KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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From Kaiser Health News - Latest Stories:

Kaiser Health News Original Stories

This Gift Voucher Might Just Get You A Kidney 

A retired California judge came up with the idea of donating his kidney to a stranger now to maximize his grandson’s prospects for such a donation later. The idea caught on. (Fran Kritz, 9/15)

Political Cartoon: 'Outside The (Litter) Box?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Outside The (Litter) Box?'" by Dave Coverly, Speed Bump.

Here's today's health policy haiku:

DOES INDUSTRY TAKE ADVANTAGE OF ORPHAN DRUG PROTECTIONS? FDA COMMISSIONER SIGNALS CHANGE AHEAD

Abusing orphan
Status? Watch out. FDA
Plans to close loopholes.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Summaries Of The News:

Health Law

Hearings Done, Senate Health Panel Now Seeks Common Ground On Stabilizing Marketplaces

The committee's chairman, Sen. Lamar Alexander (R-Tenn.), says he hopes to have a bipartisan bill by early next week that would give insurers more confidence about the market environment.

The Hill: Senate Health Panel Aims For Deal On Stabilizing Markets Early Next Week 
The Senate's health panel intends to craft a bipartisan bill to stabilize the insurance markets by early next week, enabling the full Senate to pass it by the end of the month, according to Chairman Lamar Alexander (R-Tenn.). Alexander laid out the goal Thursday during the Health Committee’s fourth hearing on stabilizing the markets ahead of a Sept. 27 deadline for insurers to sign contracts to sell plans on HealthCare.gov, with open enrollment beginning Nov. 1. Last week, Alexander said he’d hoped for a deal by the end of this week. (Roubein, 9/14)

CQ: Senate Seeks Consensus As Health Insurance Hearings Conclude
Differences remain between requests from Health, Education, Labor and Pensions Chairman Lamar Alexander, R-Tenn., and ranking member Patty Murray, D-Wash., but the two expressed confidence Thursday that they would reach a deal. ... While Alexander said he has not received assurances from Majority Leader Mitch McConnell that a bill the committee leaders produce would get a floor vote, the Kentucky Republican and Minority Leader Charles E. Schumer, D-N.Y., are monitoring their progress. “They know that we may get a result, and if we do, they’ll have to deal with it in the last week of September for it to have effect in 2018,” Alexander said. (Clason, 9/14)

Morning Consult: Some Democrats Willing To Replace Obamacare’s Individual Mandate
As a Senate panel tries to agree on a bipartisan fix to stabilize the Affordable Care Act, some Democrats appear willing to part with the law’s controversial individual mandate — as long as there is an adequate replacement. ... At least two Democratic senators — Claire McCaskill of Missouri and Tim Kaine of Virginia — have expressed interest in automatically enrolling uninsured Americans in a low-cost insurance plan, a proposal that was included in one Republican plan to repeal Obamacare earlier this year. And 10 moderate House Democrats raised auto-enrollment as a potential tool to increase coverage and stabilize the Obamacare exchanges in a health care proposal released in July. (Reid, 9/14)

Modern Healthcare: Split Over State Flexibility, Senators Hope To Craft Insurance Stability Bill By Next Week 
At the last of four hearings held by the Health, Education, Labor and Pensions Committee, expert witnesses representing insurers, providers, consumers and state insurance commissioners stressed the urgent need for Congress to fund payments to insurers for the Affordable Care Act's cost-sharing reductions to low-income consumers. ... In addition, they pressed for a federal reinsurance program to help carriers with the cost of sicker enrollees. And they urged strong enforcement of the law's requirement that everyone buy insurance, or an alternative mechanism to prod consumers to maintain continuous coverage. (Meyer, 9/14)

Nashville Tennessean: Nashville Surgeon: State Health Woes Tied To Challenge Of Buying Insurance
Nashville surgeon Manny Sethi told a Senate panel Thursday that Tennesseans’ struggles to get healthy are tied directly to the challenges facing the individual health insurance market. Critically ill patients who have undergone multiple surgeries and clinic visits have suddenly seen their health insurance canceled or have been forced to find a new doctor to comply with rules imposed by their insurance company – in some cases, the only insurer in their county, Sethi said. (Collins, 9/14)

Morning Consult: Centrist Democrats Turn to Pragmatism, Seek Bipartisan ACA Fixes
While some progressives campaigned this week for “Medicare for all,” a group of moderate House Democrats aligned themselves with a more modest push to stabilize the Affordable Care Act, arguing that it could spur broader health care reforms in the future. Thirty-five of the 61 members of the New Democrat Coalition sent a letter Friday urging the leaders of the Senate Health, Education, Labor and Pensions Committee to agree on a bipartisan bill to keep premiums from rising further for Obamacare enrollees next year. (Reid, 9/15)

Sen. Cornyn Sussing Out Support For Graham-Cassidy Health Care Bill

The legislation, which is the Republicans' last-ditch effort to repeal and replace the Affordable Care Act, has long odds in the Senate.

The Hill: Key Senator Whipping Last-Ditch ObamaCare Repeal Bill
Sen. John Cornyn (R-Texas) is measuring support for a new bill to repeal and replace ObamaCare as lawmakers head toward an end-of-the-month deadline. The vote-counting process, known as "whipping," will give GOP leadership a tentative count of which senators support the legislation spearheaded by GOP Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.). (Carney, 9/14)

Meanwhile, in the House, progress has slowed over funding for CHIP —

CQ: House Stalled On Kids' Health Bill As Senate Prepares To Act
The Senate Finance Committee is expected to unveil the legislative text for its children's health insurance bill this week but progress in the House on the issue still seems stalled before the chamber leaves for recess. “We still have some things to work through, which we'll do at the staff level and member level next week when we're out, and then I hope when we return we'll have an opportunity then to mark up,” said Rep. Greg Walden, chairman of the Energy and Commerce Committee, which oversees the Children's Health Insurance Program. (Raman, 9/14)

ACA Navigators Find Out Just How Deep Those Outreach Budget Cuts Go

Funding will be reduced by as much as 92 percent to the organizations designed to help people enroll in coverage through the Affordable Care Act. And many of the places that will be hit the hardest are in deep red territory.

The Washington Post: HHS Slashes Funding To Groups Helping ACA Consumers Enroll By Up To 92 Percent
Health and Human Services officials have informed grass-roots groups that assist with enrollment under the Affordable Care Act that their funding will be reduced by as much as 92 percent, a move that could upend outreach efforts across the country. The groups, which fund organizations known as “navigators,” had been braced for the cuts since the Trump administration announced two weeks ago that it would shrink overall program funding by 41 percent and slash the department’s ACA advertising budget from $100 million to $10 million. At the time of the announcement, HHS officials said the outreach wasted taxpayers’ money. (Eilperin and Goldstein, 9/14)

The Hill: ObamaCare Enrollment Groups Learn Extent Of Trump Cuts 
Their grant funds ran out at the beginning of the month, and they will not be paid retroactively for the first two weeks of September, according to one source. In preparation, some groups had laid off staff and cut salaries. Now, navigators will be analyzing their new budgets ahead of an ObamaCare enrollment season beginning Nov. 1. The Missouri Association of Area Agencies on Aging received “a severe cut of 62 percent,” Catherine Edwards, the executive director, wrote in an email. (Roubein, 9/14)

The Hill: Trump Cuts To ObamaCare Outreach To Hit Red States Most 
The Trump administration’s decision to slash outreach funding for ObamaCare will, perhaps unintentionally, hit red states the hardest. The move last month to cut 90 percent of funds to spur signups for healthcare.gov is likely to lead to fewer young and healthy people in the insurance pool — and thus higher costs in states with majority Trump voters, according to experts. (Weixel, 9/15)

Iowa Public Radio: Feds Cut Funding For Iowa's ACA Sign-Up Groups
Late Wednesday night, the U.S. Department of Health and Human Services announced various grant reductions for ACA navigators. Some cuts are as high as 90 percent. Genesis Health in the Quad Cities is facing a 90 percent cut to is ACA navigator grant. (Sostaric, 9/14)

Premiums To Jump 15 Percent Next Year Due To Trump's Threats To Subsidies, CBO Projects

This rise is also attributed to the projected increase to growing numbers of people living in regions where only one insurer sells policies.

The Associated Press: Analysts See Trump Threats To Insurers Boosting Premiums
Average premiums for individually purchased health insurance will grow around 15 percent next year, largely because of marketplace nervousness over whether President Donald Trump will block federal subsidies to insurers, Congress' nonpartisan fiscal analyst projected Thursday. The Congressional Budget Office estimate comes as Trump has repeatedly threatened to halt the payments in his drive to dismember President Barack Obama's health care law. (Fram, 9/14)

Reuters: Obamacare Enrollment To Fall In 2018 And Beyond After Cuts: CBO
The non partisan agency now estimates that the average monthly enrollment on the exchanges will be about 11 million people, down about 4 million from last year's forecast. People can sign up for or drop out of coverage throughout the year as their employment status or access to other government health plans changes. (Humer, 9/14)

Repeal-And-Replace Is Still An Extremely Important Priority For Many Republican Voters

Fifty-three percent of Republican respondents in a new poll classify the issue as extremely important while another 26 percent said it should be a "very important priority." Meanwhile, The Washington Post uses state-level data to examine how the Affordable Care Act has affected uninsured rates.

The Washington Post: How Health-Care Reform Affected America, In 51 Graphs
Last year, 8.6 percent of Americans lacked health insurance. Three years earlier, that figure was 14.5 percent, meaning that the rate dropped by 5.9 percentage points over the period that the Affordable Care Act went into effect, a 40 percent decline from the 2013 figure. In real terms, that’s about 19 million fewer people lacking health insurance, per estimates released Tuesday by the Census Bureau. (Bump, 9/14)

KCUR: Young, Low-Income Kansans More Likely To Be Uninsured Than Counterparts In Other States 
Low-income Kansans are less likely to have health insurance than their counterparts in other states, according to an analysis of new data from the U.S. Census Bureau. The uninsured rate among Kansans living below the federal poverty level has been worse than the national rate for many years. But the gap has widened in recent years, mainly because of the state’s rejection of Medicaid expansion, said Robert St. Peter, president and CEO of the nonpartisan Kansas Health Institute. (McLean, 9/14)

Coverage And Access

Weeding Out The Rhetoric From The Facts On Sanders' 'Medicare For All' Plan

The New York Times examines various claims -- like that the majority of people are in support of a single-payer system -- surrounding the proposal advanced by Sen. Bernie Sanders (I-Vt.). Meanwhile, Sen. John Barrasso (R-Wyo.) asks the Congressional Budget Office to score the bill, which could make it an even tougher sell than it already is.

The New York Times: ‘Medicare For All’: Is It Popular? And Is It The Same As Britain’s System?
As leading Democrats embrace Senator Bernie Sanders’s proposal to vastly expand Medicare to cover all Americans, Republicans are fighting back with familiar critiques of such a single-payer system. Mr. Sanders argued for his “Medicare for all” legislation in an Op-Ed published in The New York Times on Wednesday, while his Republican colleagues dismissed the idea in a news conference. Here’s an assessment of their claims. (Qiu, 9/14)

The Wall Street Journal: Single-Payer Health Care Could Be A Tough Sell, Polling Shows
Single-payer health care, or as Sen. Bernie Sanders (I., Vt.) calls it, “Medicare for all,” is becoming a rallying cry for many Democrats in Congress. But are Americans behind the idea of mandatory government-provided insurance? Polling from the summer tells us that it could be a tough sell. Only 33% of the overall public supports a “single payer” approach to health care, according to the Pew Research Center’s June poll. Among Democrats and those who lean Democrat, Pew says 52% support single-payer, up from 33% in March 2014. (Jamerson, 9/14)

The Hill: Senator Asks For CBO Score Of Sanders's Single-Payer Bill
Sen. John Barrasso (R-Wyo.) is asking congressional scorekeepers to analyze the cost of Sen. Bernie Sanders’s (I-Vt.) “Medicare for all” bill, which could fuel Republican attacks that a single-payer health-care system would bankrupt the country. In a letter to the head of the nonpartisan Congressional Budget Office, Barrasso — the Senate Republican Policy Committee chairman — wrote he was “deeply concerned that Senator Sanders’ Medicare-for-All legislation is not only a government takeover of health care, but would also put financial burdens on the American people that they cannot sustain.” (Roubein, 9/14)

The Washington Post: Sanders Enlists Canadians To Sell Single Payer
The day after he finally unveiled his legislation to turn Medicare into universal health insurance, Sen. Bernie Sanders (I-Vt.) built on his momentum in an unusual way: a 32-minute interview with a Canadian doctor. “We have a very, very exciting show!” Sanders said, kicking off his occasional podcast and introducing Danielle Martin, a Toronto physician and academic. “She’s kind of a household name in America now.” (Weigel, 9/14)

The Hill: Trump Calls Sanders Single-Payer Plan A ‘Curse On The US’ 
President Trump on Thursday called Sen. Bernie Sanders's (I-Vt.) "Medicare for all" plan a "curse on the U.S.” "Bernie Sanders is pushing hard for a single payer healthcare plan - a curse on the U.S. & its people," Trump tweeted. "I told Republicans to approve healthcare fast or this would happen. But don't worry, I will veto because I love our country & its people." (Hellmann, 9/14)

Quality

After Tragedy At Fla. Nursing Home, Advocates Say New Rule Protecting Residents Doesn't Go Far Enough

A new federal rule will require that nursing homes have “alternate sources of energy to maintain temperatures to protect resident health and safety." But some say it is too vague and wouldn't have necessarily avoided the deaths of the eight residents in Florida even if it had been in effect. Meanwhile, police have obtained a search warrant in their criminal investigation of the Florida nursing home, and The New York Times offers tips on choosing a reliable facility.

The New York Times: Nursing Home Deaths In Florida Heighten Scrutiny Of Disaster Planning
After an estimated 215 people died in hospitals and nursing homes in Louisiana following Hurricane Katrina in 2005, policy makers realized that the nation’s health care institutions were ill-prepared for disasters. One of the rules they created after years of discussion looked especially prescient in light of the tragic deaths on Wednesday of eight nursing home residents in Florida’s post-hurricane heat. But the rule, regarding power supplies and temperature control, will not be enforced until November, and even then, some patient advocates are concerned that it does not go far enough. (Reisner and Fink, 9/14)

Reuters: Police Obtain Search Warrant In Probe Of Eight Nursing Home Deaths
Police obtained a search warrant on Thursday in their criminal investigation of the deaths of eight elderly patients exposed to sweltering heat inside a Miami-area nursing home left with little or no air conditioning after Hurricane Irma struck. The loss of life in Hollywood, Florida, brought the overall death toll from Irma to 82, with several hard-hit Caribbean islands, including Puerto Rico and the U.S. Virgin Islands, accounting for more than half the fatalities. (Oliphant, 9/15)

Los Angeles Times: 'There For You 100%,' Trump Tells Floridians; Elderly Plight In Spotlight After Nursing Home Deaths
President Trump told Florida hurricane victims his administration is “there for you 100%” as officials moved urgently to safeguard the state’s vulnerable elderly and restore power to millions of homes and businesses still without electricity. The president and First Lady Melania Trump arrived aboard Air Force One in Fort Myers on the peninsula’s southwestern Gulf coast, then traveled by helicopter to Naples, 40 miles away. It was Trump’s third disaster-zone visit in less than three weeks. (Lee, McDonnell and King, 9/14)

The Associated Press: Vulnerable Residents A Concern In Hurricane Irma Aftermath
Florida's fits and starts toward post-Irma recovery have shifted to urgent efforts to protect its vulnerable elderly residents after a string of nursing home deaths. Several nursing homes have been evacuated because of a lack of power or air conditioning, while utility workers raced help dozens of others still lacking electricity as of Thursday. Homebound seniors found help from charities, churches and authorities. (Kay and Reynolds, 9/15)

Health News Florida: Heat Illness Can Be Deadly For Seniors Without Power
For the millions of people who are still without power across Florida, heat illness can be a concern. The old and the very young are most susceptible to heat-related health issues and the death of 8 residents at an assisted living facility in Hollywood that lost power after Hurricane Ivan illustrates the danger. (Ochoa, 9/14)

The Hill: Walden Hints At Nursing Home Oversight In Wake Of Irma Deaths 
House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) said his committee may begin looking at oversight of nursing facilities following the deaths of eight people in a Florida nursing home. The deaths occurred after the South Florida facility apparently lost its air conditioning amid widespread power outages in the wake of Hurricane Irma. The storm knocked out power for millions of people across the state. (Weixel, 9/14)

The New York Times: Five Tips For Choosing A Reliable Nursing Home
The news that eight Florida nursing home residents died in the aftermath of Hurricane Irma has prompted a criminal investigation and spurred widespread outrage. But it also poses unsettling, difficult questions for people selecting a nursing home for themselves or a loved one. This emotionally fraught choice often must be made at a chaotic moment when a relative is sick, his or her time in the hospital is running short and the options seem confusing. (Thomas, 9/14)

WMFE: Hundreds Of Elderly Residents Evacuate In Osceola County
The assisted living facility, Good Samaritan Village in Kissimmee, experienced up to four feet of flooding after Hurricane Irma passed through. On Tuesday morning, 356 elderly residents were evacuated from the facility, while close to 200 residents chose to leave. (9/14)

In related news —

The Washington Post: Texas Officials: Hurricane Harvey Death Toll At 82, ‘Mass Casualties Have Absolutely Not Happened’
Texas officials said Thursday that they believe at least 82 people died as a result of Hurricane Harvey and the intense flooding it brought to Houston and coastal areas, although it could take weeks to determine the exact death toll. The picture could have been much bleaker, given the amount of flooding and that entire communities were cut off for days. Hospitals had to be evacuated as water rose into buildings that had never before flooded; some residents found themselves trapped in their homes while chest-deep floods took over their streets; and emergency responders along the Texas coast were overwhelmed, leading civilians with watercraft to rescue one another. (Moravec, 9/14)

Pharmaceuticals

FDA Chief Stresses Competition As Way To Curb High Drug Prices

Food and Drug Administration Commissioner Scott Gottlieb said the tactic isn't new, but he wants to be more transparent with the agency's efforts going forward.

Politico: FDA Chief: Boosting Competition Is Key To Tackling Drug Prices
FDA Commissioner Scott Gottlieb said at POLITICO’s Pro Policy Summit on Thursday that his agency is focused on boosting pharmaceutical competition when it comes to the hot-button topic of drug prices. “We think about it from the standpoint of competition, trying to facilitate competition,” Gottlieb said, noting that the agency is targeting generic drugs as an avenue to address cost and access issues. (Diamond, 9/14)

In other pharmaceutical news —

Stat: Stakes Are High As Alnylam Awaits Results From Novel Rare Disease Therapy
A $7 billion market valuation and the credibility of the entire field of RNA interference drug development is riding on the results of Alnylam Pharmaceuticals’ (ALNY) next big clinical trial. No pressure, folks. Before September comes to a close, Alnylam, led by CEO John Maraganore, will announce the outcome of a phase 3 clinical trial of patisiran, the company’s lead drug designed to treat a rare nerve disorder known as familial amyloid polyneuropathy (FAP.) (Feuerstein, 9/15)

Stat: Moderna Leaves Key Questions Dangling As Investors Weigh Its Bold Claims
Moderna Therapeutics, biotech’s most richly valued and hotly debated startup, made headlines Thursday morning with a cheery update on its pipeline of futuristic medicines. Hours later, about 100 of biotech’s top investors and analysts packed into a ballroom at Manhattan’s tony W Hotel for a closed-door presentation they hoped would take them behind the press release — and tell them whether Moderna truly deserves its $5 billion valuation. (Garde, 9/14)

Medicare

Medicare Unveils Design And Publicity Campaign For New Beneficiary Cards

The new cards will be rolled out in April, but federal officials are beginning an outreach campaign now so seniors are not confused when they get theirs.

The Associated Press: Medicare Card Gets A Remake To Help Protect Senior Citizens
Medicare cards are getting a makeover to fight identity theft. No more Social Security numbers plastered on the card. Next April, Medicare will begin mailing every beneficiary a new card with a unique new number to identify them. ... One goal is to make sure seniors know what's coming so they're not confused by the change — and in the meantime, are reminded to guard their old cards that, if lost or stolen, can leave them vulnerable to financial and legal consequences. The government recorded 2.6 million cases of identity fraud involving seniors in 2014, up from 2.1 million in 2012. (Neergaard, 9/14)

Public Health And Education

Google Imposes Restrictions On Opioid Treatment Center Ads

“This is a bold move by one of the world’s biggest companies, saying people’s lives are more important than profit,” said Greg Williams, co-founder of Facing Addiction. Meanwhile, President Donald Trump's opioid commission says there's no timetable for officially declaring the crisis a national emergency.

The New York Times: Google Sets Limits On Addiction Treatment Ads, Citing Safety
As drug addiction soars in the United States, a booming business of rehab centers has sprung up to treat the problem. And when drug addicts and their families search for help, they often turn to Google. But prosecutors and health advocates have warned that many online searches are leading addicts to click on ads for rehab centers that are unfit to help them or, in some cases, endangering their lives. (Corkery, 9/14)

And in other news —

The Associated Press: Company Under Fire For Opioid Marketing Files Patent Suit
An Arizona-based pharmaceutical company targeted in lawsuits and criminal investigations over its marketing of a highly addictive painkiller has filed a related patent-infringement lawsuit against a rival drug maker. Insys Therapeutics filed the complaint against Teva Pharmaceuticals on Wednesday in federal court in Delaware. (Chase, 9/14)

The Philadelphia Inquirer/Philly.com: Toomey Asks Feds To Probe 'Pimping Out,' Other Alleged Drug-Treatment Fraud
Sen. Pat Toomey (R., Pa.)  on Thursday called on federal watchdogs to investigate an alleged scheme in which drug addicts in Philadelphia are herded into drug-treatment centers in exchange for kickbacks using Medicaid dollars. In a letter to Daniel Levinson, inspector general for the U.S. Department of Health and Human Services, Toomey cited articles in the Inquirer and Daily News that disclosed the practice. (Lubrano, 9/14)

New Hampshire Public Radio: In N.H., HHS Secretary Price Announces Funding For Mental Health And Opioid Services
U.S. Health and Human Services Secretary Tom Price made a quick trip to New Hampshire Thursday afternoon to announce $200 million in federal grants targeting community health centers, to increase access to mental health and opioid abuse services. Ten New Hampshire recipients – nine health centers and the City of Manchester – are set to receive about $175,000 each as part of the grant program. (McDermott, 9/14)

High-Risk Drinking In Older Adults A Growing Problem

The scientists who ran the study didn't investigate causes, but speculate that anxiety caused by the recession, which hit right between the two surveys, may have played a part. In other public health news: lupus, nail-biting and other tics, end-of-life discussions, cervical cancer and more.

The New York Times: Alcohol Abuse Is Rising Among Older Adults
In the summer, Henry Wrenn-Meleck likes to sit on the stoop of his building on the Upper West Side of Manhattan, observing the passing urban parade. One day in late July, “one of my neighbors could see something was wrong,” he recently recalled. “I was sort of rolling around, obviously in a lot of pain. He said, ‘I have to call 911,’ and he did.” (Span, 9/14)

The Washington Post: Selena Gomez’s Kidney Transplant: Young, Minority Women Disproportionately Affected By Lupus
In the world of celebrities, there are diseases such as HIV/AIDS and breast cancer that are very “popular” and well understood, thanks to years of fundraising and awareness campaigns by stars. And there are those diseases that are less so. Lupus, an autoimmune disorder that can damage organs, is in the second category. When Selena Gomez shocked her 126 million Instagram followers on Thursday by revealing that she had disappeared from the public eye this summer because she was getting a kidney transplant because of lupus, her fans had many questions. (Cha, 9/14)

The New York Times: Are You A Hair-Twirler, Nail-Biter Or Knuckle-Cracker?
Are you a toe-tapper, hair-twirler, eye-blinker, head-nodder, nail-biter, knuckle-cracker, skin-picker, lip-licker, shoulder-shrugger or a chin-stroker? Call it a nervous habit or tic, almost everybody has at least one — whether they are aware of it or not. Tics exist on a spectrum ranging from barely noticeable to extremely annoying to potentially injurious. (Murphy, 9/14)

Stat: End-Of-Life Decisions Can Be Difficult. This Doctor Thinks ‘Nudges’ Can Help
For tax payments, “nudges” have helped municipalities increase revenues and decrease collection-related costs. For energy consumption, “nudges” have helped homeowners save money and utilities preserve capacity. But in health care, the technique has been slower to catch on. First described by the pioneering economists Richard Thaler and Cass Sunstein (who is also a legal scholar), a “nudge” is a way of framing a set of choices to essentially steer people toward a particular option without shutting out other options. (Tedeschi, 9/14)

Stat: Armed With Data, And Twitter, This Doc Takes On The Medical Establishment
Dr. Vinay Prasad is a professional scold:  He takes to Twitter each day to critique this cancer drug as ineffective, or blast that one as overpriced, or dismiss the clinical trial of another as completely irrelevant. ... Just 34, Prasad has become an influential voice in the medical community through his prolific, high impact publishing, a steady stream of media cameos, and — of course — his vociferous Twitter presence. Among his main arguments: Drug costs have spiraled out of control. Conflicts of interest run amok in health care. We don’t have any idea how well new cancer drugs and diagnostics work, thanks to ill-designed clinical trials. And more than half of all practiced medicine is based on scant evidence — and possibly ineffectual. (Keshavan, 9/15)

The New York Times: New Product Is First To Claim It May Reduce Peanut Allergies
A new powdered peanut product is the first food item allowed to claim it may reduce peanut allergies in infants, though parents of susceptible babies are urged to consult a doctor before trying it. The product, called Hello, Peanut, can be mixed into puréed baby food to expose infants to peanuts starting around five months old. (Rabin, 9/14)

Stat: 6 Things That Happen At TV Hospitals That Don't Happen In Real Life
Medical storylines have riveted television viewers since the earliest days of the medium — and for just as long, TV writers and directors have had to navigate the age-old tension between truth and storytelling. One early solution, beginning in the 1950s, was a group of doctors who advised television producers directly. The group, known as the Physician’s Advisory Committee (PAC) on Television, Radio, and Motion Pictures, reviewed scripts, helped find props, and showed actors how to properly hold a scalpel. (Samueal, 9/15)

NPR: Public Isn't Adequately Protected Against Misuse Of Biomedical Research
For years, the government has been trying to reduce the risk that legitimate biological research could be misused to threaten the public's health, but those efforts have serious shortcomings. That's the conclusion of a report released Thursday by the prestigious National Academies of Sciences, Engineering, and Medicine that examined existing practices and policies on so-called dual-use biological research. (Greenfieldboyce, 9/14)

NPR: Just The Perception That Your Friends Have More Friends Than You Can Make You Sad
When you feel like everyone around you is having more fun and spending more time with friends, it can make you feel bad about yourself — even if it's not true. But according to Ashley Whillans, an assistant professor at Harvard Business School who studies how our view of the world affects our view of ourselves, this perception can challenge us to become more social and make more friends. (Fulton, 9/14)

State Watch

State Highlights: U.S. House Votes To Block D.C.'s Reproductive Health Rule And Death-With-Dignity Law

Media outlets report on news from the District of Columbia, California, Iowa, New Hampshire, Massachusetts, Missouri, Pennsylvania, Minnesota, Oregon and Texas.

The Hill: House Votes To Block DC Reproductive Health Law 
The House voted on Thursday to prevent D.C. from receiving funding to implement a local law making it illegal for employers to discriminate against workers based on reproductive health decisions. An amendment offered by Rep. Gary Palmer (R-Ala.) to a 2018 government-spending package would prohibit the use of funds for the District to implement the law, which bans employers from punishing workers for obtaining contraception, family planning services or abortions. (Marcos, 9/14)

The Washington Post: House Votes To Repeal D.C.’s Death With Dignity Law; Senate Has Yet To Act
The U.S. House on Thursday passed a spending bill that would block five laws affecting the District of Columbia, including the city’s new assisted-suicide law. The bill would also block the District from spending money to subsidize abortion for low-income residents; regulate the sale of marijuana; or carry out a law that says employers cannot discriminate against workers based on their reproductive decisions, such as whether to take birth control or seek an abortion. (Portnoy, 9/14)

Los Angeles Times: California Lawmakers Back Bill To Protect Workers' Reproductive Health Choices Over Opposition From Religious Groups
Employees would not risk losing their jobs for reproductive health choices, including having an abortion, in-vitro fertilization or a child out of wedlock, under a bill that passed the Legislature on Thursday. The measure, by Assemblywoman Lorena Gonzalez Fletcher (D-San Diego), takes aim at employer codes of conduct, particularly at religious institutions, that could cost workers their jobs for making such health decisions. (Mason, 9/14)

New Hampshire Union Leader: Hospital Executives Discuss Merging Challenges
The president and CEO of Wentworth-Douglass Hospital joined a senior vice president from Massachusetts General Hospital on Thursday to talk about their merger during the first CEO Forum of the academic year at the University of New Hampshire. On Jan. 1, Wentworth-Douglass was officially acquired by Massachusetts General Hospital. Tony James, senior vice president of network development and integration for Massachusetts General, told the crowd in Durham that now people who receive treatment in Boston can get the follow-up care they need in Dover. James said they have always catered to the Seacoast population. (Haas, 9/14)

Boston Globe: Hospital Industry Group Taps Ex-Lawmaker As New Chief
The Massachusetts hospital industry’s largest trade group Thursday named former state representative Steven Walsh as its new chief executive. Walsh, 44, will head the Massachusetts Health & Hospital Association beginning in November, replacing Lynn Nicholas, 63, who announced her retirement several months ago. (Dayal McCluskey, 9/14)

St. Louis Post Dispatch: SSM Consolidates Hospital Foundations, Looks To Spur Greater Change 
For decades, many of SSM’s local hospitals have had an associated foundation, a group led by a volunteer board that raises money to improve facilities and programs. But gone are the days of marrying a charitable foundation to nearly every SSM hospital in the region. Instead, Creve Coeur-based SSM Health is deliberately constructing a larger, more influential philanthropic entity to serve the entire region. (Liss, 9/15)

The Philadelphia Inquirer/Philly.com: Union Prevails At Philly LGBTQ Mazzoni Health Center
Workers at Philadelphia’s scandal-ridden LGBT health-care provider, Mazzoni Center, have won a vote to unionize. Mazzoni leaders have been scrambling to restore order to the health center, which provides vital services in particular to low-income, HIV-positive, and transgender clients, since the medical director, chief executive, and several board members all departed the agency this year. That shake-up followed allegations of sexual misconduct by former medical director Rob Winn. (Melamed, 9/14)

The Oregonian: At Least 43 Kids Reported Sick After Insecticide Exposure At Day Care 
At least 50 people – 43 children and seven adults – reported health problems after being exposed to a powerful insecticide at an Oregon day care, according to newly disclosed state records and information obtained by The Oregonian/OregonLive. The statistics reveal publicly for the first time the scope of reported ailments at a Coos Bay childcare center, which the newsroom uncovered in May. (Schmidt, 9/14)

The Philadelphia Inquirer/Philly.com: Bucks County Pharmacist Charged With Trying To Kill Her Mom With Insulin Injection
After Donna Horger injected her chronically ill mother with insulin, she would later tell authorities that she hoped the 74-year-old “would not wake up and just pass.” But Mary Horger, who suffers from dementia and osteoporosis, did not die. Instead, her daughter, a licensed pharmacist, was arrested for attempted murder. Authorities say the 50-year-old resident of Feasterville, Bucks County, surreptitiously gave her immobile mother the injections at least three times last month in an attempt to lower her blood sugar to a fatal level. (McCarthy, 9/14)

Health Policy Research

Research Roundup: Cost Sharing Reductions; Insurance Gains

Here is a selection of news coverage of other recent research:

Urban Institute/Robert Wood Johnson Foundation: How Would Coverage, Federal Spending, And Private Premiums Change If The Federal Government Stopped Reimbursing Insurers For The ACA's Cost-Sharing Reductions?
The Affordable Care Act (ACA) requires insurers to provide cost-sharing reductions (CSRs) that lower deductibles, co-payments, co-insurance, and out-of-pocket maximums for people eligible for tax credits and with incomes below 250 percent of the federal poverty level. With current policy uncertainty surrounding these CSRs, there are multiple future scenarios, but all involve increases in insurance premiums for consumers and there is a potential for large reductions in the insured population. In 2018, the number of uninsured Americans could increase by 9.4 million, and average premiums could increase by nearly 37 percent, if insurers abandon the marketplaces because of a decision to eliminate federal reimbursement of health insurance CSRs. (Blumberg, Buettgens and Wang, 9/8)

Urban Institute: Sustained Gains In Coverage, Access, And Affordability Under The ACA: A 2017 Update 
The significant gains in health insurance coverage and improvements in health care access and affordability that followed the implementation of the key coverage provisions of the Affordable Care Act in 2014 have persisted into 2017. Adults in all parts of the country, of all ages, and across all income groups have benefited from a large and sustained increase in the percentage of the US population that has health insurance. The gains have been particularly striking among low- and moderate-income Americans living in states that expanded Medicaid. Our latest survey data from the Urban Institute’s 2017 Health Reform Monitoring Survey shows that only 10.2 percent of nonelderly adults are now uninsured—a decline of almost 41 percent from the period before implementation of the ACA. (Long, Bart, Karpman et. al, 9/7)

Urban Institute: State Efforts To Lower Consumer Cost-Sharing For High-Cost Prescription Drugs 
While lowering the cost of prescription drugs has broad support across the political spectrum, there has been little change in federal policy on drug pricing and costs. In the meantime, several states have taken the lead to lower out-of-pocket costs for consumers with chronic diseases needing expensive prescription drugs or specialty drugs. In this brief, the authors provide their findings from a 50-state survey of action on such policies. Eight states have policies protecting their consumers from high out-of-pocket costs for expensive specialty medication. These states either place limits on out-of-pocket spending or require certain plan formulary designs. (Ahn and Corlette, 9/6)

The Commonwealth Fund: Where Does The U.S. Stand On Insurance Coverage? 
The uninsured rate among 19-to-64-year-old adults was 14 percent in 2017, or an estimated 27 million people, statistically unchanged from one year earlier. Uninsured rates ticked up significantly in three subgroups: 35-to-49-year-olds, adults with incomes of 400 percent of poverty or more (about $48,000 for an individual), and adults living in states that had not expanded Medicaid. Half of uninsured adults, or an estimated 13 million, are likely eligible for marketplace subsidies or the Medicaid expansion in their state. Four of 10 uninsured adults are unaware of the marketplaces. Adults in marketplace plans with incomes below 250 percent of poverty are much more likely to view their premiums as easy to afford compared with people with higher incomes. Policies to improve coverage include a federal commitment to supporting the marketplaces and the 2018 open enrollment period, expansion of Medicaid in 19 remaining states, and enhanced subsidies for people with incomes of 250 percent of poverty or more. (Collins, Gunja and Doty, 9/7)

Editorials And Opinions

Different Takes: Sanders And Single-Payer; One Last Try On Obamacare Repeal; Building On Victory

Opinion writers across the country examine the health proposal offered by Sen. Bernie Sanders (I-Vt.), where things stand for congressional Democrats and Republicans, how the Trump administration is quietly moving against the Affordable Care Act and why it's time for politicians to get real.

The Washington Post: The Biggest Thing Single-Payer Has Going For It
The smartest, savviest people in Washington will tell you Bernie Sanders’s “Medicare for all” idea is dead on arrival, a waste of time and energy. But since those same smart, savvy people told you Donald Trump didn’t have a prayer of becoming president, I’d advise keeping an open mind. What the Vermont senator’s bill has going for it is simple: It’s the right thing to do. (Eugene Robinson, 9/14)

The Wall Street Journal: One Last ObamaCare Try
Senator Lindsey Graham admits that when a defense specialist like him feels compelled to roll out a health-care bill, something has gone wrong—and that’s an understatement for the Republican failure to repeal the Affordable Care Act. The question is whether a last-ditch effort by Sen. Graham and a few colleagues represents an improvement over the Obama Care status quo. The answer is yes. (9/14)

Bloomberg: Democrats Can Build On Their Health-Care Victory
The Republicans' failure to repeal Obamacare has created a political opening. The American public, threatened with the withdrawal of health insurance from millions of people, has largely come to embrace the idea of universal coverage. At such a moment, Democrats are right to advance ideas for building on the gains accomplished by the Affordable Care Act. (9/14)

The Washington Post: How Trump Is Sabotaging The Affordable Care Act In Virginia
Since President Trump took office, he and his administration have expressed their intention to sabotage the Affordable Care Act by creating instability in state insurance markets. As governors and other leaders across the nation warned, the Trump administration’s actions could threaten the health care and indeed the lives of millions of people across our nation. Unfortunately, here in Virginia, we have seen many of those fears come to fruition. (Gov. Terry McAuliffe, 9/14)

The New York Times: Bernie’s Secret G.O.P. Allies
Bernie Sanders’s biggest ally in his push for single-payer health insurance may well be the Republican Party. Yes, Republicans criticized and mocked the “Medicare for all” bill that Sanders released yesterday, and I doubt any Congressional Republicans will support the bill in the foreseeable future. But I do think they are unwittingly helping his cause. (David Leonhardt, 9/14)

The Washington Post: Sanderscare Is All Cheap Politics And Magic Math
But the lesson the Democrats seem to have taken from the 2016 electoral trouncing is that they need to become more like Republicans. Meaning: Abandon thoughtful, detail-oriented bean-counting and attempts to come up with workable solutions grounded in (occasionally unpopular) reality, and instead chant virtue-signaling catchphrases. (Catherine Rampell, 9/14)

Milwaukee Journal Sentinel: The Magical Mystery Of Medicare For All
It’s admirable to stand up for what you believe and to try to persuade voters that the nation would be better off with single payer, a $15-an-hour minimum wage and free college. There are reasonable arguments for all three. But all three are political losers outside the liberal base — at least right now. (David D. Haynes, 9/14)

The Guardian: Universal Healthcare In America? Not A Taboo Now, Thanks To Bernie Sanders
Once radical and taboo in mainstream Democratic circles, endorsing universal healthcare coverage is now de rigueur for anyone who seriously wants to run for president on the Democratic side in 2020. Kamala Harris, the California senator who seemed to be taking the Clinton route to the nomination by courting her Hamptons donors, is now co-sponsoring Sanders’ Medicare for All bill. (Ross Barkan, 9/14)

The Charlotte Observer: Medicare For All? First, Some Big Questions
The United States has long needed a real debate about the possibility of the kind of universal healthcare system that has led to some better outcomes in other developed countries. Sen. Bernie Sanders effectively kicked off that debate Wednesday by revealing a “Medicare for All” plan, backed by 15 Democratic Senate colleagues. (9/14)

The New York Times: Politicians, Promises, And Getting Real
On Wednesday Donald Trump demanded that Congress move quickly to enact his tax reform plan. But so far he has not, in fact, offered any such plan. Not only is there no detailed legislative proposal, his administration hasn’t even settled on the basic outlines of what it wants. Meanwhile, 17 Senate Democrats — more than a third of the caucus — have signed on to Bernie Sanders’s call for expanding Medicare to cover the whole population. So far, however, Sanders hasn’t produced either an estimate of how much that would cost or a specific proposal about how to pay for it. I don’t mean to suggest that these cases are comparable: The distinctive Trumpian mix of ignorance and fraudulence has no counterpart among Democrats. Still, both stories raise the question of how much, if at all, policy clarity matters for politicians’ ability to win elections and, maybe more important, to govern. (Paul Krugman, 9/15)

Viewpoints: The Public Health Implications Of Undoing DACA; The Problems With Ohio's Drug-Pricing Ballot Question

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

The New England Journal Of Medicine: Dreams Deferred — The Public Health Consequences Of Rescinding DACA
After months of conflicting statements, President Donald Trump has announced that the Deferred Action for Childhood Arrivals (DACA) program, a landmark immigration program introduced during the Obama administration, will be rescinded as of March 2018. ... Like many other elements of the administration’s immigration platform, the termination of DACA also appeared to be driven by a belief that rescinding economic benefits granted to undocumented immigrants would enhance economic opportunities for native-born people. ... The recent policy debates about DACA have centered on the program’s economic consequences, while its substantial public health benefits have been less discussed. ... The evidence clearly indicates that rescinding DACA will have profound adverse population-level effects on mental health. (Atheendar S. Venkataramani and Alexander C. Tsai, 9/13)

The New England Journal Of Medicine: Tragedy, Perseverance, And Chance — The Story Of CAR-T Therapy
In 2010, 5-year-old Emily Whitehead was diagnosed with acute lymphoblastic leukemia (ALL). Though her parents were told that if you had to have a kid with cancer, ALL was the best one to have, Emily’s course was hardly typical. After two rounds of chemotherapy, necrotizing fasciitis developed in both legs and she barely avoided amputation. Sixteen months later, she had a relapse. Bone marrow transplantation was recommended, but the Whiteheads, concerned about toxic effects, sought a second opinion at Children’s Hospital of Pennsylvania. There they learned about a new therapy, developed by University of Pennsylvania investigators and known as CART-19, which involved genetically engineering the patient’s own T cells to kill tumor cells. (Lisa Rosenbaum, 9/13)

The Des Moines Register: What's Happening To Rural Mental Health Center Is Sickening
This is madness. A Centerville mental health center has won national attention for saving taxpayer money and helping clients stay out of jail and the hospital, but it may be forced to close next month, as Register writer Tony Leys reported Sunday. Why? Because, in part, state administrators have yet to write rules allowing Medicaid to reimburse the Oak Place center — and the 10 other “crisis-stabilization” centers set up around Iowa. (9/14)

Lexington Herald Leader: Bevin’s Quest To Outlaw Abortion In Kentucky Is Unconstitutional And Underhanded
In case there were any lingering doubts, a trial in federal court in Louisville last week made this much clear: Gov. Matt Bevin is seeking to effectively outlaw abortion in Kentucky — something the U.S. Supreme Court has long ruled states cannot do. The three days of testimony also made clear that Bevin’s administration has used underhanded tactics to accomplish its unconstitutional goal. (9/14)

Chicago Tribune: Four Weeks To Kill The Soda Tax
With both sides steadfast yet lacking the votes to prevail, Cook County Board members on Wednesday kicked to next month a decision on whether to repeal the unpopular soda tax. The board is expected to take action at its Oct. 11 meeting. In other words, soda tax opponents: You’ve got four weeks to keep up the pressure. Don’t let up. Kill this arbitrary, unnecessary, expensive tax. (9/13)