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Uncertainty Over Health Care's Future Hobbles Entrepreneurs

The Affordable Care Act gave some Americans the chance to strike out on their own in new business ventures because they didn't have to worry about keeping a job just for health insurance. But the repeal-and-replace efforts reignited this week create uncertainty about whether they can count on that insurance option in the future. (Alex Smith, KCUR, 9/22)

Political Cartoon: 'Herd This Before?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Herd This Before?'" by Nate Beeler, The Columbus Dispatch.

Here's today's health policy haiku:


Where are the options
The slimmest? When you’re shopping
For mental health care.

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

Inside The 'Most Radical Of Any Of The Republican Health Care Bills' Debated This Year

For all the last-minute rush surrounding the measure from Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.), the bill is actually the most far-reaching the Republicans have tried to pass yet. Media outlets take a look at what exactly is in the bill and what it does.

The New York Times: Latest Obamacare Repeal Effort Is Most Far-Reaching
For decades, Republicans have dreamed of taking some of the vast sums the federal government spends on health care entitlements and handing the money over to states to use as they saw best. Now, in an 11th-hour effort to repeal the Affordable Care Act, the party has come up with a way to repackage the funding for the law it loathes into a trillion-dollar pot of state grants. The plan is at the core of the bill that Senate Republican leaders have vowed to bring to a vote next week. It was initially seen as a long-shot effort by Senators Lindsey Graham and Bill Cassidy. But for all its ad hoc, last-minute feel, it has evolved into the most far-reaching repeal proposal of all. (Zernike, Abelson and Goodnough, 9/21)

The Wall Street Journal: Q&A: How The Graham-Cassidy Plan Would Change Health Coverage
The Graham-Cassidy bill would lump together the money spent on two ACA programs to expand health coverage: subsidies for private insurance and an expansion of the Medicaid program. That funding would be redistributed as block grants to states that could use it to fashion their own health systems. All of the bill’s health spending would end in 2027 and need to be reauthorized by Congress. The bill also makes structural changes to Medicaid by capping how much federal money states can get. A similar proposal, contained in the Republicans’ last effort to repeal parts of the ACA, would have resulted in 15 million people losing health coverage in a decade, according to the Congressional Budget Office. (Hackman, 9/21)

The Washington Post: How Many With Preexisting Conditions Would Be Priced Out Of Coverage Under Cassidy-Graham?
The easiest way to understand the debate over preexisting conditions in health-care coverage — a debate fueled this week by Jimmy Kimmel’s repeated disparagement of the new Republican plan to overhaul Obamacare — is to look at the Obamacare website. As of writing, explains what protections the Affordable Care Act provides to those with conditions that, before the bill’s passage, may have resulted in denial of coverage or sharply increased premiums. (Bump, 9/21)

The New York Times: The G.O.P. Bill Forces States To Build Health Systems From Scratch. That’s Hard.
In 2003, health care policy makers in Massachusetts agreed that the state should build a system to expand coverage to its uninsured residents. It took four years before Romneycare was fully up and running. In between, politicians had to think hard about how they wanted the system to work: how money would be raised and spent, what benefits would be offered, whether and how markets should be used to distribute coverage, whether people who didn’t buy coverage should be penalized. (Sanger-Katz, 9/21)

The Hill: GOP ObamaCare Repeal Takes New Step In Nixing Medicaid Expansion
The Senate GOP's last-ditch effort to repeal ObamaCare goes farther than past bids to rein in the law’s Medicaid expansion, barring states from extending the expansion past 2019 even if they use their own money. An earlier GOP repeal bill would have let states keep the program, but that is eliminated under the legislation crafted by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), which could come up for a Senate vote next week. (Sullivan, 9/21)

Roll Call: Could Be Crippled Under Latest GOP Obamacare Repeal Proposal
A federal health exchange the government spent over $1 billion to create would likely be made obsolete by the recent GOP proposal to gut the 2010 health law. Policy experts say the Department of Health and Human Services would still be required to maintain under the proposal from Republican Sens. Bill Cassidy of Louisiana, Lindsey Graham of South Carolina, Ron Johnson of Wisconsin and Dean Heller of Nevada. But the bill would axe a provision in the current law that addresses the website’s role in determining eligibility for insurance subsidies. The removal of that provision, experts say, would likely prevent any state from utilizing it for the purposes of operating their own insurance exchange. (Williams, 9/22)

CNN: 4 Charts That Explain What Graham-Cassidy Will Do
Senate Republicans continue to push forward on a plan to hold a vote sometime next week on legislation to repeal and replace the Affordable Care Act. The bill, which is sponsored by Sens. Lindsey Graham, R-South Carolina, and Bill Cassidy, R-Louisiana, still lacks the 50 votes it needs -- although Graham this week expressed confidence that they would get there. (Cillizza and Petulla, 9/22)

CNN Money: Millions Could Be Left Uninsured Under Obamacare Repeal Bill
"There will be more people covered," Cassidy said on CNN's New Day on Wednesday. Cassidy, however, is one of the few who feel this way. Many in the health care community -- doctors, hospitals and policy experts -- say it's more a question of how many people will lose their insurance. (Luhby, 9/22)

States Who Win Under Graham-Cassidy Win Big, While The Losers Get Walloped

Multiple analyses have found different results about which states come out on top and which are hit the hardest. But they all find massive financial discrepancies between the two. For example, federal funding for coverage would plunge by 41 percent in Louisiana, while it would grow by 126 percent in South Carolina, according to one estimate.

The Washington Post: Federal Estimate Shows Big Win-Loss Gap Among States Under Cassidy-Graham Bill
An internal analysis by the Trump administration concludes that 31 states would lose federal money for health coverage under Senate Republicans’ latest effort to abolish much of the Affordable Care Act, with the politically critical state of Alaska facing a 38 percent cut in 2026. The report, produced by the federal Centers for Medicare and Medicaid Services, focuses on the final year of a block grant that states would receive under the Cassidy-Graham legislation. It shows that government funding for such health insurance would be 9 percent lower overall in 2026 under the plan than under current law. (Goldstein and Eilperin, 9/22)

NPR: Latest Senate Health Bill Would Cut Funds To Blue States
Senate Republicans' latest plan to overhaul the U.S. health care system ends with a massive shift of federal money from states that expanded Medicaid — and are largely dominated by Democrats — to those that refused to expand. Several analyses of the bill show the pattern. (Kodjak, 9/21)

The Hill: Which States Could Win And Lose From The New ObamaCare Repeal Bill
The ObamaCare repeal bill set for a possible vote next week in the Senate would create winners and losers among the 50 states that would be asked to implement their own health-care plans with block grants of federal funding. The bill, sponsored by Republican Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.), ends federal funding for ObamaCare’s Medicaid expansion and the subsidies that help people afford coverage, as well as the law’s insurance mandate. (Hellmann and Weixel, 9/21)

Bloomberg: Obamacare States May Lose $180 Billion Under Senate Bill
States that expanded Medicaid under Obamacare would be hard-hit by spending cuts called for in Republican senators’ latest bill to repeal and replace the health law, while states that didn’t expand the program stand to benefit. The thirty-two states that increased their Medicaid coverage for low-income people would lose $180 billion in federal funding, but states that didn’t would gain $73 billion from 2020 to 2026, according to a study by the Kaiser Family Foundation. The state-by-state breakdown covers a wide range, with New York at one extreme seeing a cut of 35 percent and Mississippi at the other with a 148 percent boost. (9/21)

A look at individual states' fortunes —

California Healthline: A Nail-Biter: California Nervously Awaits U.S. Senate’s Verdict On Obamacare
Congressional Republicans are giving repeal of Obama’s signature health law one more try. They have until the end of the month to garner enough votes to pass the so-called Graham-Cassidy bill, which would fundamentally change how health care is funded nationwide. Its effects would be especially far-reaching in California and other states that bought heavily into the Affordable Care Act. (9/21)

The Star Tribune: Latest Health Bill In Senate Could End Up Costing Minn. Billions
Minnesota stands to lose billions of dollars in federal funding if Senate Republicans are successful next week in their latest bid to dismantle the Affordable Care Act. ... But many Minnesota health officials counter that it endangers care of seniors and people with disabilities and would lead to even more costly premiums in the individual market. (Howatt and  Brooks, 9/22)

Columbus Dispatch: Analyses Differ On Stakes For Ohio With GOP Obamacare Replacement
Contradicting a study released Wednesday that indicated Ohio would emerge as a major financial loser if the Senate approves a new GOP health-care bill, the Kaiser Family Foundation released an analysis Thursday saying Ohio’s loss would be much smaller. Kaiser, a nonprofit organization in Washington that analyzes health issues, concluded that if the bill co-sponsored by Republican Sens. Lindsay Graham of South Carolina and Bill Cassidy of Louisiana becomes law, Ohio probably would lose $610 million in federal dollars from 2020 through 2026, compared with projections under Obamacare. (Torry, 9/22)

Cleveland Plain Dealer: How Would The Senate's Latest Obamacare Repeal Plan Affect Ohio?
Ohio stands to lose billions of dollars in federal money that it got for expanding Medicaid if a new Obamacare repeal proposal being pushed in the U.S. Senate becomes law. Congressional Republicans are taking another stab at fulfilling their longtime campaign promise to repeal and replace the Affordable Care Act with a plan put forth last week -- which could be hurried to a vote without customary hearings by next week. (Eaton, 9/21)

Provision Tucked Into Bill Benefits Alaska, Just When GOP Is Desperate For Murkowski's Vote

Sen. Lisa Murkowski (R-Alaska) is a crucial vote for Republicans to secure if they want to pass their health law. Critics blast a provision of the legislation that only benefits Alaska and Montana as the GOP try to sway votes. "Everyone involved in this moral and intellectual monstrosity should be ashamed of themselves," Sen. Chris Murphy (D-Conn.) says.

The Washington Post: Cassidy-Graham Bill Provision Would Exempt Alaska, Montana From A Cap On Medicaid Spending
As GOP leaders continue to drum up support for the health-care proposal written by Republican Sens. Bill Cassidy (La.) and Lindsey O. Graham (S.C.), a provision buried deep in the 140-page bill benefiting Alaska has begun to draw greater scrutiny. Beginning on page 95, the bill has a provision that exempts low-density states whose block grants either decrease or stay flat between 2020 and 2026 from the Medicaid per capita cap. Under that scenario, Alaska and Montana would be exempted from the funding cap that applies to all other states during that period. (Eilperin, 9/21)

The Hill: Graham And Cassidy Go Into Overdrive To Win Murkowski Vote
Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) are going into overdrive to win over Alaska Sen. Lisa Murkowski (R), a pivotal vote for their bill to dismantle ObamaCare and give states more authority over healthcare. The two have seen Murkowski, one of three Republicans to sink the GOP’s last repeal bill, as a critical vote for some time. (Bolton, 9/22)

The Hill: Pence Urges Alaskans To Contact Murkowski, Sullivan For Repeal Bill
Vice President Pence urged Alaska residents on Thursday to contact the state's Sens. Lisa Murkowski and Dan Sullivan, who are among the Republicans undecided on the new ObamaCare repeal plan, and ask them to support the bill. Pence said in an interview with Anchorage radio host Mike Porcaro that "now is the time to reach out to Sen. Dan Sullivan and Sen. Lisa Murkowski and let them know that you'd be grateful if they'd stand with President Trump and they'd vote in favor of Graham-Cassidy when it comes to the Senate floor next week." (Delk, 9/21)

Although Publicly Enthusiastic About Efforts, Trump Has Little Sway Over Crucial Senators

GOP Sens. Rand Paul of Kentucky, Susan Collins of Maine, John McCain of Arizona and Lisa Murkowski of Alaska are not senators that are likely to be wooed or threatened by President Donald Trump.

Politico: Trump Publicly Backs Healthcare Effort, Privately Harbors Doubts
In public, President Donald Trump is all-in on the Senate’s final chance to repeal Obamacare. But privately, there’s ambivalence in the White House about the bill’s contents and its chances of clearing the tightly divided chamber next week. Trump spent time between meetings at the United Nations calling senators and other senior White House officials about the Graham-Cassidy bill, asking for updated vote tallies and how to woo senators for the bill. White House officials have considered tweaking the state funding to win a vote from GOP Sen. Lisa Murkowski of Alaska — and others. Trump has also publicly excoriated Kentucky Sen. Rand Paul for voting against the legislation, telling aides he would go after other senators. (Dawsey and Everett, 9/22)

Meanwhile, will this help Senate Majority Leader Mitch McConnell (R-Ky.) bounce back from his terrible summer —

Politico: McConnell Lays It On The Line
He's been battered by President Donald Trump and had his vaunted legislative acumen called into question. Now, Mitch McConnell has a chance to put his cruel summer behind him. Over the next week, the Senate majority leader will try one last time to rescind the Democratic health care law. At the same time, he's put his political reputation on the line in Alabama, where his chosen candidate, incumbent Sen. Luther Strange, faces off against anti-establishment Roy Moore in a special Senate election on Tuesday. (Everett and Bresnahan, 9/21)

The Road To 50 Votes: Which Senators To Watch In Health Care Talks Over The Next Week

Republicans can only afford to lose two votes. In other news on the repeal-and-replace efforts: a national Democratic poll finds that the measure has 24 percent support; opponents in California go hard against it; Nevada's governor says the legislation's increased funding is a "false choice"; and more.

Bloomberg: Here Are The Senators To Watch On Obamacare Repeal
Senate Republican leaders are struggling to win support from holdouts in their party for what may be their last chance for a long time to pass a GOP-only repeal of Obamacare. The Senate needs to act by Sept. 30 to use a fast-track procedure to keep Democrats from blocking the proposal by Republicans Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. But a cluster of GOP senators haven’t committed to the bill, which would send federal Obamacare money to the states in block grants to create their own health programs, cut funding to most states, and potentially let insurers charge sick people more. (Litvan, 9/22)

Bloomberg: GOP Pushes McCain To Back ‘Last Best Hope’ For Obamacare Repeal
Republicans are working to win Senator John McCain’s support for a likely vote next week on the GOP’s "last best hope" for repealing Obamacare, second-ranking Senate Republican John Cornyn said Thursday. “We’re doing everything we know how to do" to get the votes to pass the bill that would convert the Affordable Care Act into block grants to states, Cornyn said during a trip to Texas to survey damage from Hurricane Harvey. (Edgerton, 9/21)

The Associated Press: Iowa Sen. Ernst Hopes, But Isn't Sure, Health Bill Has Vote
Republican Sen. Joni Ernst said Thursday she isn't sure her party's last-ditch effort to repeal Barack Obama's health care law has the votes to pass, as she faced tough questions from Iowa constituents about the political drive for the measure. "If it's brought up, I hope we have the votes to pass it," Ernst told reporters after a meeting with constituents in northern Iowa. "I hope there's consensus on the bill." (Beaumont, 9/21)

Des Moines Register: Joni Ernst Is 'Leaning Yes' On Graham-Cassidy Health Care Bill
The Iowa Republican said so Thursday at a town meeting here dominated by the latest GOP plan currently under discussion to repeal and replace the Affordable Care Act and by broader concerns over the future of health care. Ernst appeared noncommittal on the bill until asked directly by an attendee more than halfway through the hour-long forum. (Noble, 9/21)

Politico Pro: Democratic Poll: Graham-Cassidy Bill Has 24 Percent Support
The first national poll on congressional Republicans latest health care bill finds the effort by Sens. Lindsey Graham and Bill Cassidy to be just as unpopular as previous efforts, with only 24 percent of the public supporting the proposal in a survey from a left-leaning firm. The survey, from the Democratic automated polling firm Public Policy Polling, found 50 percent of registered voters disapprove of the law, which would repeal Obamacare and its expansion of Medicaid and replace it with fixed-cost block grants to states. (Robillard, 9/21)

Sacramento Bee: Health Care Protests Target California Republicans
Mass protests this week are targeting California’s 14 House Republicans, with activists seeking to pressure them to oppose the latest Republican Obamacare repeal proposal from Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. California would be hardest hit state in the nation, with an estimated cut of $28 billion to its health care system by 2026, according to the left-leaning Center on Budget and Policy Priorities. (Hart, 9/21)

The Hill: Nevada GOP Gov Rips ObamaCare Repeal Bill: Flexibility It Promises 'A False Choice'
Nevada Gov. Brian Sandoval (R) on Thursday amped up his criticism of the new plan to repeal and replace ObamaCare, saying the GOP bill would “pit Nevadans against each other.” “Flexibility with reduced funding is a false choice,” Sandoval said in a statement to The Nevada Independent. “I will not pit seniors, children, families, the mentally ill, the critically ill, hospitals, care providers, or any other Nevadan against each other because of cuts to Nevada’s healthcare delivery system proposed by the Graham-Cassidy amendment.” (Carter, 9/21)

New Orleans Times-Picayune: Many Louisiana Health Care Stakeholders Oppose Bill Cassidy's Plan
Louisiana organizations that represent hospitals, health clinics and retired people have all come out against U.S. Sen. Bill Cassidy's proposal for replacing President Barack Obama's health care law, often referred to as Obamacare. They say Cassidy's proposal could jeopardize affordable health care coverage and make operations more difficult for hospitals and clinics around the state. (O'Donoghue, 9/21)

The Hill: CNN To Host Health-Care Debate With ObamaCare Repeal Sponsors
CNN will host a town hall-style debate Monday night where senators will face off over the new ObamaCare repeal bill. The network announced that Sens. Bernie Sanders (I-Vt.) and Amy Klobuchar (D-Minn.), opponents of the bill, will debate its co-sponsors, Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.). (Concha and Sullivan, 9/21)

The Hill: Medicaid Directors Issue Warning On New ObamaCare Repeal Bill
The National Association of Medicaid Directors (NAMD) warned Republicans on Thursday that the Senate's latest ObamaCare repeal bill would place a massive burden on states. The bill, sponsored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), would eliminate ObamaCare's Medicaid expansion and subsidies beginning in 2020, converting the funding to state block grants. (Hellmann, 9/21)

Neither Side In Kimmel, Cassidy Dust-Up Conveys Complexities Of Health Care, But TV Host Gets The Edge

Jimmy Kimmel himself admits that he "should not be the guy you go to for information on health care," but fact checkers say he's presenting a more realistic picture of the effects of the Graham-Cassidy bill.

The New York Times: Jimmy Kimmel Accused A Senator Of Lying About His Health Care Bill. Who’s Right?
Jimmy Kimmel, the talk show host who has become the unlikely face of opposition to Senate Republicans’ latest health care push, insisted he had done his homework. Mr. Kimmel spent a second straight night arguing against the proposal on Wednesday. Senator Bill Cassidy of Louisiana, a co-sponsor of the bill, responded by telling news outlets that “Jimmy doesn’t understand.” (Qiu and Victor, 9/21)

The Associated Press Fact Check: Kimmel’s Take On Health Care Harder To Refute
Who’s right — President Donald Trump and Sen. Bill Cassidy, or late-night host Jimmy Kimmel? None has really captured the complexity of the debate over who might lose insurance protections in the latest Republican health care bill. But of the three, the TV guy is the hardest to refute. Trump insists in a tweet that the bill covers pre-existing conditions, a point also made by Cassidy, a sponsor of the legislation. But there’s a catch. It allows states to get a waiver from “Obamacare” requirements that insurers charge the same to people with health problems as they do to healthy people. (Alonso-Zaldivar, 9/22)

The Associated Press: Jimmy Kimmel Transforms Debate, And Shows Comedy's New Role
If the latest Republican attempt to repeal Obamacare doesn't work, it may become known as the Jimmy Kimmel Non-Law. The comic's withering attacks this week have transformed the debate over the bill (sponsored by Sens. Lindsey Graham and Bill Cassidy) and, in the process, illustrated how thoroughly late-night talk shows have changed and become homes for potent points of view. (Bauder, 9/21)

Politico: Kimmel Tells Viewers: ‘We Have Until Sept. 30’ To Stop GOP Health Bill
Jimmy Kimmel on Thursday said it’s not his job to talk about health care — but he’s doing it anyway, until Senate Republicans’ last-ditch bill to repeal Obamacare is stopped. “I should not be the guy you go to for information on health care,” the late-night TV host said on Thursday’s show. “And if these guys … would tell the truth for a change, I wouldn’t have to.” (Diamond, 9/21)

The Hill: Jimmy Kimmel Becomes Thorn In The GOP's Side
Republicans racing against the clock to repeal ObamaCare are fighting against Democrats, angry patient advocates and a who’s-who of health industry groups. Yet one of the most formidable opponents they face is an unlikely wild card: the comedian Jimmy Kimmel. (Lillis, 9/21)

Cash-Strapped Rural Hospitals Already On Financial Brink See GOP Bill As Potential Last Straw

Rural hospitals would be hit especially hard by the legislation, which would increase the uninsured, boost deductibles for patients or threaten already shrinking Medicare payments.

Modern Healthcare: Rural Hospitals See Graham-Cassidy As Latest Threat To Survival
Leaders of cash-strapped rural hospitals worry that the latest proposal to repeal and replace the Affordable Care Act could destroy them. With higher rates of Medicaid patients than their urban counterparts, rural hospitals would be disproportionately hurt by an end of the Medicaid expansion proposed in the so-called Graham-Cassidy Senate bill, said Maggie Elehwany, vice president of government affairs at the National Rural Health Association. (Barkholz, 9/21)

Meanwhile —

Stat: Without Congressional Action, Hospital Payments At Risk Of Expiring
Drive around this city long enough, and you’ll see the billboards that have become a staple of the skyline. They read: Atlanta can’t live without Grady. For many here, that’s indeed the case. Grady Memorial Hospital, a safety net hospital with more than 950 beds, is where people go if they come down with the flu or if they suffer a gunshot wound, but can’t afford care anywhere else. (Blau, 9/22)

Administration News

Since May, HHS Secretary Price's Trips Via Private Jets Have Cost Taxpayers More Than $300,000

Health and Human Services Secretary Tom Price’s use of private jets represents a sharp departure from his two immediate predecessors, Sylvia Mathews Burwell and Kathleen Sebelius, who flew commercially in the continental United States.

Politico: Price Traveled By Private Plane At Least 24 Times
Health and Human Services Secretary Tom Price has taken at least 24 flights on private charter planes at taxpayers’ expense since early May, according to people with knowledge of his travel plans and a review of HHS documents. The frequency of the trips underscores how private travel has become the norm — rather than the exception — for the Georgia Republican during his tenure atop the federal health agency, which began in February. The cost of the trips identified by POLITICO exceeds $300,000, according to a review of federal contracts and similar trip itineraries. (Pradhan and Diamond, 9/21)

The Washington Post: How Tom Price Decided Chartered, Private Jets Were A Good Use Of Taxpayer Money
After Tom Price was sworn in as health and human services secretary, the Georgia Republican faced an inconvenience known to millions of Americans: His flight was delayed, an aide said, and he was forced to spend hours at an airport. The delay left Price a no-show at an early public appearance his office helped plan. Price knew well the pain of flying to and from Washington as a member of Congress for 12 years. But now he was the head of a trillion-dollar federal agency and one of President Trump’s point men to fulfill the campaign promise of repealing the Affordable Care Act. Flight delays and no-shows would not do. (Davis, 9/22)


Medicare Seeks Suggestions From Doctors, Hospitals, Patients On New Payment Models

The request for proposals is seeking ideas to promote better competition among health providers and enhance patients' choices. It also hints at some conservative policies the Trump administration may be interested in implementing.

Stat: HHS Hints At Major Changes To Medicare That Could Mean Higher Costs For Patients
The Trump administration is signaling it will pursue significant changes to Medicare that could put beneficiaries on the hook for higher costs. In an informal proposal on Wednesday, federal health officials hinted at several new pilot programs it may implement in the months ahead. One idea would give doctors more latitude to enter into so-called private contracts to charge Medicare beneficiaries more for certain services, if the patients were willing to pay. (Mershon, 9/21)


Suit Alleging Calif.'s Low Medicaid Payments Hinder Care For Hispanics Being Watched Closely

Suing Medicaid is difficult so other civil rights groups are monitoring this case, but experts say similar actions elsewhere could be difficult to win. In other Medicaid news, Virginia advocates raise concerns about the delay in reauthorizing the Children's Health Insurance Program, a successful program to help low-income mothers is profiled in North Carolina and two transgender women sue Iowa's program for failing to cover sex-reassignment surgery.

Stateline: Are Medicaid’s Payment Rates So Low They’re Discriminatory?
Civil rights lawyers suing the state of California over low Medicaid payments say advocates elsewhere should pay attention to a potentially novel legal tactic — accusing the Golden State of racial discrimination in order to increase funding — but some health law experts and even sympathetic observers say they’re watching with some skepticism. (Beitsch, 9/22)

Richmond Times-Dispatch: As Tens Of Thousands Of Children's Health Insurance Hangs In The Balance, Virginia Waits For Answers From Congress
Virginia will run out of money to provide health care to 65,000 children from low-income families by January if federal lawmakers fail to reauthorize the Children’s Health Insurance Program, which is set to expire when the federal fiscal year ends Sept. 30, said Linda Nablo, chief deputy director of the Department of Medical Assistance Services, which administers the services in question. (O'Connor and Evans, 9/21)

WRAL (Raleigh, N.C.): Medicaid Pregnancy Program Helps Maternal Mortality Rates In NC
It is an unpleasant statistic -- more mothers die during, or just after, giving birth in the United States than any other developed country. Black women are at particular risk. But in North Carolina, the maternal mortality of black women has decreased by 40 percent in the last 15 years, and unlike most of the country, the rate of maternal mortality for white and black women is about the same. A state-wide Medicaid program is credited with the gains. (9/21)


Drug's $475K Cost Highlights Pricing Problems With Unique, Breakthrough Therapies

“We need a new payment model,” Steve Miller, chief medical officer at Express Scripts Holding Co., said while criticizing Novartis' new drug.

Bloomberg: Novartis's $475,000 Price On Cancer Therapy Meets Resistance
The $475,000 price tag on Novartis AG’s latest breakthrough cancer therapy came under fire from one of the biggest managers of drug costs in the U.S., underscoring the challenges the Swiss drugmaker will face in promoting the potential blockbuster. The cost of the leukemia treatment, called Kymriah, is “dramatically higher” than other such complex treatments, and the health-care system isn’t ready to pay for it, Steve Miller, chief medical officer at Express Scripts Holding Co., said Thursday in a blog post on his company’s website. Gene therapies like Novartis’s are targeted at a small number of patients and typically used just once, meaning that drug companies have limited chances to recoup their investment. (Lauerman and Paton, 9/22)

In other pharmaceutical news —

Bloomberg: FDA Warns Doctors After 19 Deaths On Intercept Liver Drug
Nineteen patients died after taking a liver-disease drug from Intercept Pharmaceuticals Inc., the U.S. Food and Drug Administration said, warning doctors about risks from a product that the company is seeking to make into a blockbuster. Shares of the drugmaker sank 24.9 percent to $73.70 at 4:00 p.m. in New York, the company’s biggest loss since November 2014. (Langreth, 9/21)

Veterans' Health Care

VA Steps Up Efforts To Screen And Treat Veterans For Hepatitis C

With a higher rate of infection reported among vets than the general population, the Department of Veterans Affairs started taking proactive measures three years ago to cure patients. Meanwhile, Agent Orange exposure and a wrongful death case are also in veterans health news headlines today.

KQED: In The Battle Against Hepatitis C, The VA Takes The Lead
The VA has implemented an aggressive effort to screen and treat all veterans under their care for the virus. Hepatitis C experts and advocates have praised the VA for its proactive approach, and say it should be a model for other government health programs, and even private insurers. (Klivans, 9/2!)

Kansas City Star: VA Medical Center In Kansas City Focus Of Wrongful Death Suit Alleging Allergic Reaction
An 84-year-old patient developed pustular lesions on his face and died after a Veterans Affairs hospital in Kansas City treated him with a drug he was allergic to, according to a lawsuit filed Wednesday. The suit filed in federal court by Kansas City lawyer Leland Dempsey alleges that staff at the VA Medical Center on Linwood Boulevard caused Mark Beemer’s death last year by giving him Ceftriaxone, and the death could easily have been prevented. (Marso, 9/21)

Public Health And Education

Massive Data-Gathering Project Strives To Be Inclusive Where So Many Studies Have Failed In Past

The National Institutes of Health's wide-sweeping data-gathering project, called "All Of Us," has set a goal of ensuring that more than half of the participants come from communities that are historically underrepresented in biomedical research. In other public health news: brain science, diabetes-related amputations, kidney disease and more.

Stat: To Advance Precision Medicine, NIH Turns To Long-Mistreated Communities
The National Institutes of Health would like six vials of your blood, please.Its scientists would like to take a urine sample, measure your waistline, and have access to your electronic health records and data from the wearable sensor on your wrist. And if you don’t mind sharing, could they have your Social Security number? It is a big ask, the NIH knows, and of an equally big group — the agency eventually hopes to enroll over 1 million participants in the next step of what four researchers referred to in a 2003 paper as “a revolution in biological research.” (Facher, 9/22)

Stat: Zapping The Brain For Stroke Rehab: Pivotal Clinical Trial Begins
Despite being forced by Hurricane Irma to close its outpatient facilities for several days, the Mayo Clinic in Jacksonville, Fla., is expected to forge ahead this month with a pivotal clinical trial testing whether an electrical implant can rewire the brains of stroke patients so they can use their arms and hands again. (Begley, 9/22)

Los Angeles Times: UC Irvine To Debut Brain Research Center With Advanced MRI Machine
UC Irvine’s Campus Center for Neuroimaging will have a grand opening next month for its new research center that aims to make breakthroughs in human brain research. The centerpiece of the center — dubbed FIBRE, or Facility for Imaging & Brain Research — is a $3-million Siemens Prisma 3T magnetic resonance imaging, or MRI, machine noted for its technology that collects higher-quality images in a shorter time. It came to UCI with help from Siemens and the National Institutes of Health. (Zint, 9/21)

inewsource: Diabetes-Related Amputations Increase In California — And San Diego
Clinicians are amputating more toes, legs, ankles and feet of patients with diabetes in California — and San Diego County in particular — in a “shocking” trend that has mystified diabetes experts here and across the country. Though they often prolong lives, diabetes-related amputations deprive patients of independence, increase the need for social services and add to disability and medical costs.Explore the rate of amputations in California.Statewide, lower-limb amputations increased by more than 31 percent from 2010 to 2016 when adjusted for population change. In San Diego County, the increase was more than twice that: 66.4 percent. (Clark, 9/20)

The New York Times: Air Pollution Tied To Kidney Disease
Add a new potential ill to the list of problems linked to air pollution: kidney disease. Previous studies have linked high levels of the fine particulate matter known as PM 2.5 to cardiovascular disease and stroke. A new analysis, in The Journal of the American Society of Nephrology, followed 2,482,737 veterans for an average of eight and a half years. The Department of Veterans Affairs database includes information on glomerular filtration rate, or G.F.R., a measure of kidney function. (Bakalar, 9/21)

The Washington Post: She Chose To Die So She Could Give Birth. Now Her Newborn Is Dead, Too.
The headaches began in March. The couple didn’t think much of them — until Carrie DeKlyen began vomiting. An initial scan showed a mass in her brain. More tests showed that it was a form of cancer, possibly lymphoma, but treatable. But a pathology exam revealed a more grim diagnosis. The 37-year-old mother of five from Wyoming, Mich., had glioblastoma, an aggressive form of brain cancer. If lucky, she could live for five more years. (Phillips and du Lac, 9/21)

California Healthline: FDA Approves Scope With Disposable Part Aimed At Reducing Superbug Infections
Seeking to prevent superbug outbreaks, federal health officials said they have approved the first gastrointestinal medical scope with a disposable cap for use in the U.S. The Food and Drug Administration said that the design of the new duodenoscope by Japanese device maker Pentax should make it easier to remove dangerous bacteria that can become trapped inside these reusable instruments. (Terhune, 9/22)

NPR: Pee In The Pool Can Cause Breathing And Eye Irritation
Water parks can be fun, but they also can pose unexpected health risks – in this case, eye and respiratory problems. And that shower you never take before you get in the pool plays a role. In July 2015, patrons at an indoor water park resort in Ohio started to complain about eye and respiratory problems. Local health officials surveyed patrons and water park employees, who reported issues like eye burning, nose irritation, difficulty breathing and vomiting. The Centers for Disease Control and Prevention then stepped in to investigate. (Jochem, 9/21)

Hospital Cracks Down On Inconsistencies With Prescribing Opioids As It Tries To Battle Crisis

Anne Arundel Health System joins hospitals across the region and the state of Maryland in attempting to eradicate a problem medical institutions now realize they helped create. Meanwhile, the Senate HELP Committee will hold a hearing to address the epidemic next month.

The Hill: Senate Health Committee Schedules Hearing On Opioid Crisis
The Senate Health Committee will hold a hearing on the opioid crisis next month. The committee will focus on the federal response to the crisis and conduct oversight of the Comprehensive Addiction and Recovery Act, a law passed in 2016 that supports efforts to address the issue. (Hellmann, 9/21)

And in other news —

The Associated Press: Opioid Epidemic Laws Lead Panel To Revisit Recovery Schools
A fire led to the eventual end of Phoenix — a groundbreaking Maryland public school program for children with addiction that closed in 2012 — but the state could see institutions like it rise again from the ashes. Recent spikes in the Maryland heroin and opioid epidemic have triggered calls for substantial changes in education systems statewide, and a state work group is weighing the return of recovery schools after a Sept. 7 meeting. (Slater, 9/21)

Football Player Who Was Convicted Of Murder Found To Have Severe Brain Damage

The severity of former NFL player Aaron Hernandez's CTE, a degenerative disease believed to be caused by concussions, is usually found in players in their 60s. He was 27 when he committed suicide in jail.

The New York Times: Aaron Hernandez Found To Have Severe C.T.E.
The brain scan came as a surprise even to researchers who for years have been studying the relationship between brain disease and deaths of professional football players. Aaron Hernandez, the former New England Patriots tight end and a convicted murderer, was 27 when he committed suicide in April. Yet a posthumous examination of his brain showed he had such a severe form of the degenerative brain disease C.T.E. that the damage was akin to that of players well into their 60s. (Belson, 9/21)

Los Angeles Times: Disgraced Ex-Patriots Player Aaron Hernandez Found To Have CTE And Early Brain Atrophy
In an announcement Thursday, Boston University’s CTE Center said doctors diagnosed Hernandez with Stage 3 CTE. Stage 4 is the most serious. Both stages, usually found in much older former players, are associated with aggressiveness, impulsivity, depression and memory loss. The effort, led by Dr. Ann McKee, also found he had “early brain atrophy” and “large perforations” on a central membrane in his brain. (Fenno, 9/21)

The Boston Globe: Learn The Symptoms In The Four Stages Of CTE
A statement released by the BU CTE Center stated that Hernandez was found to have Stage 3 CTE, with Stage 4 being the most severe. According to a 2012 BU study, CTE begins with simple symptoms such as headaches and difficulty concentrating, but as the disease progresses, other, much more worrying conditions appear. (Ortiz, 9/21)

Dangers of such diseases put the spotlight on how schools handle young players —

San Francisco Chronicle: How California Puts High School Athletes At Great Risk
According to a recent study published in the Orthopedic Journal of Sports Medicine and conducted by the University of Connecticut’s Korey Stringer Institute, a nonprofit dedicated to minimizing preventable death on the playing field, California ranks second to last in the nation — ahead of only Colorado — when it comes to implementing policies that help prevent the leading causes of sudden death in high school athletes. (Saracevic, 9/21)

State Watch

State Highlights: In Calif., Gubernatorial Candidates Try To Prove Health Care Street Cred; Death Toll Rises In Fla. Nursing Home Tradgedy

Media outlets report on news from California, Florida, Texas, Illinois and Pennsylvania.

Los Angeles Times: The Push For Single-Payer Health Care Just Went National. What Does That Mean For The California Effort?
When Vermont Sen. Bernie Sanders visited Beverly Hills last May, he made a full-throated appeal for California to “lead the country” and pass a pending state proposal to establish single-payer health care. On Friday, he’ll return here for a San Francisco speech trumpeting his own higher-stakes plan — a bill to drastically overhaul the nation’s health-care system by covering everyone through Medicare. (Mason, 9/22)

Los Angeles Times: Two Top Candidates For California Governor Have Been Touting Their Healthcare Wins. Here's What They Really Did
Gavin Newsom and Antonio Villaraigosa are depicting themselves as Democratic healthcare visionaries as they campaign to become California’s next governor. To prove his healthcare mettle, Newsom points to Healthy San Francisco, a first-of-its-kind universal system adopted while he reigned as the city’s mayor in 2006. Newsom’s work on the program helped him land an endorsement from the influential California Nurses Association, and a boast or two will surely punctuate his speech at their convention on Friday as hyper-partisan politics intensify over efforts to repeal the Affordable Care Act and implement a national single-payer plan. (Willon, 9/22)

Reuters: Death Toll From Overheated Florida Nursing Home Rises To 10
A 10th elderly patient at a Miami-area nursing home has died after she was exposed to sweltering heat in the aftermath of Hurricane Irma, police said on Thursday. The resident of the Rehabilitation Center at Hollywood Hills died on Wednesday, police in Hollywood, Florida, said in a statement, without giving details. (Simpson, 9/21)

Los Angeles Times: Multiple Cases Of West Nile Virus In Glendale Prompt Education Campaign
With eight cases of West Nile virus reported in Glendale so far this year, health officials took part in a door-to-door education campaign Wednesday, informing residents of what they can do to protect themselves from infection. Conducted by the Greater Los Angeles County Vector Control District, the effort informed residents in Glendale, Los Feliz and Atwater Village about the preventive measures they can take to reduce the risk of being bitten by mosquitoes. Levy Sun, a spokesman for vector control, said wearing insect repellent and dumping out any stagnant water near homes are measures people should take regularly. (Nguyen, 9/21)

Houston Chronicle: Residents Near Houston Superfund Site Await Answers After Hurricane Harvey
Bonner and others in Channelview, Baytown and Highlands neighborhoods along this industrial stretch of the river south of the Lake Houston dam worry about the toxicity of murky water, white dust and the foul-smelling sludge covering their properties. The question for dozens of people, who a week after the storm still guard wrecked riverfront properties from marauders seeking scrap, is whether their neighborhoods are now too contaminated to recover. (Olson, 9/22)

Health Policy Research

Research Roundup: Hospital Transportation; Medicaid Expansion; Obesity Treatment

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

Urban Institute: The Affordable Care Act Medicaid Expansions And Personal Finance 
Results demonstrate financial improvements in states that expanded their Medicaid programs as measured by improved credit scores, reduced balances past due as a percent of total debt, reduced probability of a medical collection balance of $1,000 or more, reduced probability of having one or more recent medical bills go to collections, reduction in the probability of experiencing a new derogatory balance of any type, reduced probability of incurring a new derogatory balance equal to $1,000 or more, and a reduction in the probability of a new bankruptcy filing. (Caswell and Waidmann, 9/17)

Health Affairs: Networks In ACA Marketplaces Are Narrower For Mental Health Care Than For Primary Care
Using data for 2016 from 531 unique provider networks in the Affordable Care Act Marketplaces, we evaluated how network size and the percentage of providers who participate in any network differ between mental health care providers and a control group of primary care providers. Compared to primary care networks, participation in mental health networks was low, with only 42.7 percent of psychiatrists and 19.3 percent of nonphysician mental health care providers participating in any network. (Zhu, Zhang and Polsky, 9/1)

Pediatrics: Cost-Effectiveness Of Family-Based Obesity Treatment 
We translated family-based behavioral treatment (FBT) to treat children with overweight and obesity and their parents in the patient-centered medical home. ... For families consisting of children and parents with overweight, FBT presents a more cost-effective alternative than an IC group. (Quattrin, Cao, Paluch et. al., 9/1)

Editorials And Opinions

Political Perspectives: Pleas For Truth Talk Regarding Graham-Cassidy; Does Panic On Left Suggest Progress On Right?

Opinion writers express outrage at the contents of the Senate GOP's latest attempt to repeal and replace Obamacare and explore the political motivations for pursuing the measure's passage.

The New York Times: Senator Cassidy, Please Stop Lying About Health Care
Here’s a giveway about how bad the new Senate health care bill is: Bill Cassidy, one of its authors, keeps trying to sell it by telling untruths. “The relatively new phenomenon of just ‘up is down’ lying about your bill’s impacts is jarring,” says Loren Adler of the USC-Brookings-Schaeffer Initiative on Health Policy. Most egregiously, Cassidy is claiming that the bill would not ultimately deprive sick people of health insurance. That’s false, as NPR calmly explained when Cassidy said otherwise. (David Leonhardt, 9/21)

The Wall Street Journal: The Panic Over Graham-Cassidy
Senate Republicans must be making progress on their latest attempt to reform health care, because the opposition is again reaching jet-aircraft decibel levels of outrage. The debate could use a few facts—not least on the claims that the GOP is engaging in an unfair process. Republicans are scrambling to pass Lindsey Graham and Bill Cassidy’s health-care bill before Sept. 30, when the clock expires on the budget procedure that allows the Senate to pass legislation with 51 votes. The bill would devolve ObamaCare funding to the states, which could seek waivers from the feds to experiment within certain regulatory boundaries, and it also repeals the individual and employer mandates and medical-device tax. (9/21)

The New York Times: Cruelty, Incompetence And Lies
Graham-Cassidy, the health bill the Senate may vote on next week, is stunningly cruel. It’s also incompetently drafted: The bill’s sponsors clearly had no idea what they were doing when they put it together. Furthermore, their efforts to sell the bill involve obvious, blatant lies.Nonetheless, the bill could pass. And that says a lot about today’s Republican Party, none of it good. (Paul Krugman, 9/22)

The Washington Post: This Republican Health-Care Bill Is The Most Monstrous Yet
Motivated by the cynical aims of fulfilling a bumper-sticker campaign promise and lavishing tax cuts on the wealthy, Republicans are threatening to pass a health-care bill they know will make millions of Americans sicker and poorer. Do they think we don’t see what they’re doing? Does Sen. Charles E. Grassley (R-Iowa) think we didn’t hear what he said Wednesday? “You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” he told reporters. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.” (Eugene Robinson, 9/21)

The Wall Street Journal: The Graham-Cassidy Show Is Like ‘Jaws’—And You’re The Swimmer
If you’ve been following the congressional health-care “debate”—an overly kind word, to be sure—you may now be getting an eerie feeling. It’s sort of like “Jaws.” You thought it was safe to go back into the health-care waters. The poor and the powerless seemed to be out of harm’s way. Sens. Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.) were reporting progress on a bipartisan compromise. Then the Graham-Cassidy bill came out of nowhere, like a great white shark, accompanied by a bit of ominous music. (Alan S. Blinder, 9/21)

Policy Implications: The GOP Bill's Math Problems; The Importance Of Funding CHIP

Editorial pages include policy analysis of the Graham-Cassidy health care bill and examine some of the key policies now in play.

The Washington Post: Tens Of Millions Of Americans Could Lose Obamacare Tax Credits Because Thousands Of Alaskans Won’t
American politics is always a math problem. If you have a group of x people, you need (x/2) + 1 votes to win the most votes. That holds true for most elections pitting two candidates against each other, and it holds true for passing legislation. In the case of Cassidy-Graham, the clumsily named bill that is the latest and last iteration of Republican efforts to gut the Affordable Care Act, also known as Obamacare, the x is 100 — the number of votes in the Senate. Thanks to two quirks of the process, the legislation would pass with just (x/2) votes, with the +1 being added by VPOTUS-ex-machina Mike Pence. (Philip Bump, 9/21)

Los Angeles Times: Believe It Or Not, Graham-Cassidy Socializes The Cost Of Health Insurance
There are plenty of things wrong with the Graham-Cassidy-Heller-Johnson proposal to overhaul Obamacare (and Medicaid, while it’s at it), from its cockamamie approach to helping people not insured by their employers to its blithe indifference to the rising cost of medical care. But give sponsoring Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Dean Heller (R-Nev.) and Ron Johnson (R-Wis.) credit for doing something remarkable: They got even the most conservative of their Republican colleagues to agree to socialize more of the cost of health insurance. (Jon Healey, 9/21)

The Washington Post: Republicans’ Brave New Strategy For Fixing The U.S. Health-Care System
Republicans have unveiled their brave new strategy for fixing the U.S. health-care system: Make someone else deal with it. Of all the god-awful Obamacare-repeal-and-replace plans that Republicans have proposed, Cassidy-Graham might be the god-awfulest. It’s definitely the most cowardly. Republicans spent nine months fighting over how to repeal Obamacare without shafting the poor and enraging voters, and they failed. So instead they’re passing the buck. (Catherine Rampell, 9/21)

Viewpoints: Nursing Homes And Hurricanes; Winning The War On Drugs

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

Miami Herald: Protect Nursing Home Residents, Not Bad Facilities
When they get together in Tallahassee on Friday, the members of Florida’s nursing-home industry can either circle the wagons or lay the groundwork to take a deep, honest look at how best to confront the one the worst tragedies the industry seen. The Florida Health Care Association has called a “summit” to address emergency preparedness. This comes after eight, then nine and, as of Thursday, 10 elderly residents in a Hollywood Hills nursing home were left to suffer and die because they were in an stiflingly hot facility that lost electricity as Hurricane Irma blew through. (9/22)

USA Today: In Hurricane Irma, Why Did Nursing Home Patients Have To Die?
The deaths have set off the predictable round of finger-pointing among the nursing home, the electric utility, state agencies and the governor over responsibility for decisions and ineptitude that turned deadly. This blame game avoids the real problem. The facility had one operable backup generator, which did not run air conditioning. And no one — not the federal government, not the state and not the county — required the facility to have an emergency generator dedicated to keeping fragile residents cool in a state that regularly experiences hurricanes, flooding and sweltering heat. (9/21)

USA Today: Florida Health Care Association: We're Dedicated
As caregivers dedicated to helping Florida’s frail elders, all of us at Florida Health Care Association grieve the loss of nine elderly residents of a single, non-member South Florida nursing home in the wake of Hurricane Irma. Our members accept the enormous daily responsibility of caring for Florida’s frailest residents. Ever since Florida’s horrendous storm season of 2004, we have committed to ongoing intensive disaster response training — most recently, the week before Hurricanes Harvey and Irma struck. (Emmett Reed, 9/21)

Bloomberg: Tom Price Flies Blind On Ethics
Under the lax ethical standards President Donald Trump brought to the White House, rampant conflicts of interest are treated with casual indifference. This disregard has sent a message to his entire administration that blurring lines -- between public and private, right and wrong -- will be not just tolerated but defended. At least one cabinet member appears to have taken the message to heart. (9/21)

The New York Times: How To Win A War On Drugs
Decades ago, the United States and Portugal both struggled with illicit drugs and took decisive action — in diametrically opposite directions. The U.S. cracked down vigorously, spending billions of dollars incarcerating drug users. In contrast, Portugal undertook a monumental experiment: It decriminalized the use of all drugs in 2001, even heroin and cocaine, and unleashed a major public health campaign to tackle addiction. Ever since in Portugal, drug addiction has been treated more as a medical challenge than as a criminal justice issue. ... Portugal may be winning the war on drugs — by ending it. Today, the Health Ministry estimates that only about 25,000 Portuguese use heroin, down from 100,000 when the policy began. (Nicholas Kristof, 9/22)

The New England Journal Of Medicine: The Fate Of FDA Postapproval Studies
Both Congress and the Food and Drug Administration (FDA) have sought to accelerate the availability of new drugs by allowing sponsors to wait to resolve many questions about safety and benefit until after their drugs receive marketing approval. As a result, most approval letters require phase 4 studies to address issues such as optimal dosing, potential long-term side effects, and use in children or to confirm the clinical benefit of drugs that receive conditional approval on the basis of preliminary evidence. (Steven Woloshin, Lisa M. Schwartz, Brian White, and Thomas J. Moore, 9/21)

Chicago Tribune: Will Rauner Complete A 'Full Obama' On Abortion Rights?
Common usage notwithstanding, a flip-flop is actually a double inversion: First the flip — a reversal on an earlier position — then the flop — a return to the original position. A 360, to put it geometrically. A classic example is Barack Obama on same-sex marriage. In February 1996, when he was running for the state Senate, he expressed unequivocal support for gay marriage in candidate questionnaires, writing that he “would fight efforts to prohibit such marriages." ... A big question in Illinois these days is if Gov. Bruce Rauner will end up performing a “Full Obama” on the issue of Medicaid and state-employee health insurance funding of abortion services. (Eric Zorn, 9/21)

The New England Journal Of Medicine: A Nicotine-Focused Framework For Public Health
With the tools provided to the Food and Drug Administration (FDA) under the Family Smoking Prevention and Tobacco Control Act of 2009, the agency has taken consequential steps to prevent sales of tobacco products to children, expand the science base for understanding traditional and newer tobacco products, and conduct public education campaigns. But the agency needs to do more to protect Americans; in particular, we must shape a regulatory framework that reduces their use of combustible cigarettes. (Scott Gottlieb and Mitchell Zeller, 9/21)

Chicago Tribune: Cook County’s ‘Health’ Lie, In Black And White
Let Michael Bloomberg spend his millions to defend Cook County’s hated sweetened beverage tax. Opponents don’t need to pay a dime for advertising. That’s because taxpayers get a written reminder of this brazen cash grab every time they make a purchase. County Board members who are on the fence about next month’s vote to repeal the tax should keep that in mind. (9/21)

The New England Journal Of Medicine: Tuberculosis Elimination In The United States — The Need For Renewed Action
Once called “the captain of all these men of death,” tuberculosis continues to kill 1.8 million people globally each year. In 2014, the World Health Assembly embraced an ambitious resolution to reduce deaths from tuberculosis by 95% by 2035. But despite such global concern, tuberculosis has all but vanished from the U.S. public’s mind as a perceived threat. Although this lack of attention is understandable, given the substantial decrease in disease burden over the past several decades, it jeopardizes the prospect of tuberculosis elimination in the United States — a goal established by the Department of Health and Human Services in 1989. Critical ethical and policy questions must be addressed if elimination is to be pursued in earnest. (Ronald Bayer and Kenneth G. Castro, 9/21)