- Kaiser Health News Original Stories 3
- Taken For A Ride? Ambulances Stick Patients With Surprise Bills
- Surprise Ambulance Bills: A Consumer's Guide
- Marketplace Confusion Opens Door To Questions About Skinny Plans
- Political Cartoon: 'Ch-ch-ch-chia?'
- Health Law 2
- Pace Of Health Law Sign-Ups Dips In Third Week, But Percentage Of New Enrollees Creeps Up
- Individual Mandate Repeal May Cause Already-Struggling Rural Markets In Red States To Collapse
- Medicaid 1
- States Prepare For CHIP Funding To Run Out: 'You Can’t Say Probably Everything Is Going To Be All Right'
- Administration News 2
- Some Question If HHS Nominee, Who Has Ties To Industry, Will Really Combat Pharma 'Greed'
- 146 Lawmakers Press HHS To Roll Back Nursing Home Rules
- Quality 1
- CMS' Readmissions Policy: Are Patient Deaths The 'Unintended Consequence' Of This Quality Measure?
- Women’s Health 1
- Notre Dame's Reversal On Contraception Rules 'Baffles' Critics, But Reveals Complexities Of Issue
- Public Health And Education 2
- 'Recovery-Friendly' Job Fair Offers Those Recovering From Opioid Addiction Another Chance
- Mysterious Bacterium Could Offer New Key Insights Into Fight Against Cancer
- State Watch 1
- State Highlights: Growing Number Of States Approving Marijuana To Treat PTSD; Program Aims To Tackle Ohio's High Rate Of Diabetes
From Kaiser Health News - Latest Stories:
Public outrage over surprise medical bills prompted 21 states to pass consumer protection laws. But these laws largely ignore ambulance rides, which can leave patients stuck with hundreds or even thousands of dollars in bills. (Melissa Bailey, 11/27)
What to do if you get hit by an exorbitant ambulance bill — and how to avoid them in the first place. (Melissa Bailey, 11/27)
Regulators are beginning to scrutinize claims by companies that their alternative plans help people meet Obamacare requirements. (Julie Appleby, 11/27)
Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Ch-ch-ch-chia?'" by Hillary B. Price.
Here's today's health policy haiku:
A HOLIDAY RECIPE COURTESY OF GOP
Whip up a tax reform law,
Garnish with health care.
- Ernest R. Smith
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.
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Summaries Of The News:
In the first three weeks of the abbreviated open enrollment period, nearly 2.28 million people signed up for a plan through the exchanges.
The Washington Post:
Enrollment In ACA Health-Care Plans Is Still Running Ahead Of Last Year
The number of Americans signing up for health-care plans under the Affordable Care Act continues to run ahead of last year in states relying on the federal insurance exchange, according to federal figures released Wednesday that span nearly half of an abbreviated enrollment season. Between the start of the current sign-up period on Nov. 1 and Saturday, nearly 2.28 million people chose health-care plans for the coming year — slightly more than during the first four weeks of the ACA enrollment period a year ago, reports from the Centers for Medicare and Medicaid Services show. (Goldstein, 11/22)
Sign-Up Pace Slows in Third Week of 2018 Obamacare Enrollment
The pace slowed in the third week of enrollment for 2018 Obamacare individual insurance as nearly 800,000 people signed up through the federal government website HealthCare.gov, down about 75,000 people from the previous week, a U.S. government agency reported on Wednesday. There was an increase, however, in the number of new consumers to the program created by former President Barack Obama, to 220,323 from 208,397 in the previous week, the U.S. Department of Health and Human Services said. (Hummer, 11/22)
In more enrollment news —
New Hampshire Union Leader:
Sticker Shock Hits NH Health Insurance Buyers
Small business owners and middle-class individuals buying health insurance in New Hampshire have been warned for months that soaring premiums were in the offing for 2018. But once the open enrollment period began earlier this month and they took to “shopping” for the limited options on the Obamacare exchange, the numbers were still eye-popping. (Landrigan, 11/23)
New Hampshire Union Leader:
Minuteman Health Customers Get Reprieve To Make Health Insurance Call
Members who have health care insurance with Minuteman Health have just been given three more months to select a new plan. Insurance Commissioner Roger Sevigny announced the new deadline of March 1 for the 20,000 who were insured by the Massachusetts-based health plan that has withdrawn from the market starting this Jan. 1. Sevigny explained that the circumstances of Minuteman’s exodus qualify the members for an extended open enrollment. (Landrigan, 11/23)
Health Insurance Could Be Free For Some After Subsidy Changes
A recent analysis by the Kaiser Family Foundation found about 4.5 million people nationwide, or 42 percent of the 10.7 million eligible to purchase coverage on the exchange, could get a bronze-level plan at no cost. Bronze plans typically carry lower premiums than silver and gold plans offered on the exchange. (Candisky, 11/26)
Republican states with one insurer offering coverage through the exchanges are particularly vulnerable to the GOP's plan to scrap the individual mandate. In other health law news, industry groups push for repeal or delay of some ACA taxes.
Los Angeles Times:
Republicans' Latest Plan To Repeal Obamacare's Insurance Requirement Could Wreak Havoc In Some Very Red States
The Senate Republican plan to use tax legislation to repeal the federal requirement that Americans have health coverage threatens to derail insurance markets in conservative, rural swaths of the country, according to a Los Angeles Times data analysis. That could leave consumers in these regions — including most or all of Alaska, Iowa, Missouri, Nebraska, Nevada and Wyoming, as well as parts of many other states — with either no options for coverage or health plans that are prohibitively expensive. (Levey, 11/27)
Groups Make Year-End Push To Delay ObamaCare Taxes
Industry groups are gearing up for a final push to repeal or delay taxes in ObamaCare before the end of the year. Stalling the taxes on medical devices and health insurance, which were included in the health law to help pay for its coverage expansion, has been a rare area of some bipartisan cooperation on ObamaCare. There are members of both parties who oppose the taxes and have previously come together to push them off. (Sullivan, 11/26)
Kaiser Health News:
Marketplace Confusion Opens Door To Questions About Skinny Plans
Consumers coping with the high cost of health insurance are the target market for new plans claiming to be lower-cost alternatives to the Affordable Care Act that fulfill the law’s requirement for health coverage. But experts and regulators warn consumers to be cautious — and are raising red flags about one set of limited benefit plans marketed to individuals for as little as $93 a month. Offered through brokers and online ads, the plans promise to be an “ACA compliant, affordable, integrated solution that help … individuals avoid the penalties under [the health law].” (Appleby, 11/27)
California Winces At Trump’s Turn Back To ‘Bad Old Days’ Of Health Plan Associations
Just a few decades ago, small businesses in California often banded together to buy health insurance on the premise that a bigger pool of enrollees would get them a better deal. California’s dairy farmers did it; so did car dealers and accountants. But after a string of these “association health plans” went belly up, sometimes in the wake of fraud, state lawmakers passed sweeping changes in the 1990s that consigned them to near extinction. (Bartolone, 11/27)
Some states have enough funding for a few months if Congress fails to soon renew the funding for the Children’s Health Insurance Program, but others are going to run out imminently. “Everybody is still waiting and thinking Congress is going to act, and they probably will, but you can’t run a health-care program that way,” says Linda Nablo, chief deputy director at Virginia’s Department of Medical Assistance Services.
The Washington Post:
States Prepare To Shut Down Children’s Health Programs If Congress Doesn’t Act
Officials in nearly a dozen states are preparing to notify families that a crucial health insurance program for low-income children is running out of money for the first time since its creation two decades ago, putting coverage for many at risk by the end of the year. Congress missed a Sept. 30 deadline to extend funding for CHIP, as the Children’s Health Insurance Program is known. Nearly 9 million youngsters and 370,000 pregnant women nationwide receive care because of it. (Itkowitz and Somashekhar, 11/23)
States Preparing For Children's Health Insurance Program To Run Out Of Funding: Report
Nearly a dozen states are readying for the Children’s Health Insurance Program (CHIP), which provides insurance to low-income children, to run out of funding, according to a report from The Washington Post. Five states are at risk of running out of funding for their individual programs by late December, according to the report. Other states reportedly have enough money to keep their programs afloat for a few more months at least. (Manchester, 11/26)
During Alex Azar's tenure at Eli Lilly, the drugmaker instituted steep price increases on insulin and other medicines.
The New York Times:
He Raised Drug Prices At Eli Lilly. Can He Lower Them For The U.S.?
Alex M. Azar II, President Trump’s nominee to lead the Department of Health and Human Services, has expressed concern about the soaring cost of prescription drugs for many consumers. This week, Mr. Azar, a former pharmaceutical executive, is expected to face tough questions at a Senate confirmation hearing over why his own company raised prices. Democratic senators say that, as a top manager at Eli Lilly and Company, he was responsible for steep increases on insulin and other drugs. How he would now tackle that problem as secretary, along with the future of the Affordable Care Act, promises to dominate the hearings. (Pear, 11/26)
Last year, federal officials implemented the first stage of new rules to improve care that won praise from advocates for residents. But the industry has complained that the regulations go too far. Also, in Kansas, the high use of anti-psychotics among nursing home residents is raising concerns, and in one county in Maryland nursing homes are working to make Asians feel their care is culturally sensitive.
Cleveland Plain Dealer:
Lawmakers, Advocates Bicker Over Updated Regulations For Nursing Homes
Federal regulations designed to protect residents in the nation's nursing homes are facing mounting pressure from Congress. A group of 146 lawmakers has urged federal government officials to re-evaluate revised standards in care centers, claiming some of the measures are excessive and are financial burdens for facility owners. (Caniglia and Corrigan, 11/26)
Kansas City Star:
Kansas Nursing Homes Have ‘Become Far Too Dependent’ On Mind-Altering Meds
Anti-psychotics are contraindicated for people with dementia and include a U.S. Food and Drug Administration warning that they increase the risk of falls, stroke and other potentially fatal side effects. The federal government started tracking the off-label use of such medications in nursing homes in 2011. Since then, Kansas has always ranked at or near the top in percentage of medicated residents, suggesting there are thousands of residents in the state’s certified nursing facilities who have been given drugs that aren’t medically indicated for them, and could actually harm them. (Marso and Ryan, 11/26)
The Baltimore Sun:
Columbia Nursing Home Makes Elder Koreans Feel At Home
In Howard County, 16.2 percent of the population is Asian, including 4.2 percent who are Korean, according to 2015 U.S. Census estimates. That’s up 33 percent since 2010, when Asians made up 13.3 percent of the population. ... While there are religion-based retirement communities — think Catholic or Lutheran homes — nursing care is often less culturally focused. But more facilities are adapting to the nation’s growing ethnic diversity, hiring multilingual staff, serving multi-ethnic foods and in some cases devoting whole floors to one culture. The focus on culture and ethnicity is an example of how nursing homes are looking at innovative ways to better better serve the communities where they are located, those in the nursing home industry said. (McDaniels, 11/24)
More and more, health companies are broadening their security and their reach by moving beyond their traditional boundaries. In other health industry news: electronic health records, medical-device companies and the cost of ambulance rides.
The New York Times:
As Health Care Changes, Insurers, Hospitals And Drugstores Team Up
They seem like odd couples: Aetna, one of the nation’s largest health insurers, is in talks to combine with CVS Health, which manages pharmacy benefits. The Cleveland Clinic, a highly regarded health system, joined forces with an insurance start-up, Oscar Health, to offer individuals a health plan in Ohio. Aetna also has new partnerships with large health systems that include hospitals and doctors’ groups in Northern California and Virginia. (Abelson, 11/26)
Providers And Vendors Team Up For User-Friendly EHRs
Electronic health records are notoriously clunky. Vendors, with the help of their provider clients, are out to change that. Such interaction is crucial, given that clinicians spend about half the workday working with EHRs. And many of those hours are during patient encounters. (Arndt, 11/25)
Medical-Device Companies Alpha Source And BC Technical Complete Merger
Medical-device repair company Alpha Source completed the acquisition of imaging system developer BC Technical to create one of the largest independent imaging services and equipment repair companies, the organizations announced Tuesday. The deal will expand Alpha Source's ultrasound and bone density equipment service to include maintenance services and refurbished equipment for CT, MRI and molecular scans. (Kacik, 11/22)
Kaiser Health News:
Taken For A Ride? Ambulances Stick Patients With Surprise Bills
One patient got a $3,660 bill for a 4-mile ride. Another was charged $8,460 for a trip from one hospital that could not handle his case to another that could. Still another found herself marooned at an out-of-network hospital, where she’d been taken by ambulance without her consent. These patients all took ambulances in emergencies and got slammed with unexpected bills. Public outrage has erupted over surprise medical bills — generally out-of-network charges that a patient did not expect or could not control — prompting 21 states to pass laws protecting consumers in some situations. (Bailey, 11/27)
Kaiser Health News:
Surprise Ambulance Bills: A Consumer’s Guide
What’s a surprise ambulance bill? When the ambulance service that picks you up is out-of-network, your insurer pays what it considers fair. And then — surprise! — the ambulance service sends you a bill for the rest. (Bailey, 11/27)
For hospitals in non-urban areas and those with large numbers of Medicare patients, the gap between their costs and the reduced federal payments is becoming a serious concern. Also, time is growing short for Medicare beneficiaries to sign up for 2018 coverage.
Slumping Medicare Margins Put Hospitals On Precarious Cliff
David Ramsey is in a dark place. Despite running West Virginia's largest hospital, a sense of dread has grown about the facility's future. "There is no light at the end of the tunnel other than another train," said Ramsey, CEO of Charleston Area Medical Center. "There no reason to feel optimistic." Ramsey, and many of his C-suite peers, are grappling with that fact that Medicare margins are in a free fall. In 2015, the aggregate margin hit a negative 7.1% across hospitals, according to the Medicare Payment Advisory Commission; margins are expected sink to a negative 10% this year. While Medicare has never totally covered the cost of care, hospital executives say the chasm between the two has widened in recent years. (Dickson, 11/25)
Time Is Running Out To Lock In Your Medicare Coverage
Medicare recipients who haven't yet re-evaluated their coverage have about two weeks left to make changes. The program's open enrollment period, which started Oct. 15, ends on Dec. 7. This seven-week window is generally the only time you can make changes to your Advantage Plan (Medicare Part C) or prescription drug coverage (Part D). And with premiums for Part B (outpatient care) jumping by 23 percent for many Medicare beneficiaries, trying to contain costs in other areas is crucial. (O'Brien, 11/24)
News outlets report that by linking quality scores to payments, the Centers for Medicare & Medicaid Services may have caused some facilities and providers to avoid patients who could ultimately make them look bad.
Unintended Consequences: CMS' Readmissions Program Might Be Harming Patients
Overall, the penalty program, which was established under the Affordable Care Act, has effectively motivated hospitals to change wasteful care practices and better manage populations. Readmissions have fallen as hospitals respond to penalties that can dock up to 3% of their Medicare payments. But the tactics hospitals have adopted to avoid a penalty might not always be in the best interest of patients. As hospitals reduced readmissions for heart failure patients, their mortality rates increased, according to a recent JAMA study. (Castellucci, 11/25)
Patient Deaths: Unintended Consequence Of Quality Measurement?
As the country struggles with its nearly $3 trillion annual health care budget, policymakers have tried to tie payments to quality scores. ... In response, doctors and scholars say, many providers are avoiding patients who might make them look bad or cost them money. (Pittman, 11/27)
Catholic institutions have wrestled over how closely to adhere to their religious doctrine in the face of shifting governmental policies. In other women's health news, a federal judge rules that a Texas law banning a common second-trimester abortion procedure is unconstitutional, and a restrictive law in Maine becomes the ACLU's next target.
The Wall Street Journal:
Notre Dame’s Stance On Birth Control Highlights Divide
The University of Notre Dame fought in court for five years to limit the government’s ability to push religiously affiliated employers to offer contraception benefits. Now, the university is voluntarily allowing birth-control benefits, exposing a divide among Catholic institutions. The university’s shift comes as the litigation enters a fresh phase after two U.S. Supreme Court cases and new rules championed by President Donald Trump’s administration. These rules, if implemented, would reverse a requirement set by Mr. Trump’s Democratic predecessor that most employers include birth-control benefits in workers’ health plans. (Radnofsky and Lovett, 11/23)
The New York Times:
Texas Abortion Law Is Unconstitutional, Federal Judge Rules
A Texas law restricting the most common form of second-trimester abortion is unconstitutional, a federal judge ruled on Wednesday, saying it would impose an undue burden on women. A lawyer for abortion providers called the decision “a complete victory,” while state officials immediately said they would appeal. Ultimately, the case could make its way to the United States Supreme Court. (Astor, 11/22)
The Associated Press:
Federal Judge Blocks Texas Ban Of Common Abortion Procedure
Federal judges have already ruled against past Texas efforts to change the disposal of fetal remains and deny Medicaid funding to abortion provider Planned Parenthood over videos secretly recorded by an anti-abortion group. Last year, the U.S. Supreme Court gutted most of a sweeping, anti-abortion law approved in Texas in 2013 which helped force the closure of more than half of the state's abortion clinics. (11/22)
ACLU Targets ‘Restrictive’ Maine Abortion Law
Because of Maine’s vast rural expanse and often difficult travel conditions, the American Civil Liberties Union has settled on the state as promising terrain to challenge the law, which carries criminal charges for people who perform an abortion without a physician’s license. ...If successful in Maine, the plaintiffs in the case, filed in US District Court for the District of Maine, expect similar legal challenges across the country. (Jacobs, 11/24)
In New Hampshire, where unemployment rates are at record lows, employers struggle to find workers to fill positions. But a new effort sees a solution in one of the state's other problems: the opioid epidemic. Also in the news, telemedicine's role in helping curb the epidemic; what insurance companies cover in terms of opioids; the responsibility of hospitals for post-surgical patients; and more.
Wall Street Journal:
Amid A Dearth Of Workers, New Hampshire Taps Recovering Addicts For Jobs
At a recruiting event in a sunlit parish hall here, job seekers from sober houses streamed in, looking for opportunities from a range of employers all willing to look beyond gaps in resumes, criminal records and messy pasts. Making the rounds at the “recovery-friendly job fair” was Ben Gale, who said it was tough getting work when he had to explain his history with drugs. “A lot of places look at you very differently,” said the 25-year-old, now sober from a heroin addiction. “A lot of them don’t want to give you a chance.” (Levitz, 11/27)
Telemedicine For Addiction Treatment? Picture Remains Fuzzy
When President Trump declared the opioid epidemic a public health emergency, it came with a regulatory change intended to make it easier for people to get care. Doctors are now allowed to prescribe addiction medicine virtually, without ever seeing the patient in person. In Indiana, this kind of virtual visit has been legal since early 2017. So I called about a dozen addiction specialists in Indiana to find out how it was going. But no one had heard of doctors using telemedicine for opioid addiction treatment until I ran across Dr. Jay Joshi. (Forman, 11/24)
The Insurance Company Paid For Opioids, But Not Cold Therapy
As a lifelong racket-sports fanatic, I've dealt with shoulder pain for decades, treating it with bags of frozen peas, physical therapy, cortisone shots and even experimental treatments like platelet-rich plasma. Eventually, however, the soreness prevented me from handling daily-living tasks like pulling a bottle of olive oil off the top shelf of my kitchen or reaching to the back seat of my car to grab my purse. Even low-impact activities such as swimming freestyle hurt a lot. Sleeping also got tougher. After MRI showed two full-thickness rotator-cuff tears, I finally called a surgeon. (Kafka, 11/25)
Should Hospitals Be Punished For Post-Surgical Patients' Opioid Addiction?
In April this year, Katie Herzog checked into a Boston teaching hospital for what turned out to be a nine-hour-long back surgery. The 68-year-old consulting firm president left the hospital with a prescription for Dilaudid, an opioid used to treat severe pain, and instructions to take two pills every four hours as needed. Herzog took close to the full dose for about two weeks. Then, worried about addiction, she began asking questions. "I said, 'How do I taper off this? I don't want to stay on this drug forever, you know? What do I do?' " Herzog says, recalling conversations with her various providers. She never got a clear answer. (Bebinger, 11/26)
The Associated Press:
Maryland Tests Out Part Of Federal Response To Opioid Crisis
A federal initiative to combat the opioid epidemic is being tested in Maryland. The Baltimore Sun reports Maryland, where overdose deaths are surging, is one of seven states approved to allow large residential centers to bill Medicaid for substance abuse treatment. Under the new structure, treatment centers receive reimbursement for each patient rather than a set grant. (11/22)
Tampa Bay Times:
Report: Opioid, Cocaine Deaths On The Rise Statewide And In Tampa Bay
According to the annual Medical Examiners Commission Drug Report, deaths in which opioids were either present in the system or identified to be the cause of death saw a 35 percent increase from 2015, up to a total of 5,725 statewide. Cocaine-related deaths shot up from 1,834 to 2,882 during the same time, a 57 percent increase. (Varn, 11/27)
Charleston (S.C.) Post and Courier:
Opioid Use By S.C. Medicaid Recipients Is Down Due To Drug Monitoring Program, Report Says
The state's prescription drug monitoring program is showing promising results in reducing opioid prescriptions written in South Carolina, according to a new University of South Carolina report. ... In response to the epidemic, state health leaders set up a prescription monitoring program and made it mandatory for all doctors to check before prescribing opioids. The database is run through the Department of Health and Environmental Control. USC's work focused on the Medicaid population, but lead researcher Ana Lopez-De Fede said the trends extend beyond those patients. (Wildeman, 11/26)
An Accused Pill Doctor And A Groin-Punching Nurse’s Assistant Get Licenses Suspended
A doctor accused of drug trafficking, a registered nurse twice convicted of prostitution, and a certified nursing assistant who punched a sick senior citizen in the genitals have been suspended, according to November’s Florida Department of Health discipline report. (Neal, 11/26)
Scientists have discovered that a type of bacterium travels with some types of cancer as it spreads through the body, and that in those cases using an antibiotic actually slows the growth of cancer cells in mice. In other public health news: HIV guidelines, do-it-yourself gene editing kits, depression, tobacco, medical care for homeless, light therapy and more.
The New York Times:
Why Is This Bacterium Hiding In Human Tumors?
A mysterious bacterium found in up to half of all colon tumors also travels with the cancer as it spreads, researchers reported on Thursday. Whether the bacterium, called Fusobacterium nucleatum, actually plays a role in causing or spurring the growth of cancer is not known. But the new study, published in the journal Science, also shows that an antibiotic that squelches this organism slows the growth of cancer cells in mice. (Kolata, 11/23)
The Washington Post:
‘I Don’t Feel Like I’m A Threat Anymore.’ New HIV Guidelines Are Changing Lives.
Last year, Chris Kimmenez and his wife asked their doctors a simple question. Could Chris, who has been HIV positive since 1989 but keeps the virus in check through medication, transmit it sexually to Paula? They were pretty sure they knew the answer. Married for more than 30 years, they had not always practiced safe sex, but Paula showed no signs of having the virus. Their physicians were less certain. “They had a conversation, and they did some research on it,” Kimmenez said. “They came back to us and said there may still be a risk, but we’re comfortable enough” that unprotected sex is safe. (Bernstein, 11/24)
The FDA Says It’s Illegal To Sell Do-It-Yourself Kits To Edit Human Genes. But What, Exactly, Does That Mean?
It’s unclear exactly which law would be violated by sale of those products. An FDA spokesperson declined to clarify. Nor would the FDA identify any specific products that regulators believe cross the line. Instead, the spokesperson sent links to two articles. One featured Josiah Zayner, who runs a company called The ODIN that sells genetic engineering kits for bacteria as well as genetic material that could be used to modify human muscle cell growth. Last month, he injected himself with a purified version of that genetic material. (Swetlitz, 11/24)
The Washington Post:
From Pills To Psychotherapy, Treating Depression Often Lies In A Gray Zone
Depression afflicts an estimated 16 million Americans every year, many of whom go to their doctors in despair, embarking on an often stressful process about what to do next. These visits may entail filling out forms with screening questions about symptoms such as mood changes and difficulty sleeping. Doctors may ask patients to share intimate details about such issues as marital conflicts and suicidal urges. Some patients may be referred to mental-health specialists for further examination. Once diagnosed with depression, patients frequently face the question: “Are you interested in therapy, medications or both?” (Morris, 11/25)
The New York Times:
Why Tobacco Companies Are Paying To Tell You Smoking Kills
The biggest tobacco companies in the United States will start running prime-time television commercials and full-page ads in national newspapers on Sunday — but the campaign is unlikely to spur enthusiasm for their products. “More people,” one ad says, “die every year from smoking than murder, AIDS, suicide, drugs, car crashes, and alcohol, combined.” Another reads: “Cigarette companies intentionally designed cigarettes with enough nicotine to create and sustain addiction.” (Maheshwari, 11/24)
The Washington Post:
In The Woods And The Shadows, Street Medicine Treats The Nation’s Homeless
Nurse Laura LaCroix was meeting with one of her many homeless patients in a downtown Dunkin’ Donuts when he mentioned that a buddy was lying in agony in the nearby woods. “You should check on him,” said Pappy, as the older man is known. “But don’t worry, I put him on a tarp, so if he dies, you can just roll him into a hole.” LaCroix called her boss, Brett Feldman, a physician assistant who heads the “street medicine” program at Lehigh Valley Health Network. He rushed out of a meeting, and together the two hiked into the woods. They found Jeff Gibson in a fetal position, vomiting green bile and crying out in pain from being punched in the stomach by another man days earlier. (McGinley, 11/22)
The Washington Post:
Hoping To Find Other Patients, He Revealed A Cancer Often Mistaken For ‘Jock Itch’
Stephen Schroeder figured he had little to lose, his growing sense of desperation fueled by the loneliness of his unusual diagnosis. For more than two years, Schroeder had been coping with an extremely rare, invasive cancer called extramammary Paget’s disease (EMPD), which had invaded his scrotum, requiring multiple surgeries. Women account for roughly half of EMPD cases; the cancer, often misdiagnosed as eczema or contact dermatitis, attacks the sweat-producing apocrine glands, including those in the genital and anal areas. (Boodman, 11/25)
Light Therapy Might Help People With Bipolar Depression
As the months grow colder and darker, many people find themselves somewhat sadder and even depressed. Bright light is sometimes used to help treat the symptoms of seasonal affective disorder, or SAD. Researchers are now testing light therapy to see if it also can help treat depression that's part of bipolar disorder. It's unclear how lack of light might cause the winter blues, although some suggest that the dark days affect the production of serotonin in the skin. (Neighmond, 11/27)
The Washington Post:
Pulling Your Hair Or Picking At Skin Can Be Signs Of Serious Disorders
Lucy Harper, 17, a high school junior who lives in College Station, Tex., has been picking at her skin for as long as she can remember. When she was in seventh grade, she also started pulling out her hair. “For a while my skin picking was under the radar, but it was because I was pulling my hair,” she says. “If I wanted my skin to clear up, I’d stop picking and start pulling. If I wanted my hair to grow back, I’d stop pulling and start picking.” (Cimons, 11/26)
Human Brains Have Evolved Unique 'Feel-Good' Circuits
A brain system involved in everything from addiction to autism appears to have evolved differently in people than in great apes, a team reports Thursday in the journal Science. The system controls the production of dopamine, a chemical messenger that plays a major role in pleasure and rewards. "Humans have evolved a dopamine system that is different than the one in chimpanzees," says Nenad Sestan, an author of the study and a professor of neuroscience at Yale. (Hamilton, 11/23)
The Washington Post:
Having Trouble Sleeping? It Is Not Just Because Of Aging.
Many older adults have sleep problems that can be caused by aging. But other issues also contribute to the prevalence of sleep complaints, and they should be discussed and investigated, experts say. A national poll conducted by the University of Michigan and released in October found that almost half of those 65 and older have trouble getting to sleep, and more than a third are taking prescription or over-the-counter sleep aids. (Sadick, 11/26)
Apps Can Cut Blue Light From Devices, But Do They Help You Sleep?
If you're losing sleep over the blue light coming from your phone, there's an app for that. In fact, there are now lots of apps that promise to improve sleep by filtering out the blue light produced by phones, tablets, computers, and even televisions. But how well do these apps work? (Hamilton, 11/27)
The New York Times:
Dog Owners Live Longer
A Swedish study suggests that owning a dog is linked to a reduced risk for cardiovascular disease and death. Researchers used demographic data on 3.4 million Swedes ages 40 to 80. In Sweden, all dogs are registered with the Swedish Board of Agriculture and identified by number with an ear tattoo or a subcutaneous chip. (Bakalar, 11/22)
Media outlets report on news from Ohio, Texas, Virginia, Connecticut, Minnesota and Florida.
The Associated Press:
Veterans Are Key As Surge Of States OK Medical Pot For PTSD
It was a telling setting for a decision on whether post-traumatic stress disorder patients could use medical marijuana. Against the backdrop of the nation's largest Veterans Day parade, Democratic Gov. Andrew Cuomo announced this month he'd sign legislation making New York the latest in a fast-rising tide of states to OK therapeutic pot as a PTSD treatment, though it's illegal under federal law and doesn't boast extensive, conclusive medical research. (11/26)
Ohio Doctors Urged To Screen Patients For Prediabetes To Prevent Problems
A new statewide initiative aimed at curbing Ohio’s high rate of type 2 diabetes is encouraging physicians to screen more people for prediabetes and refer those who are at risk to programs that spur lifestyle changes. ...The AMA is partnering in the project with the Ohio State Medical Association, which will reach out to physicians through its website, magazine, e-newsletters, emails and social media, to provide them with prediabetes-specific tools and resources. (Viviano, 11/26)
Texas Governor, Who Fought Obamacare, Ignores State's Health Woes Ahead Of Reelection Effort
By any measure, Texas' health care system is a mess. But Gov. Greg Abbott, expected to coast to reelection in 2018, scarcely gives it a mention. ...Texas’ 16.6 percent uninsured rate leads the country, its maternal mortality rate is the worst in the developed world and rural hospital closures have hit large swaths of the state hard. (Rayasam, 11/27)
The Washington Post:
Teenager Dies After Being Found Unresponsive At Behavioral Center In Virginia
Authorities are investigating the death of a teenager who was reported to be unresponsive and not breathing at a behavioral treatment center in Northern Virginia. Officials responded at 3:37 p.m. Sunday to a call at North Spring Behavioral Healthcare on Victory Lane in Leesburg, Va., according to Kraig Troxell, a spokesman for the Loudoun County Sheriff’s Office. ... The teenager was taken to a hospital where he later died. Troxell did not provide the youth’s exact age or other details, citing the ongoing investigation. The cause of death is pending the results of an autopsy. (Silverman, 11/24)
Officer Helps Others By Sharing How PTSD Changed Him
The training program that [Jamie] Ingles developed educates officers and dispatchers about PTSD, how to recognize its symptoms, questions to ask veterans about their service and experiences, and where to take or refer them for help. He also encourages follow-up with the veterans after the initial contact, much like the work that Officer Goudy has done with the man who used to call 911. (Futty, 11/24)
How Do You Want To Die? Write It Down …
Last April, the Connecticut Hospital Association launched Care Decisions Connecticut, a statewide initiative aimed at increasing public knowledge and awareness about end-of-life planning and implementing best practices for providers across Connecticut. The group includes representatives from hospitals, state agencies and insurance companies, as well as long-term, home, hospice and palliative care. (Rigg, 11/16)
University Of Minnesota Research Was Pivotal In Landmark Gene Editing Trial
A bold attempt this month to cure a lethal genetic disease by editing DNA inside a patient was carried out in San Francisco and made headlines around the country — but it was based largely on mouse research at the University of Minnesota Medical Center. Now, the second, third and additional attempts may occur in Minneapolis — as researchers race to prove the safety and effectiveness of editing genes inside patients. (Olson, 11/25)
Without Recovery Funds, More Than 50 Texas Day Cares Close After Harvey
Across Harvey-affected counties, 52 child care centers have permanently closed and an additional 65 are voluntarily suspended and expected to reopen with three months, as of Nov. 10, according to the Texas Health and Human Services Commission. ...With so many day cares closed and more in danger of closing, parents face difficulty moving back to their homes and getting back to normal, with no one to take care of their kids when they're at work. (Swaby, 11/27)
Medical Marijuana Advocate Won’t Run For Governor As A Democrat — Or Stay In The Party
One of Florida’s most prolific Democratic donors, a bourbon-swilling, salty-tongued lawyer with his own slogan and medical marijuana as his pet cause, is out. In a series of tweets Friday morning, John Morgan announced his flirtation with running for governor as a Democrat is over, as is his affiliation with either political party. (Harris, 11/24)
A selection of opinions on health care from around the country.
The New York Times:
When A Tax Cut Costs Millions Their Medical Coverage
Though their ham-fisted attempts to repeal the Affordable Care Act failed in September, Republican lawmakers and the Trump administration won’t give up on efforts that would take away health care from millions of people. They’re now out to do it through the equally sloppy and cruel tax bills barreling through Congress. The Senate could vote as soon as next week on a bill that, according to one government estimate, would increase the number of people who don’t have health insurance by 13 million and cause insurance companies to raise premiums substantially. (11/24)
The GOP Crusade Against Obamacare’s Mandate Says A Lot About How The Party Changed
Senate Republicans are set to vote next week on tax legislation that would eliminate the financial penalty for people who don’t get health insurance, often called the “individual mandate.” And plenty of Republicans seem positively giddy about the prospect. ... Republicans and their supporters have been bashing the individual mandate so loudly and so vociferously that it’s easy to forget this outrage is a relatively recent phenomenon. Not so long ago, it was easy to find GOP officials and conservative intellectuals who supported the mandate, and not simply because they thought it was the smart thing to do. They also thought it was the right thing to do. In fact, they were the ones who first put the idea on the political agenda. (Jonathan Cohn, 11/25)
Obamacare’s Individual Mandate Is A Tax On The Working Poor
[Alaska Republican Sen. Lisa] Murkowski’s positions — unwilling to kill Obamacare but very willing to kill the individual mandate — put her squarely in the mainstream. The individual mandate, unfair and ineffective, has always been the most disliked feature of the law, and not just by Republicans. (Jeff Jacoby, 11/25)
No, Obamacare Enrollment Is Not Strong, Not By A Longshot
A headline this week in The Hill shocked me: "ObamaCare enrollment strong in third week of sign-ups." The Hill is a serious, well-respected, non-partisan news source. But any reader taking this headline at face value would be seriously misled about what is really going on with Obamacare enrollments during this fifth open enrollment season. ... Even the guru of ACA enrollment figures--Charles Gaba, who runs ACASignups.net -- concedes that total Exchange enrollments this year likely will top out at only 10 million. Yet even this prediction (made just before the open enrollment began) now already seems optimistic. To hit that target, the pace of enrollments for the balance of the open enrollment period would have to be 2.2 times as high as we've observed in the first 19 days! Not impossible, to be sure, but neither is this highly probable. (Chris Conover,11/24)
Veteran RVA Docs Propose A Common-Sense Plan To Improve American Health-Care Delivery
The Affordable Care Act has not met our country’s needs, and it is highly unlikely to do so. With incidental adjustments, we may make little or no progress. ... To test whether our best is conceivable, we convened four retired physicians of diverse expertise and a retired regulator/judge to foresee what might be best for America. (Hunter H. McGuire Jr., Robert B. Scott Sr., Clarence Thomas, Thomas Davis and Hullinen W. Moore, 11/25)
Alabama Senate Race Leaves Pro-Lifers No Choice
For many voters in Alabama, the Senate election is more than an agonizing choice. It is an impossible one. National attention has focused on half the dilemma. Roy Moore, the Republican candidate, is credibly accused of having been a sexual predator, including against girls. His defenders, all too many of them pastors, have been disgraceful: casting the victims as temptresses, excusing him on the basis of idle speculation that other politicians have been guilty of worse. We have no reason to believe that the Democratic candidate, Doug Jones, is guilty of anything remotely as horrible. He appears to be a run-of-the-mill Democrat. His disqualifications are different in kind. If you take seriously the view that abortion is the unjust taking of human life, as many Alabamians do, then Jones’s position on it is a nearly insuperable barrier to voting for him. (Ramesh Ponnuru, 11/22)
The Kansas City Star:
Dr. Google Should Not Be Your Primary Care Physician
Scrolling through Facebook, I am inundated with advertisements claiming that I can “transform my body in 4 weeks,” “cleanse my liver,” or “lose 10 pounds in 1 week with apple cider vinegar.” These clickbait posts often operate under the guise of “natural remedies,” but they are the modern-day snake oil salesmen. They promise that I can drastically improve my life and even halt the aging process with a green smoothie and, occasionally, by ignoring the advice of years of extensive medical research. (Dahnika Short, 11/26)
The Washington Post:
When Doctors Refuse To See Transgender Patients, The Consequences Can Be Dire
Go back to California, the physician at a minor emergency center in a suburb of Tulsa told me. The words were flung — practically vomited — at me. I had gone to the center, a relatively new building that was beautifully decorated, on a Sunday morning in 2010 in terrible pain because of complications from surgery. The receptionist was pleasant, and the physician had entered the exam room smiling. He was about 50 years old and seemed friendly. But when I explained why I was there, the friendly smile quickly disappeared, and his face contorted into an expression of disgust and revulsion. (Laura Arrowsmith, 11/26)