At Nobel Prize time, journalists tend to celebrate the ingenuity of scientists. This year, let’s show some appreciation for the ingenuity of evolution and the human body instead. The 2017 Nobel for medicine went to three researchers who uncovered the workings of tiny clocks inside your cells -- clocks that tell you when to eat, when to stop eating, and when to shut off that computer and get some sleep. The prize-winning work was done on fruit flies, but its findings are relevant to us humans, since once evolution invents something useful, it often spreads far and wide. (Faye Flam, 10/5)