KHN Morning Briefing

Summaries of health policy coverage from major news organizations

In This Edition:

From Kaiser Health News - Latest Stories:

Kaiser Health News Original Stories

Patients, Health Insurers Challenge Iowa's Privatized Medicaid

Complaints are rising against for-profit insurance companies that manage Medicaid for about 600,000 Iowans. The privatization of Medicaid is a national trend affecting more than half of the 74 million Americans who get their health care through the state-federal program. (Clay Masters, Iowa Public Radio, 10/9)

Political Cartoon: 'Gather No Moss?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Gather No Moss?'" by Jeff Koterba, Omaha World Herald.

Here's today's health policy haiku:

A PLEA TO CONGRESS

Reauthorize CHIP
And warm the hearts of children
Before winter comes.

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:

Administration News

New Moral, Religious Exemptions To Birth Control Mandate Prompt Medical Groups To Speak Out

“Contraception is a medical necessity for women during approximately 30 years of their lives,” the American Congress of Obstetricians and Gynecologists said. About 200 employers that are involved in suing the government over the requirement to provide contraception coverage would likely take advantage of the rule change, the administration estimated.

The New York Times: Trump Administration Rolls Back Birth Control Mandate
The Trump administration on Friday moved to expand the rights of employers to deny women insurance coverage for contraception and issued sweeping guidance on religious freedom that critics said could also erode civil rights protections for lesbian, gay, bisexual and transgender people. The twin actions, by the Department of Health and Human Services and the Justice Department, were meant to carry out a promise issued by President Trump five months ago, when he declared in the Rose Garden that “we will not allow people of faith to be targeted, bullied or silenced anymore.” (Pear, Ruiz and Goodstein, 10/6)

The Washington Post: Trump Administration Narrows Affordable Care Act’s Contraception Mandate
The rules significantly widen the range of employers and insurers that can invoke religious or moral beliefs to avoid the ACA requirement that birth control pills and other contraceptives be covered by insurance as part of preventive care. Administration officials and their allies on the right downplayed the impact of the change on American women, while women’s rights and civil liberties groups portrayed it as a massive, discriminatory act. (Goldstein, Eilperin and Wan, 10/6)

The Associated Press: Birth Control: Trump Expands Opt-Out For Workplace Insurance
The new policy was a long-anticipated revision to Affordable Care Act requirements that most companies cover birth control as preventive care for women, at no additional cost. That Obama-era requirement applies to all FDA-approved methods, including the morning-after pill, which some religious conservatives call an abortion drug, though scientists say it has no effect on women who are already pregnant. (10/6)

Politico: Trump Rolls Back Obamacare Birth Control Mandate
The new policies, which take effect immediately, reignite a fierce battle over one of the health care law's most controversial provisions and quickly drew legal challenges. The requirement to provide FDA-approved contraception at no cost was long opposed by religious groups that heavily favored Trump, and has been wrapped up in litigation for more than five years. (Ehley, 10/6)

NPR: Trump Weakens Requirement That Work-Based Health Policies Cover Birth Control
"This provides an exemption, and it's a limited one," said Roger Severino, director of the HHS Office of Civil Rights. "We should have space for organizations to live out their religious identity and not face discrimination." He said he expects that most companies will continue to provide coverage for birth control and that the changes will only affect a tiny percentage of U.S. women. The new rules are being published Friday in the Federal Register and go into effect immediately. But some health policy analysts say the new rule creates a huge opening that lets any employer claim an exemption, leaving their female workers to pay the full cost of any birth control out of pocket. (Kodjak, 10/6)

Stat: Obamacare' Birth Control Mandate Rolled Back By Trump Administration
Women’s health advocates said millions of women who had gained access to birth control at no cost would be at risk of losing that coverage. They also said some employers not associated with religious movements will use the move to justify declining to cover birth control because of unspecified moral objections. (Facher, 10/6)

Bloomberg: Trump Religion Rule Curbs Obamacare’s Birth Control Coverage 
The American College of Physicians said the rule change will “create substantial barriers to patients receiving appropriate medical care as recommended by their physicians.” The American Congress of Obstetricians and Gynecologists said the rules would hurt patients. “Contraception is a medical necessity for women during approximately 30 years of their lives,” the group said. “It improves the health of women, children and families as well as communities overall; reduces maternal mortality; and enhances economic stability for women and their families.” (Tracer, Edney and Larson, 10/6)

California Sues To Stop Contraception Rollback, Saying New Rules Are Unconstitutional

California Attorney General Xavier Becerra says the rule unlawfully targets women. “What group of Americans will they target next? Will they allow businesses to deny you cancer treatment?" Other states react as well.

The Hill: California Challenges Trump’s Rollback Of Birth Control Mandate 
California Attorney General Xavier Becerra (D) on Friday filed a lawsuit challenging the Trump administration's rollback of an Obama-era policy that required employers include birth control coverage in their health insurance plans. “Donald Trump wants businesses and corporations to control family planning decisions rather than a woman in consultation with her doctor. These anti-women's health regulations prove once again that the Trump administration is willing to trample on people’s rights,” Becerra said in a statement. (Manchester, 10/6)

San Francisco Chronicle: California Sues Over Trump Administration’s Rollback Of Birth Control Mandate
The lawsuit claims the rule change is unconstitutional because it specifically targets and harms women — thus denying their Fifth Amendment rights to equal protection under the law — and allows employers to use their religious beliefs to discriminate against employees. The suit also accuses the Trump administration of violating a federal law that requires regulatory changes to go through a public comment period before taking effect. It seeks an injunction to stop the policy change from taking effect. (Ho, 10/6)

Boston Globe: Maura Healey To Sue Trump Over Birth Control Regulation
Massachusetts dove headfirst into another legal confrontation with the Trump administration Friday, as Attorney General Maura Healey sued the federal government over newly issued rules giving employers the right to deny women birth control coverage by claiming religious or moral objections. (Ebbert, 10/6)

The Oregonian: Will Oregon Women Still Get No-Cost Birth Control After Trump Rollback? 
For Oregon women, the change comes just months after House Bill 3391 went into effect. That bill, also called the Reproductive Health Equity Act, requires all insurance plans to cover no-cost birth control beginning Jan. 1, 2019. Will that mean possible a year gap in coverage for Oregon women in 2018? Jake Sunderland, spokesperson Oregon Department of Consumer and Business Services, Oregon's largest consumer protection and business regulatory agency, said they are still trying to figure that out. (Acker, 10/6)

Dallas Morning News: Texas Lawmakers, Businesses React To Rollback Of Obamacare Birth Control Mandate
Experts don’t anticipate a plethora of North Texas companies will drop contraceptive coverage from their offerings in the short or long term, however. “There’s a real business reason to offering coverage for abortion and contraceptives,” said Marianne Fazen, executive director of the Dallas-Fort Worth Business Group on Health. For one, few companies would take the route Hobby Lobby chose, publicly taking a controversial position that draws unwanted attention to their organizations. But more important, large employers benefit from coming up with the most competitive packages they can offer. (Rice and Kelly, 10/7)

Detroit Free Press: Battle Renewed Between Birth Control Coverage And Religious Freedom
The Trump administration put in place a new rule Friday that allows employers to deny insurance coverage of birth control under the Affordable Care Act if that employer has a religious or moral objection to providing that coverage. The new U.S. Department of Health and Human Services rule, which takes effect immediately, lifts a requirement under ACA that employers provide free birth control coverage, and pits employers' religious freedom and morality against women's reproductive rights for a second time in three years. (Shamus, 10/7)

Health Law

Trump's Proposed 'Association Plans' Popular With Conservatives, But Insurers Aren't Fans

The White House plans to issue executive orders to promote selling insurance across state lines and "association health plans," which would allow small employers to band together to offer coverage that wouldn’t be subject to the full range of ACA requirements. But some insurers fear that associations would peel off healthier and younger individuals and leave traditional insurance plans to cover sicker and older customers.

The Associated Press: White House Plans Order To Expand Health Care Options
The White House is finalizing an executive order that would expand health plans offered by associations to allow individuals to pool together and buy insurance outside their states, a unilateral move that follows failed efforts by Congress to overhaul the health care system. President Donald Trump has long asserted that selling insurance across state lines would trigger competition that brings down premiums for people buying their own policies. Experts say that's not guaranteed, partly because health insurance reflects local medical costs, which vary widely around the country. (Thomas and Alonso-Zaldivar, 10/9)

The Wall Street Journal: Trump To Sign Order Easing Health Plan Rules, Official Says
Mr. Trump will order three agencies, the departments of Health and Human Services, Labor and Treasury, to take steps to make it easier for people to band together and buy insurance through “association health plans,” the official said. Such plans would in some ways be like large employer’s health plans, subject to some restrictions set by the Affordable Care Act, including a ban on lifetime limits. But they would be free of other regulations, including the requirement that insurance plans cover a set package of benefits. These plans are popular with conservatives; some insurers fear that associations would peel off healthier and younger individuals and leave traditional insurance plans to cover sicker and older customers. (Radnofsky, Armour and Mathews, 10/7)

The Wall Street Journal: Trump Executive Order Could Divide The Health Insurance Market
Together, if executed in an expansive way, Mr. Trump’s changes could “cause a bifurcation of the market,” said Cori Uccello, senior health fellow at the American Academy of Actuaries. Insurers that offer plans under the ACA could face new difficulties, but companies also might find opportunities in offering new types of insurance. Mr. Trump’s order, described by a senior administration official, will include broad instructions for federal agencies to loosen rules on health plans that the administration says have driven up premiums and reduced insurance offerings available to people who buy coverage on their own or who work for a small employer. (Radnofsky, Mathews and Armour, 10/8)

Trump Reaches Out To Dems On Health Care, But Schumer Makes Clear Repeal Is Off Table

"If he wants to work together to improve the existing health care system, we Democrats are open to his suggestions," Senate Minority Leader Chuck Schumer (D-N.Y.) says. "A good place to start might be the Alexander-Murray negotiations that would stabilize the system and lower costs.”

The New York Times: Schumer Says He Rebuffed Another Offer From Trump On Health Care
President Trump reached out to the Senate Democratic leader, Chuck Schumer, on Friday to propose yet another effort to repeal and replace the Affordable Care Act, but Mr. Schumer later said he had quickly shot down the offer. Mr. Trump’s phone call, which he announced in a tweet on Saturday morning, was his latest overture to Democrats, after reaching a bipartisan spending deal and forging an unexpected, if tentative, alliance on immigration with Mr. Schumer and the House Democratic leader, Nancy Pelosi. (Landler, 10/7)

The Associated Press: Trump Reaches Out To Democrats In Bid For 'Great' Health Law
Trying to revive health care talks, President Donald Trump said Saturday that he had spoken to the Senate's Democratic leader to gauge whether the minority party was interested in helping pass "great" health legislation. The answer back: Democrats are willing to hear his ideas, but scrapping the Obama health law is a nonstarter. (Thomas, 10/7)

Politico: Trump Vents To Wealthy Donors About Failure To Repeal Obamacare
Trump, appearing at the Greensboro home of Republican Party donor Louis DeJoy, did not pinpoint any lawmakers for criticism, as he has done previously with Arizona Sen. John McCain and Kentucky Sen. Rand Paul, both of whom have balked at getting behind the specific repeal efforts. Trump also chose not to attack Senate Majority Leader Mitch McConnell, another past target of his frustration, the two attendees said. (Isenstadt, 10/8)

Politico: Democrats Accuse Trump Of ‘Sabotage’ On Obamacare Sign-Ups
Obamacare's first open enrollment season under the Trump administration is expected to be a flop — and even the law's most ardent supporters are worried there's little they can do to change that. With less than a month before sign-up begins, the federal government has gutted outreach and marketing, slashed funding to outside enrollment groups and left state officials in the dark on key details. (Demko and Cancryn, 10/6)

The Hill: Critics See Trump Sabotage On ObamaCare
The administration has cut funding for advertising and outreach by 90 percent, raising the odds that fewer people will join the health-care exchanges during the fall enrollment period. It has slashed funds by 41 percent for outside groups that help reach and enroll likely ObamaCare consumers. (Sullivan and Roubein, 10/7)

The Hill: GOP Senator: ObamaCare Repeal 'Alive And Well' 
Sen. Ron Johnson (R-Wis.) on Sunday pushed back on the thinking that the GOP's effort to repeal and replace ObamaCare collapsed. "Just ran out of time," Johnson said on CNN's "State of the Union." "I wouldn't say collapsed, I think it's still alive and well ... We need more time." Republicans have long been pushing to repeal and replace ObamaCare, but multiple efforts stalled in the Senate due to a lack of GOP support. (Savransky, 10/8)

Red And Blue States Alike Frustrated That Crucial Health Programs Are Languishing In Washington

Everything from the funding of community clinics and CHIP to the uncertainty in the ACA marketplaces is worrying state officials.

Los Angeles Times: Even Red States Feel Left In The Lurch By The Trump Administration's Management Of Healthcare
As it works to roll back the Affordable Care Act, the Trump administration is letting crucial state health initiatives languish, frustrating a growing number of state leaders, including several from solidly Republican states. Last week, Oklahoma’s health secretary sent a blistering letter to senior administration officials, taking them to task for failing to approve a plan state officials drew up to protect their consumers from large rate hikes. (Levey, 10/6)

The Associated Press: Oklahoma Health Officials Warn Of Dire Budget Consequences
For 66-year-old Richard Boston, an Army veteran who has been disabled for more than 20 years, Oklahoma's Advantage program is a lifeline that allows him to continue living in his modest home in southwest Oklahoma City. The state-funded program provides volunteers who do light housework and run errands. It also gives out medical equipment like a lift chair that allows him to get in and out of the bathtub despite his bad knees and back, the result of a disabling fall he suffered during his career as a truck driver. (10/5)

Washington Examiner: States Plead For Federal Flexibility On Health Spending
In a strongly worded letter to the Trump administration, Oklahoma's health commissioner recently expressed frustration that a state waiver to lower costs for Obamacare customers had not been approved as quickly as federal officials had promised. The proposal called for a reinsurance program in which government funding pays for costly medical claims while keeping prices down for other customers. (Leonard, 10/9)

And in marketplace news —

Nashville Tennessean: Open Enrollment 2018: How To Prepare
Consider this your official notice – open enrollment is less than one month away. Beginning Nov. 1, individual health insurance consumers will be able to compare and select 2018 health coverage. That might seem far away now, but don’t procrastinate this year. Open enrollment will be shorter this year than ever before. You have just 45 days to sign up for 2018 coverage. The final deadline is Dec. 15. In years past, open enrollment has extended through January, so be aware that this will not be the case this year. You will have just six weeks to sign up once open enrollment begins, and Healthcare.gov will also be down for maintenance every Sunday morning, with the exception of Dec. 10. (Tolbert, 10/8)

Kaiser Health News: Overlooked By ACA: Many People Paying Full Price For Insurance ‘Getting Slammed'
Paul Melquist of St. Paul, Minn., has a message for the people who wrote the Affordable Care Act: “Quit wrecking my health care. ”Teri Goodrich, of Raleigh, N.C., has the same complaint. “We’re getting slammed. We didn’t budget for this,” she said. Millions of people have gained health insurance because of the federal health law. Millions more have seen their existing coverage improved. (Rovner, 10/9)

Medicaid

After Congress' Repeal Failure, States Become Battleground In Fight Over Medicaid

Changes made in the states -- such as adding work requirements -- could reshape how people think about the program.

The Wall Street Journal: Health-Care Standoff In Washington Raises Stakes Of State-Level Fights
The collapse of the Republican effort to overhaul the health-care system and the resulting standoff in Washington has pushed the fight to the states, where a brewing conflict over Medicaid is shaping up as the next battleground. The Trump administration is expected to rule soon on Kentucky’s push to impose work requirements and other rules on Medicaid enrollees, as other states line up to follow suit. Democrats say that would weaken the program. (Armour, 10/7)

Columbus Dispatch: GOP Fight Means 3 Million Ohioans Could Lose Medicaid Next Spring
Republican state lawmakers’ unhappiness with Ohio’s Medicaid expansion is setting up a high-stakes showdown that could — just could — end all Medicaid funding by May 2018. That worst-case scenario would translate into a $1 billion-a-year cut in health-care services used by more than 3 million lower-income Ohioans ranging from nursing home residents to pregnant women to those fighting drug addiction. (Rowland and Siegel, 10/6)

The Hill: Puerto Rico Faces Looming Medicaid Crisis
Puerto Rico is facing an imminent Medicaid funding crisis, putting nearly one million people at risk of losing their health-care coverage. Even before Hurricane Maria caused major damage to the island’s struggling health-care system, the U.S. territory’s Medicaid program barely had enough money left to last through the next year. (Weixel, 10/7)

Kaiser Health News: Patients, Health Insurers Challenge Iowa’s Privatized Medicaid
Iowa is one of 38 states that radically changed the way it runs Medicaid over the past few years. The state moved about 600,000 people on the government-run health program into care that is managed by for-profit insurance companies. The idea is that the private companies would save the state money, but it has been a rocky transition in Iowa, especially for people like Neal Siegel. (Masters, 10/9)

Medicare

Some Physicians Who Were Initially Skeptical Of Bundled-Payment Program Coming Around

Administrators and physicians say they're impressed with how the programs have engaged physicians to produce lower costs and better outcomes.

Modern Healthcare: Bundled-Payment Joint Replacement Programs Winning Over Surgeons
[S]ome experts fear HHS' recent decision to shrink the CJR program to 34 from 67 markets and shelve plans for two mandatory bundled-payment programs for cardiac care may slow such collaborations. They say the financial rewards to physicians for reducing costs and improving quality for entire episodes of care—which can amount to a 50% bonus in the BPCI program—are strong motivators to get them engaged. They hope that HHS and the CMS at least maintain and expand voluntary bundled-payment initiatives. (Meyer, 10/7)

In related news —

Modern Healthcare: Plan​ To​ Scrap​ Bundled​ Payments​ Will​ Get​ Industry​ Scrutiny
Beyond loosening requirements for physicians to contend with the Medicare Access and CHIP Reauthorization Act, CMS officials are looking to free hospitals and doctors from bundled-payment initiatives. The agency in August proposed canceling mandatory bundled-payment initiatives for heart attacks, bypass surgeries and hip and femur fractures that were set to begin in January. Industry groups will be busy this week putting the final touches on comments to the agency, which are due Oct. 16. ... While industry groups have generally opposed the mandatory nature of these programs, there wasn't unanimous support for axing them entirely when the proposed rule was issued. (Weinstock, 10/7)

Pharmaceuticals

Drugmakers On Edge As California Governor Expected To Sign Bill To Curb Prices

For pharmaceutical companies, California is seen as a bellwether state that often sets the pace and tone for other legislative efforts around the country.

Stat: California Governor Will Sign Drug Pricing Bill That Infuriates Pharma Industry
In a blow to the pharmaceutical industry, California Gov. Jerry Brown is expected on Monday to sign a bill that would require drug makers to explain and justify price hikes, making this the latest state to actively address the high cost of medicines. The bill, which has been vociferously fought by the pharmaceutical industry, is set to become one of the more comprehensive state efforts to address pricing transparency. (Silverman, 10/8)

San Jose Mercury News: Gov. Brown To Sign Drug Pricing Transparency Bill
What is believed to be the nation’s most comprehensive legislation aimed at shining a light on prescription drug pricing is expected to be signed into law Monday morning by Gov. Jerry Brown, according to an advisory issued by his office Sunday. ...Senate Bill 17 aims to make drug prices for both public and private health plans more transparent in California. (Seipel, 10/8)

Sacramento Bee: California State Senator Ed Hernandez Helped Drug Companies
Hernandez is the author of heavily lobbied drug-price transparency legislation, Senate Bill 17, that’s currently sitting on Gov. Jerry Brown’s desk. ... Between 2011 and this June, Hernandez, who chairs the Senate Health Committee, accepted at least $207,411 from drug-makers and their interests, including $11,200 from Pfizer. Mylan Laboratories PAC wrote him a $1,500 check in 2008, state records show. (Cadelago and Miller, 10/6)

In other news —

Washington Post/Stateline: Pressure Mounts To Lift FDA Restrictions On Off-Label Drugs
When the Food and Drug Administration gives its okay for a new drug to be sold, it specifies the diseases or conditions for which the medicine has been approved. That does not mean doctors can’t prescribe that drug for other ailments. They do. All the time. And it’s perfectly legal. But for decades drugmakers have been barred from promoting their drugs for uses that hadn’t gone through clinical trials. Worried about safety issues, the FDA has prosecuted numerous drugmakers for illegal promotion of off-label uses and extracted billions of dollars in fines and settlements. (Ollove, 10/8)

Women’s Health

U.S. One Of Only Seven Countries That Allows Elective Abortions After 20 Weeks

The Washington Post fact-checks this particular talking point and finds it passes the Pinocchio test.

The Washington Post: Is The United States One Of Seven Countries That ‘Allow Elective Abortions After 20 Weeks Of Pregnancy?’
There are 59 countries that allow abortion “without restriction as to reason,” or “elective,” or “abortion on demand.” These are countries where the letter of the federal law does not impose specific eligibility requirements for women. The other 139 countries “require some reason to obtain an abortion, ranging from most restrictive (to save the life of the mother or completely prohibited) to least restrictive (socioeconomic grounds) with various reasons in between (e.g., physical health, mental health),” the report says. Only seven of the 59 countries allow elective abortions after 20 weeks, the group found: Canada, China, Netherlands, North Korea, Singapore, the United States and Vietnam. (Lee, 10/9)

In other news on abortion —

The Associated Press: Oklahoma Judge Again Overturns Medical Abortion Restriction
An Oklahoma judge has again overturned a state law restricting women's access to drug-induced abortions, according to attorneys for the state and for the groups challenging the law. Oklahoma County District Judge Patricia Parrish on Friday overturned a 2014 state law that banned "off-label" use of medication used for abortions. (10/7)

Public Health And Education

Frequency Of Gun Shot Wounds In America Provide 'Ideal Trauma Training' For Military Surgeons

The training programs “reflect the reality that you have 34,000 to 35,000 people who die of a gunshot a year, and also two to three times that many who are injured,” said Sandro Galea, dean of Boston University’s School of Public Health.

The Wall Street Journal: Training Ground For Military Trauma Experts: U.S. Gun Violence
As he raced to triage victims of the Las Vegas shooting on the night of Oct. 1, Brandon Snook encountered many familiar wounds. He had seen them in the bodies of U.S. soldiers evacuated from battle in Fallujah, Iraq. Dr. Snook, a surgeon and colonel in the Air Force, is one of several military personnel who pitched in to treat shooting victims at University Medical Center of Southern Nevada. The nearby Nellis Air Force Base supplies the hospital with doctors and nurses aiming to maintain their battlefield skills when they are stateside, where gun violence in some cities provides a steady supply of horrific wounds. (Whalen, 10/9)

KQED: Talking To Kids About Violence: Experts Weigh In
Sticking to the facts—mass public shootings in the U.S. are still quite rare—and answering kids’ questions in words they can understand is a good strategy for caregivers to help children cope with news of tragedies and avoid becoming unnecessarily fearful, according to psychologists. (Romero, 10/6)

How Cracking The Code Behind The Body's Internal Clock Could Help Prevent Poor Health

Scientists are working to understand how the body's clock affects disease, heart attacks, obesity and more health problems. In other public health news: breast cancer, health care marketing, flu shots, heart disease, and more.

The Washington Post: Time Sleuths Think Our Body Clock Could Help Crack The Code About Chronic Disease
Commute. Work. Commute. Sleep. Commute. Work. Commute. Sleep. If you think your daily grind’s killing you, you may be right, according to an article by Leslie Kaufman in the September/­October issue of Popular Science. Kaufman examines the work of chronobiologists — scientists who add the element of time to their research on topics such as the neurons that help awaken the human brain and the metabolic processes that occur after a midnight snack. (Blakemore, 10/8)

The New York Times: Researchers Predict A Quarter-Million New Cases Of Breast Cancer In The U.S.
Breast cancer is the most common cancer in American women except for skin cancers. Researchers at the American Cancer Society estimate that there will be 252,710 new cases of invasive breast cancer in women in the United States in 2017. Some 40,610 women will die from the disease. In addition, there will be 63,410 cases this year of carcinoma in situ, abnormal cells that may be an early form of cancer. (Bakalar, 10/6)

NPR: Positive Hospital Marketing Campaigns Have A Painful Downside
Lori Wallace is sitting on a couch with her 11-year-old son and his new pet snake. It's burrowing under his armpit, as if it were afraid. But Wallace says it's not. "If he was terrified, he would be balled up," Wallace says. "See, that is why they are called ball pythons. When they are scared, they turn into a little ball. "Wallace is dying of breast cancer, but a stranger couldn't tell. (Harnett, 10/8)

The New York Times: Is There Any Reason Not To Get A Flu Shot?
Health officials urge all Americans 6 months and older to get an annual flu shot — except for those who have ever had a severe or life-threatening allergic reaction to an influenza vaccine or vaccine component. Individuals who have had severe allergic reactions to a flu vaccine “should not get the vaccine again,” said Dr. Lisa Grohskopf, a medical officer with the Centers for Disease Control and Prevention. (Rabin, 10/6)

The Washington Post: Heart Problems Can Harm Even Dedicated Exercisers
Jason Lathrop was training for a solo backpacking trip in 2015 when he started to feel a creaking sensation in his knees during morning runs near his home in Portland, Ore. Expecting to learn that he’d torn his meniscus or strained a ligament, he went to his doctor, who told him his knees were just fine. Instead, he learned, he had a heart murmur. Six weeks later, the 43-year-old father of two was undergoing open-heart surgery to repair a faulty mitral valve. (Sohn, 10/7)

Reuters: Older Adults May Confide Suicidal Thoughts Especially If They Have Chronic Health Problems Or Depression
More than 1 in 5 older adults who commit suicide disclose their intention to kill themselves before taking their own lives, a study suggests. Overall, 23 percent of suicide victims age 50 or older shared suicidal thoughts with another person in the month before their death, the study found. Disclosure rates were higher among the elderly and more common when people had chronic health problems or suffered from depression. (Rapaport, 10/7)

Dallas Morning News: Mental Health Support Can Help Students Making Tough Transition To College
On Twitter, hundreds of thousands of people are #TalkingAboutIt. The popular hashtag is all over the social media platform, denoting tweets on experiences and concerns about mental health conditions. Its goal is to demystify mental illness, promote open conversation and encourage people to seek support. But for many, it can be hard to have those same conversations offline. People often find it tough to communicate what they’re going through or to get the help they need. Similarly,  it can be difficult for people to figure out the best way to support loved ones. (Salazar, 10/7)

States Experiment With New Approaches To Try To Combat The Opioid Crisis

Health and law enforcement officials in Connecticut, Massachusetts, Maryland, Virginia and Ohio continue to try new approaches in order to tackle the drug epidemic.

The CT Mirror: A ‘Glimmer Of Hope’ Seen On Opioids
Opioid overdoses killed so many people in the past year that Connecticut’s forensic examiners ran out of cooler space for the bodies. And yet professionals at the front lines of the crisis reported on a few reasons for hope: Doctors are prescribing fewer painkillers, while local law enforcement possesses more tools to reverse overdoses and lock up drug dealers who enabled them. (Peak, 10/8)

The Baltimore Sun: Anne Arundel Opens The Doors Of Fire, Police Stations To Heroin Addicts Seeking Help 
When Anne Arundel County announced a program to open police and fire stations to people seeking treatment for drug addiction, expectations were low that many people would actually come. ...To date, more than 200 people have come to fire and police stations in the county seeking heroin treatment. About 60 percent have entered 28-day inpatient treatment programs in then county. Five percent went to outpatient treatment and 9 percent went to mental health treatment. Even those who have come from outside Anne Arundel have found help: Crisis counselors placed about half of out-of-county cases into treatment facilities as well. (Wood, 10/9)

State Watch

State Highlights: Calif. Officials Scramble To Get Ahead Of Hep A Outbreak; Nursing Home Connected With Irma Deaths Shuts Down

Media outlets report on news from California, Florida, Kansas, Maryland, Massachusetts, Wisconsin and Pennsylvania.

Los Angeles Times: How San Diego's Hepatitis A Outbreak Became The Worst The U.S. Has Seen In Decades
Experts say San Diego took all the right steps in addressing what is now one of the largest hepatitis A outbreaks the country has seen in decades, but variables unique to the city’s situation contributed to the outbreak. At least 481 people have been infected and 17 have died of the infection since November in San Diego. Another 88 cases have been identified in Santa Cruz and Los Angeles counties, where hepatitis A outbreaks have been declared. (Schroeder, 10/8)

The Hill: Nursing Home Where 12 Died After Irma Shuts Down 
The Florida nursing home where 12 elderly residents died in the aftermath of Hurricane Irma has shut down and laid off its staff. The Rehabilitation Center at Hollywood Hills, Fla. laid off 245 employees and notified the state of the layoffs on Sept. 20, the Sun Sentinel reported Friday. (Thomsen, 10/7)

The Associated Press: Maryland Health Officials Held In Contempt To Appeal
Several Maryland health department officials will appeal a Baltimore judge’s decision to hold them in contempt of court in a lawsuit over a shortage of hospital beds for mentally ill defendants. A spokeswoman for the Maryland Attorney General’s Office told The Baltimore Sun on Friday that the decision was made this week but the appeal hasn’t been filed. (10/7)

Boston Globe: State Seeks To Reassure Adult Day Health Centers
MassHealth, which covers the state’s poor and elderly residents, proposed new rules several weeks ago in an effort to tighten oversight and ensure “program integrity.” But the proposal caused a backlash in the adult day health industry, where executives said the rewritten rules would have eliminated nursing care and supervision for people who had nowhere else to turn. (Dayal McCluskey, 10/8)

Los Angeles Times: Hacking Your Health At The New Bulletproof Labs In Santa Monica
The first thing Dave Asprey will tell you about his newly opened Bulletproof Labs in Santa Monica is that it’s not a gym. Rather, he says, it’s the world’s first “human upgrade” facility dedicated exclusively to biohacking, or tweaking your biology for better performance. At first glance, the light-filled space adjacent to his Bulletproof Coffee café on Main Street certainly looks like a gym, with personal trainers standing by and gleaming equipment lined up. (Fulmer, 10/6)

The Philadelphia Inquirer/Philly.com: Uncertainty For 120,000 Ends As Independence Reaches Deal With Tower Health
The 120,000 Independence Blue Cross members in the Philadelphia area who faced potential loss of access to several community hospitals — Brandywine, Chestnut Hill, Jennersville Regional, Phoenixville, and Pottstown Memorial — can rest easy. Independence and Tower Health have reached a three-year deal to keep the five hospitals “in-network” for Independence members, the two organizations said Friday. Reading Hospital also will remain in-network; it could have fallen out in November. (Fernandez, 10/6)

Editorials And Opinions

Perspectives On New Contraception Rule: End To Obamacare's Coercion; Road To More Unwanted Pregnancies

The Obama administration's decisions about how to handle insurance coverage of contraception was controversial, and the rollback announced by the Trump administration is also sparking debate.

The Wall Street Journal: A Nun’s Right To Choose
The Trump Administration on Friday eased Obama Care’s contraception mandate, the now infamous regulation that coerced Americans (even Catholic nuns) to pay for forms of birth control that violate their religious beliefs. This is welcome news for American tolerance and pluralism, not a scene from “The Handmaid’s Tale.” (10/8)

The New York Times: Mr. Trump’s Attack On Birth Control
Under the guise of protecting religious freedom and moral sensibilities, the Trump administration is making it harder for women to get access to birth control. On Friday, it rolled back an Obama-era rule requiring most employers to provide their employees with birth control coverage without co-payments. The mandate, established under the Affordable Care Act, has helped millions of women avoid unwanted pregnancy by eliminating out-of-pockets costs for contraception. (10/6)

The Washington Post: Does The Trump Administration Want More Unintended Pregnancies?
The Trump administration on Friday tore a big hole in an important public-health law, eroding the federal requirement that health insurance plans cover contraception. ... the Trump administration decided that the federal government’s interest in ensuring women access to birth control is not very important, and therefore surrendered to the objectors. Universities, charities and small businesses will now be able to ignore the contraception mandate without doing anything but informing their employees that they will get no birth control coverage. They could allow the government to independently arrange contraception coverage for their employees — or forbid such a workaround. (10/7)

The New York Times: Trump Takes Away Fundamental Health Care For Women
The average American woman spends just three years pregnant or trying to become pregnant, and a full 30 years trying not to be pregnant. So it’s no surprise that birth control is a standard part of most women’s lives. In fact, roughly nine out of 10 women will use birth control during their lifetime. On Friday, the Trump administration revealed its disdain for women when it removed the guarantee that health insurance will cover their birth control. (Raegan McDonald-Mosley, 10/6)

The New York Times: Out Of Control On Contraception
This week in the world of Washington and sex: The House of Representatives passed a bill banning late-term abortions. One of the co-sponsors announced he was resigning from office after word came out that he had urged his lover to have an abortion. The anti-abortion Trump administration announced it was going to let employers off the hook if they didn’t want to cover contraception in their employee health programs. Is anything wrong with this picture? (Gail Collins, 10/6)

Bloomberg: Trump's Harmful And Unwanted Rule On Contraceptives
Better access to contraception under Obamacare has measurably improved women's health, finances and lives. The Trump administration's move to reverse these gains is wrong. ... One more thing. This abrupt and destructive new policy is not what Americans want. More than two-thirds -- including a majority of Republicans -- say they favor the requirement that employers cover the full cost of birth control. (10/7)

Different Takes On The Health Law: Trump's Determination; Undermining Cost Cutting

Opinion writers take a look at a variety of benefits and problems they see in the health law.

The Washington Post: Congress Quietly Puts A Crucial Part Of Obamacare On The Chopping Block
The Obamacare debate has been out of whack from the start. Republicans have criticized the wrong things, allowing Democrats to ignore the Affordable Care Act’s biggest flaws. Now, this off-kilter debate may lead to the quiet loss of one of the law’s most important provisions, currently on Congress’s chopping block. ... A bipartisan bill ending the [Independent Payment Advisory Board] passed the House Ways and Means Committee last Wednesday. Republicans, who claim they want to reduce wasteful government spending, should stop trying to repeal this important piece of Obamacare. So should Democrats. (10/8)

The Washington Post: Support For Medicaid In Virginia Keeps Growing
Despite years of Republican efforts in Washington to repeal the Affordable Care Act, support in Virginia for Medicaid expansion remains as strong as ever. A new University of Mary Washington survey of 1,000 adult Virginians found that 70 percent favor increasing access to Medicaid, an important but optional part of the Affordable Care Act, with only 25 percent opposed. A year ago, 68 percent said they wanted Virginia to expand this public health-insurance program for low-income, uninsured state residents. (Stephen J. Farnsworth, 10/6)

The Detroit News: Take Honest Look At Medicaid Costs
As a numbers guy, Gov. Rick Snyder can surely see the rising costs of the state’s Medicaid expansion. The governor has defended the Healthy Michigan program as a model for other states, but now the program expansion across the country has prompted questions from a Republican U.S. senator. ... In his letter to Snyder, [Sen. Ron] Johnson wrote: “I am seeking to better understand these rising costs and higher-than-expected enrollment, especially in states where costs are increasing especially quickly. Has Michigan taken any steps to control these costs and, if so, what are those steps?” Johnson is right to ask these questions, and we join him in awaiting the state’s response. (10/7)

And on the issue of Medicare for all —

The New York Times: A Health Care Plan That’s Universal And Bipartisan
After the collapse of Republican efforts at one-party health care reform, many Democrats have embraced Senator Bernie Sanders’s Medicare for All proposal. Few liberals would object to this “single payer” plan if it could be enacted with a magic wand, but the political realities of getting it through Congress are daunting. (Ed Dolan, 10/9)

San Jose Mercury News: Does The Gig Economy Mean It’s Time For Medicare-For-All?
For decades, millions of Americans have received insurance through a patchwork quilt of employer-based insurance and government programs to cover vulnerable populations. With the rise of the gig-economy, the quilt is unravelling, presenting an opportunity to fix our country’s flawed healthcare system. ... If we were to shift to a system where the government was the primary insurer, we could help employees and businesses more freely make decisions about what is best for their careers, families, and growth. People would be able to move jobs easily, innovate and build their own business, or work in the growing class of gig-economy jobs without the fear of bankruptcy from medical costs. (Charlie Simmons, 10/7)

NJ.com: Trial Of Menendez And The Medicare-Milking Doctor Shows Flaws Of Single-Payer System
I don't know how the federal corruption trial of U.S. Sen. Bob Menendez will turn out, but after following the case for almost four years I do know this: Medicare is guilty. Guilty of not having a "gate-keeper" that is. In health-care parlance, a gate-keeper is an administrator who decides whether a certain drug or treatment should be funded. ... But without such monitoring we see the sort of thing that was exposed last week at the trial in Newark of Menendez and his co-defendant, Florida eye doctor Salomon Melgen. (Paul Mulshine, 10/8)

Viewpoints: Stopping Gun Violence; Helping Patients Once They Leave The Hospital

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

Modern Healthcare: Bad Advice For Chaotic Times
These all-too-frequent outbursts of individual insanity-for some reason these attacks with automatic rifles are never called an act of terror-continue to be our No. 1 public health crisis. Tens of thousands of innocent people-the wounded, family members, neighbors, friends-will suffer a lifetime of physical and emotional scars because of these senseless acts of slaughter. Yet our elected leaders can't summon up the courage to do something about it. The National Rifle Association's chokehold on American politics appears resistant to even the most repugnant reality. (Merrill Goozner, 10/7)

Modern Healthcare: It's Time To Take Action And End The Gun Violence Epidemic
One of our country's longest-running and most inadequately addressed health challenges reared its ugly head last week in Las Vegas. The gun violence epidemic that kills over 33,000 people each year produced the largest outbreak in modern history in last week's mass slaughter, leaving 58 dead and nearly 500 injured. This epidemic is growing. In the past 477 days, there have been 521 mass shootings. But those numbers are just the tip of the iceberg. On an average day, 91 people are killed with a firearm, seven of them children, with another 200 injured. Many of these tragedies are preventable. The most important question now: When are we going to act to stop this epidemic? (Georges Benjamin, 10/7)

Modern Healthcare: Guest Commentary: UMC CEO VanHouweling On Community-Wide Teamwork Amid Tragedy In Las Vegas
In the wake of the deadliest mass shooting in modern American history, Las Vegas continues to mourn and the wounded continue to heal as our community demonstrates an unparalleled level of unity in the face of an unspeakable tragedy. As our team at University Medical Center continues to treat victims of this horrific shooting, we find strength in the tremendous outpouring of local and national support for our patients and their families. (Mason VanHouweling, 10/5)

San Francisco Chronicle: Helping Patients Lead Normal Lives Almost As Important As Fighting Disease
Life for patients extends beyond the sterile corridors of the hospital, and careful consideration of these factors and potential solutions — including consolidating treatments, coordinating appointments with other providers, and providing resources for patients and families, both medical and financial — can make all the difference in the world. It’s time to look beyond the conventional understanding of what it means to treat, be treated, and establish patient-centered policies. (Jacquelyn Corley, 10/6)

Omaha World-Herald: State Must Continue Improving Its Medicaid System
It’s vital that the state manage these millions of Medicaid claims in a timely and efficient manner so that needed services are rendered and providers are compensated. Nebraska has about 228,000 Medicaid recipients. At the start of the year, Nebraska launched a new system, called Heritage Health, for handling most Medicaid accounts. ... The arrangement so far has brought important positives, with better coordinated care and additional services, but also troubling negatives in some cases. At public hearings, some providers and clients have vented their frustration, describing failure to be paid, long lag times and other problems. (10/9)