KHN Morning Briefing

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Two can play at that
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Well-known Trump tactic.

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Summaries Of The News:

Administration News

Price Promises Not To 'Pull The Rug Out' From Under Americans, But Offers Few Details On Replacement

At a four-hour hearing, Donald Trump's nominee for HHS secretary backed away from the incoming president's promises of insurance for everyone, but set lofty goals for his own replacement plans.

The New York Times: Choice For Health Secretary Is Vague On Replacing Affordable Care Act
Representative Tom Price, the man President-elect Donald J. Trump has chosen to lead the Department of Health and Human Services, promised on Wednesday to make sure people do not “fall through the cracks” if the Affordable Care Act is repealed, and set a goal to increase the number of people with health insurance But at a hearing before the Senate Health, Education, Labor and Pensions Committee, Mr. Price provided only vague reassurance to members of both parties who pressed him for specific policies. (Pear and Kaplan, 1/18)

The Associated Press: Price Tries To Reassure On Health Care; Dems Not Buying It
Rep. Tom Price, R-Ga., told the Senate Health, Education, Labor and Pensions Committee that Trump is "absolutely not" planning to launch an overhaul of Medicare as he tries to revamp coverage under President Barack Obama's signature health care law. He acknowledged that high prescription drug costs are a problem, but did not endorse the idea of government directly negotiating prices. (Alonso-Zaldivar and Fram, 1/18)

The Washington Post: HHS Nominee Price Pressed Hard On Health Policy Positions, Financial Dealings
Price began by laying out central elements of his years-long attempt to replace the Affordable Care Act. In doing so, he signaled ways in which Trump’s more populist message could collide with the core beliefs of congressional Republicans. He told senators that “it is absolutely imperative” for the government to ensure that all Americans “have the opportunity to gain access” to insurance coverage — a more modest goal than the “insurance for everybody” declaration that the incoming president made this past weekend. (Eilperin and Goldstein, 1/18)

Los Angeles Times: Trump's Pick For Health Secretary Tells Senators He Will Protect The Vulnerable, But Doesn't Say How
During a testy four-hour hearing on Capitol Hill — which also featured several heated exchanges about Price’s ethics — Price also repeatedly dodged questions from Democrats seeking assurance that he would preserve basic protections required by law. Among other things, Obamacare bans lifetime limits on coverage, requires that health plans offer basic benefits such as substance abuse treatment and mandates that plans allow parents to keep their children on their insurance until they are 26. (Levey, 1/18)

Modern Healthcare: Price Promises Access, But Not Insurance For Everyone 
Republicans referenced the replacement plan Trump alluded to over the weekend but offered no new details, and some in the party reportedly are not sure Trump's plan actually exists. Price said he shared Trump's goal of coverage for everyone and believed the Republicans' plan would accomplish that. But he emphasized the importance of access to coverage and the financial feasibility to buy it, dodging a question from Sen. Bernie Sanders (I-Vt.) about whether healthcare is a right. (Muchmore, 1/18)

The Wall Street Journal: Key Republicans At Tom Price Hearing Still Wary On Health Law Repeal
A hearing on President-elect Donald Trump’s choice for health secretary became an arena Wednesday for key Republicans to stress their opposition to overturning the current health law without a clear replacement. ... Mr. Alexander, who chairs the Senate Health, Education, Labor and Pensions Committee, warned that the fragile insurance market in his state means he cannot support anything that would trigger further disruption. He finished on a similar note, telling Mr. Price he was confident he had secured his agreement. (Armour and Radnofsky, 1/18)

The Hill: Five Takeaways From Price's Confirmation Hearing
Price kept his cards close to his chest, parrying questions from Democrats by speaking in broad terms about wanting to provide access to healthcare coverage while providing few details. Here are five takeaways from the hearing. (Sullivan and Hellmann, 1/18)

The Fiscal Times: Tom Price Makes A Big Claim: People Won’t Get Shafted On Health Care
Questioned by Sen. Bernie Sanders (I-VT) about Trump’s intentions to keep his campaign promises to safeguard Medicare, Medicaid and Social Security, Price said that while he hasn’t had extensive discussions with Trump about those comments, “I have no reason to believe that he has changed his position.” “So you are telling us that to the best of your knowledge, Mr. Trump will not cut Social Security, Medicare and Medicaid,” Sanders persisted. “As I say, I have no reason to believe that position has changed,” Price replied. (Pianin, 1/18)

Stat: Tom Price Sidesteps Question On Medicare Drug-Pricing Negotiations
Congressman Tom Price, the Republican nominated by Trump to lead HHS, was asked by Democratic lawmakers whether he would agree to support empowering Medicare to negotiate prices with drug companies. After initially sidestepping those questions, he seemed to suggest that the policy would at least be considered, given Trump’s outspoken support for it, but he expressed no enthusiasm for the proposal. (Scott, 1/18)

Democrats Put Pressure On Price Over Stocks, Nominee Says It Was All 'Above Board'

At the Senate HELP Committee hearing on the nominee for HHS secretary, a main focus of the questioning centered around Rep. Tom Price's stocks in health care related companies.

The Washington Post: Trump Cabinet Nominees Meet Growing Ethical Questions
One factor making it easier for Trump’s nominees to prevail in the GOP-controlled Senate is a 2013 rule change — ironically, one that was engineered over Republican objections by the Democrats who were then in the majority. It ended the ability of senators to filibuster Cabinet nominees, which means that nominees can be confirmed with 51 votes. There are 52 Republicans in the chamber. “What’s different now is that [blocking a nominee] is going to require Republicans to stand up to their own president,” said Jim Manley, a longtime aide to former minority leader Harry M. Reid (D-Nev.). (Tumulty, Wagner and O'Keefe, 1/18)

Bloomberg: Trump’s Health Pick Gets Grilled On Stock Trading, Obamacare 
Price said he learned of the drugmaker from Representative Chris Collins, a Republican who sits on the board of the company, but wasn’t privy to non-public information before purchasing the stock. He said he paid market price for Innate shares in 2015, but may have paid a lower price for three additional purchases. (Edney and Tracer, 1/18)

Politico: Democrats Pummel Price On Stock Trades, Sweetheart Deals
Sen. Elizabeth Warren (D-Mass.) demanded to know whether Price had actively tried to "help the company that you now own stock in." It was one of the only moments in the nearly four-hour grilling by the Senate HELP Committee when Price flashed anger. "I'm offended by the insinuation, senator," he responded. (Diamond, 1/18)

USA Today: Price, HHS Nominee, Says Trump Doesn't Want To 'Pull The Rug Out On Anyone'
Price and his longtime friend, Senate Ethics Chairman Johnny Isakson, R-Ga., defended Price's purchases. Price said his broker bought shares in one medical device company without his knowledge and others were part of mutual fund or pension plan purchases that are made on behalf of many members. Sen. Christopher Murphy, D-Conn., raised the issue of Price's stock purchases in six companies that would have been hurt by a Centers for Medicare and Medicaid Services pilot project that Price led opposition to in the House. More ominously, Murray peppered Price for details on his purchase of stock in the company Innate Immunotherapeutics after discussing the company with Trump transition official Rep. Chris Collins, R-N.Y., a large shareholder who sits on the company's board. Price acknowledged he directed his broker to make the purchases. Murray pointed out that was soon before Senate action on the 21st Century Cures Act, which benefited drug companies. (O'Donnell, 1/18)

On the other side of the hearing bench —

Health Law

With Dreams Of Fewer Restrictions, GOP Governors Now Interested In Federal Medicaid Money

The governors who decided not to expand under the health law, now see an opportunity in the form of block grants. Meanwhile, governors who did expand will also be giving their two cents to the Finance Committee on Thursday at a round table on the future of health care coverage.

The Wall Street Journal: Republican Governors Warn Lawmakers About Repeal Of Obamacare
As U.S. Congress moves ahead with repealing the Affordable Care Act, some Republican governors are reaching out to lawmakers and urging caution. In recent comments and letters to Republican House leaders who sought input from state officials on potential health-system changes, several governors have voiced concerns about the effects of abruptly scrapping the 2010 law. At least nine governors and two lieutenant governors have signed up for a Thursday round table held by Senate Finance Committee Republicans on the future of the health law’s Medicaid expansion. (Levitz and Kamp, 1/19)

Detroit News: Snyder Vouching For Medicaid Expansion Plan In D.C.
Gov. Rick Snyder is expected to vouch for the state’s Healthy Michigan plan Thursday in Washington D.C., where he’ll join a Senate committee roundtable discussion on the future of the larger Medicaid health care program for low-income and other vulnerable residents. The Republican governor is a vocal proponent of Michigan’s unique form of expanded Medicaid eligibility funded through the Affordable Care Act. (Oosting, 1/18)

MLive: Snyder Hints He'll Fight To Keep Medicaid Expansion As Feds Consider ACA Repeal
Gov. Rick Snyder fought to expand Medicaid in Michigan under the Affordable Care Act when some Republicans at the state level were opposed to it. Now, it's Republicans at the federal level he might find himself on the opposite side of. ... Michigan's Healthy Michigan plan, which Snyder signed into law in 2013, covers 638,845 people, according to statistics maintained by the Michigan Department of Health and Human Services. Snyder said in his speech that Michigan's Medicaid expansion had reduced uncompensated care by an average of 44 percent. (Lawler, 1/18)

USA Today: Cuomo Warns Trump On Obamacare Cuts
Gov. Andrew Cuomo warned President-elect Donald Trump on Wednesday of a "dramatic impact" on New Yorkers if Trump moves ahead with a repeal and replace of the Affordable Care Act. The meeting at Trump Tower was the first face-to-face sit down between the two New Yorkers, who are both Queens natives, since Trump was elected. (Spector, 1/18)

And in other news —

Lawrence (Kan.) Journal-World: Medicaid Expansion Bill Introduced In Kansas House
A bill to expand the state Medicaid program has been introduced in the Kansas House, but lawmakers may have to rush in order to pass it before the Republican-controlled Congress repeals the federal Affordable Care Act that makes the expansion possible. In fact, while supporters believe the idea has more than enough support to pass the 125-seat Kansas House, all of whose members were just elected in November, the state's entire delegation in the U.S. House is on record supporting repeal of the federal law, even though they were all re-elected on the same ballot. (Hancock, 1/18)

Lincoln (Neb.) Journal Star: Morfeld Proposes Medicaid Expansion
Sen. Adam Morfeld of Lincoln on Tuesday introduced legislation to expand Medicaid coverage in Nebraska, suggesting it as a means of transitioning into a forthcoming Republican health care plan. "LB441 allows us to bring home $775 million (in federal funds) paid in part by hard-working Nebraska taxpayers to reduce health care costs, improve efficiency in our Medicaid system and make sure the workers who are the backbone of our state's economy are as healthy and productive as they can be," Morfeld said. (Walton, 1/17)

After Capitalizing On Antipathy Against Health Law, E&C Chairman Now Focusing On 'Repair And Rebuild'

Rep. Greg Walden, R-Ore., has taken over the Energy and Commerce Committee, a role in which he'll be required to steer Republicans' efforts to replace the health law. Meanwhile, incoming Vice President Mike Pence says Donald Trump is getting "very close" to a health care plan, and Republicans look to avoid any YouTube moments that could undermine their messaging for replacement.

CNN: Mike Pence: Trump 'Getting Very Close' To Obamacare Replacement
Vice President-elect Mike Pence said Wednesday that Republicans do not yet have a bill to replace Obamacare, but that he has "seen a lot of great ideas" and that transition officials and GOP leaders are "getting very close" to having a replacement. "It's being crafted right now," Pence said Wednesday in an interview with CNN's Dana Bash, when asked about a replacement to the President's signature health care law. "We're getting very close. We expect to have that plan come forward in the early days of the administration." Pence's comments came after Trump said in an interview Saturday with The Washington Post that his health care replacement plan "is very much formulated down to the final strokes." (Diamond, 1/18)

The Washington Post: Republicans Look To Avoid YouTube Moments In Fight Over Obamacare Repeal
Seven years after unruly Democratic town halls helped stoke public outrage over the Affordable Care Act, Republicans now appear keen to avoid the kind of dustups capable of racking up millions of views on YouTube and ending up in a 2018 campaign commercial. One week after the Republican Congress kicked off the process of repealing the landmark health-care legislation, only a handful of GOP lawmakers have held or are currently planning to host in-person town hall meetings open to all comers — the sort of large-scale events that helped feed the original Obamacare backlash in the summer of 2009. (DeBonis, 1/19)

On the public opinion front —

The Associated Press: AP-NORC Poll: Americans Of All Stripes Say Fix Health Care
Sylvia Douglas twice voted for President Barack Obama and last year cast a ballot for Democrat Hillary Clinton. But when it comes to "Obamacare," she now sounds like President-elect Donald Trump. This makes her chuckle amid the serious choices she faces every month between groceries, electricity and paying a health insurance bill that has jumped by nearly $400. "It's a universal thing, nobody likes it," Douglas, a licensed practical nurse in Huntsville, Alabama, said of Obama's signature law. (Kellman and Swanson, 1/18)

The Hill: GOP Rep Faces Testy Crowd At Constituent Meeting Over ObamaCare 
Rep. Kevin Brady (R-Texas) on Tuesday had contentious exchanges with some constituents during a local meeting about the GOP plan to repeal and replace ObamaCare. Dozens showed up to a meeting with Brady, the chairman of the House Ways and Means Committee, meant as a chance for "local people affected by ObamaCare" to "share their experiences with rising costs and loss of coverage and choice," the Houston Chronicle reported. (Savransky, 1/18)

Houston Chronicle: Woodlands Crowd Grills Brady Over ACA Repeal
U.S. Rep. Kevin Brady, R-The Woodlands, faced a skeptical and at times testy crowd Tuesday as dozens of people arrived at an afternoon meeting to make sure he knew they would not let the Affordable Care Act end without a fight. The hourlong session, tucked away in a back meeting room at The Woodlands Area Chamber of Commerce headquarters, was not publicly announced and was billed by Brady's staff as a chance for "local people affected by ObamaCare" to "share their experiences with rising costs and loss of coverage and choice." ... But if he was expecting a completely friendly, like-minded group, he quickly found something else from many in the 50 or so who crowded the room. (Deam, 1/18)

And in other health law news —

The Washington Post: Can Donald Trump And The Republicans Repeal Obamacare? Here’s What Hundreds Of Forecasters Predict.
No item on Donald Trump’s agenda seems to have received as much publicity as his desire to repeal the Affordable Care Act and replace it with “something terrific.” Since his election, the prospects for repeal have taken many a twist and turn. Two weeks ago, repeal suddenly appeared doubtful — as key Senate Republicans balked at the idea of repeal without a full-fledged replacement. (Sides, 1/19)

Kaiser Health News: One Foot Out The Door, Medicare Chief Launches His Own Twitter Barrage
Government bureaucrats are not often Twitter celebrities. But Andy Slavitt, current head of the agency that runs Medicare and Medicaid, is making a name for himself with a barrage of fiery Tweets in defense of the Affordable Care Act, breaking with the traditionally mute posture taken by federal employees. As the Act — known as Obamacare — is coming under attack by the new Republican-controlled Congress and incoming Trump administration, Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, isn’t being shy online. (Bluth, 1/19)

Denver Post: Colorado Hospitals Could Close If Obamacare Is Repealed And Not Replaced, Execs Say 
Hospitals across the state could be forced to cut back services or even close if the Affordable Care Act is repealed without an adequate replacement, several health care executives in Colorado warned on Wednesday. A hospital in the San Luis Valley, for instance, may not be able to maintain a level of care that means patients currently don’t have to leave the valley for chemotherapy or to have surgery on broken bones, its CEO said. A hospital in Delta County — already with a profit margin only in the low single digits — could see its revenue dip dangerously close to the red, its CEO said. (Ingold, 1/18)

PBS NewsHour: Reassessing The Value Of Care For Chronic Health Conditions 
Surgeon Atul Gawande says we need to reconsider health care’s focus on generously rewarding physicians who practice heroic interventions, rather than those who practice incremental medicine for chronic conditions. Gawande talks with William Brangham about the value of that kind of care, and the potential effects of a Republican repeal of the Affordable Care Act. (Brangham, 1/18)

The Baltimore Sun: Evergreen Health Finalizes Deal With Investors, Severs Ties With Federal Co-Op Program 
Evergreen Health, an innovative Baltimore-based health insurer, took a big step toward assuring its future by finalizing a deal to repay part of a federal startup loan and sever ties with the Affordable Care Act program under which it was founded. The deal with federal health regulators, made possible by an influx of cash from unnamed investors, allows Evergreen to move forward with plans to seek state approval to convert to a for-profit insurer. (Gantz, 1/18)

California Healthline: Foul-Up Means Thousands On State Exchange Surprised By Higher Premiums
Thousands of Covered California enrollees face higher-than-expected bills from their insurers because the exchange sent incorrect tax credit information to the health plans. The exchange confirmed it gave insurers wrong subsidy information for about 25,000 policy holders, resulting in inaccurate bills. Insurers are now sending out new bills correcting the errors, and in most cases that means higher premiums than consumers had initially anticipated. (Bazar, 1/18)

California Healthline: California’s Community Clinics, Big ACA Beneficiaries, Worry About Their Future
Paula Wilson has seen some tough times in her 23 years as the CEO of Valley Community Healthcare, a clinic that provides care for the poor in North Hollywood, Calif. But nothing was quite like November 9, the day after the U.S. elections, when walking around the office “was like coming into a funeral,” she said. Her staff worried that a repeal of the Affordable Care Act, long promised by Republicans, would obliterate their jobs. Patients fretted it would jeopardize their care. (Brown, 1/19)

Enrollment Numbers Still Tracking Higher Than Last Year's Despite Uncertainty

The current open enrollment period ends on Jan. 31, 2017.

CQ Roll Call: HealthCare.Gov Enrollment Tops 8.8 Million
More than 8.8 million Americans signed up for 2017 insurance coverage through as of Jan. 14, 2017, about 100,000 more than over a similar time frame last year. The enrollment snapshot provided Wednesday by the Centers for Medicare and Medicaid Services is the final one of President Barack Obama’s administration. The numbers do not include people in the 12 state-based marketplaces that use their own websites. About 2.8 million people in these states were enrolled as of Dec. 24. (Willilams, 1/18)

The Baltimore Sun: Health Exchange On Pace To Meet, Exceed Enrollment This Year
With less than two weeks left to sign up for insurance under the Affordable Care Act, advocates and officials launched their last push to draw Maryland residents. The effort announced Wednesday involves enrolling people through churches and other faith-based groups, a campaign called "Extol & Enroll." "It is important to us that our people have adequate health care and are living healthy lives," said the Rev. Cleveland Mason, president of the United Baptist Missionary Convention of Maryland. He spoke during a news conference Wednesday that drew lawmakers, advocates from the Healthcare for All! Coalition and the NAACP, and officials from the state health exchange, the online market created to enroll people who do not get health insurance through work. (Cohn, 1/18)


Medicare Releases Details From Review Of Advantage Plan Directories' Accuracy

The Centers for Medicare & Medicaid Services, which earlier had given a summary that showed overall problems, provides names of companies that fared badly in the survey and other details.

PBS NewsHour: Care Provider Directories Wrong Nearly Half The Time In Medicare Advantage Plan Lists
As Congress continues to move toward repealing part or even all of Obamacare, it’s not surprising that other health care news has fallen off our radar. Last week, however, the Centers for Medicare & Medicaid Services, the agency that oversees Medicare, released some very upsetting results of a study that reviewed the accuracy of the directories of health care providers in the networks used by Medicare Advantage plans. (Moeller, 1/18)

Kaiser Health News: 21 Medicare Health Plans Warned To Fix Provider Directory Errors
Federal officials this month warned 21 Medicare Advantage insurers with high rates of errors in their online network directories that they could face heavy fines or have to stop enrolling people if the problems are not fixed by Feb. 6. Among the plans that were cited are Blue Cross Blue Shield of Michigan, Highmark of Pennsylvania, SCAN Health Plan of California as well as some regional plans owned by national carriers such as UnitedHealthcare and Humana. (Galewitz and Jaffe, 1/18)

Modern Healthcare: CMS Announces New Participants For Alternative Payment Models In 2017 
The CMS expects 359,000 clinicians to participate in four alternative payment models this year, the agency said Wednesday, touting those numbers as evidence of success in shifting away from fee-for-service and into value-based care. Those alternative payment models include accountable care organizations—the Medicare Shared Savings Program, the Next Generation ACO Model and the Comprehensive End-Stage Renal Disease Care Model—and the Comprehensive Primary Care Plus Model. (Whitman, 1/18)

Health Policy Research

Obama Administration Releases Final Rule Relaxing Patient Consent Requirements For Research

The revised regulation lifts a proposal that would have required scientists to get written consent before using patient samples, DNA or other “biospecimens” obtained during medical procedures.

Stat: New Rules Ease Consent Requirements For Scientists Using Patient Specimens
With only two days left in office, the Obama administration on Wednesday issued new rules intended to protect people who participate in scientific research, stepping back from proposals that would have imposed significant new regulatory requirements on scientists. In particular, the administration abandoned a proposal that would have required researchers to obtain written consent before using cells, blood, tumor samples, DNA, or other “biospecimens” obtained during medical procedures, even when the samples were stripped of the person’s name and other identifying information, or obtained from earlier studies the person had participated in. That was intended to prevent outrages such as the unauthorized use of cancer cells from patients like Henrietta Lacks, the African-American tobacco farmer whose tissue was taken in the 1950s without her permission or even her (or her family’s) knowledge. (Begley, 1/18)

Modern Healthcare: Patient Advocacy Groups Worry About Lax Consent Requirements In Common Rule 
Patient privacy advocates are not pleased with the Obama administration's decision to release a final rule that lifts a burden on scientists working with human subjects. The revised Common Rule, as it's known, dials back a proposal requiring researchers to get written consent from patients before using any biospecimens obtained during medical procedures. The HHS issued the proposal in 2015. The draft drew more than 2,100 comments, mostly negative. (Conn, 1/18)

CQ HealthBeat: HHS Releases Final Update To Medical Research Rule
The Obama administration on Wednesday released a sweeping final rule that will update many long-standing federal protection measures for people who participate in medical research trials. The regulation, known as the Common Rule, has not been revised since 1991. Several contentious provisions were dropped or scaled back from a draft rule released in September 2015, including a measure that was vigorously opposed by academic medical interest groups pertaining to the use of blood, urine and other samples from the human body in research. Lobbyists say the exclusion of the provision will likely reduce any opposition to the rule from congressional leaders who were concerned about the impact it would have on medical research institutions. (Williams, 1/18)

Women’s Health

House Democrats Implore Trump Not To Undermine Women's Health Care

As Congress stands poised to strip away funding for Planned Parenthood and dismantle the health law, thus possibly rolling back protections on women's health care, Democrats warn Donald Trump that the eyes of America's women are watching him.

The Washington Post: House Democrats To Donald Trump: ‘The Women Of America Are Watching’
One day before President-elect Donald Trump’s inauguration, the vast majority of House Democrats are warning him to think twice before supporting and signing Republican laws that they say would undermine women’s health care. A letter set to be delivered to Trump on Thursday urges the soon-to-be president to oppose GOP plans in Congress to repeal the Affordable Care Act — which includes measures to prohibit discriminatory insurer practices and expand access to breast-cancer screenings and birth control — and to strip Planned Parenthood of federal funding. It is signed by 173 of 194 House Democrats. (DeBonis, 1/19)

In other news, states are exploring the idea of cost-free vasectomies —

The Associated Press: Insurance Equality? States Push For Cost-Free Vasectomies
Vasectomies, which are not covered under President Barack Obama's health care law, are increasingly being included in state measures that would require insurers to provide cost-free coverage of birth control. Backers of laws and proposals in such states as Illinois, Vermont, Maryland and most recently New York say that if women can get tubal ligations with no out-of-pocket costs, men should be able to get their surgical sterilization covered cost-free as well. (1/18)

Health IT

Startup Starts From Scratch To Revolutionize Primary Care

Forward looks to offer patients a high-tech, personalized health care service for a monthly membership fee.

The Associated Press: New Prescription: Doctor Offices That Look Like Apple Stores
After a relative suffered a heart attack a few years ago, Silicon Valley entrepreneur Adrian Aoun got an unsettling look at a health-care system that he diagnosed as an inefficient and outdated mess. Now he believes he has a remedy. It's called Forward, a health-management service that charges a $149 per month — roughly $1,800 a year — to tend to all of its patients' primary-care needs. And not just with attentive doctoring, either; Forward plans to deploy body scanners, sensors, giant touch-screen monitors, infrared devices and other high-tech gizmos that could make a doctor's appointment feel more like a trip to an Apple store. (Liedtke, 1/17)

Bloomberg: This Startup Is Making The Doctor’s Office Of The Future 
Most health-care startups try to fix things by spreading software across the analog parts of the medical industry. For Forward, founder Adrian Aoun is ditching that approach in favor of engineering a doctor's office from scratch. Forward doesn't replace your health insurance. Instead, members pay a steep $149 per month to have unlimited access to Forward's primary care services and its first office—a gleaming lobby in San Francisco's Financial District full of body scanners and infrared vein finders. Forward hopes that by making it easier and more pleasant to see a doctor, patients will do it more often—and catch expensive health issues like cancer and heart disease earlier. (Huet, 1/18)


In Ironic Tale, Martin Shkreli Helps Feds Collar Drugmaker For Monopolizing Market

Mallinckrodt will have to pay a $100 million fine to settle antitrust allegations. Stat looks at Martin Shkreli's role in the investigation.

Stat: Drug Maker Pays Antitrust Fine Thanks, In Part, To Shkreli
Martin Shkreli, the pharma bad boy who was vilified for price gouging, apparently alerted the feds to another drug maker that was monopolizing the market for a vital medicine and continually raising its price to sky-high levels. And that other drug maker, Mallinckrodt, has now agreed to pay $100 million to settle antitrust allegations brought by the US Federal Trade Commission. (Silverman, 1/18)

And in other pharmaceutical news —

Stat: FDA Memo Rebuffs Ideas For Expanding Off-Label Marketing
After weeks of anticipation, the FDA has issued a lengthy memo about the extent to which so-called off-label information about medicines may be disseminated to physicians, one of the most contentious issues to roil both the agency and the pharmaceutical industry. But rather than spell out possible solutions to this particularly thorny topic, the 63-page missive essentially summarized key points framing the long-running debate and carefully rebuffed many of the suggestions made by drug makers and others that support expanding pharmaceutical marketing. Meanwhile, the agency continues to seek comments while working to develop a final guidance. (Silverman, 1/18)

Boston Globe: Merrimack Pharmaceuticals Names New Chief Executive 
Cambridge biotech Merrimack Pharmaceuticals Inc. has named Richard Peters as its chief executive, filling a role that’s been vacant since the October resignation of Robert Mulroy. Merrimack board chairman Gary Crocker has been serving as interim chief executive. The appointment of Peters, a veteran health care and biopharma executive who most recently has been senior vice president and head of global rare diseases at Sanofi Genzyme in Cambridge, will take effect Feb. 6. (Weisman, 1/18)

Public Health And Education

Prompted By Recent Failures, New $500M Initiative To Target Epidemics Before They Spiral Out Of Control

The partnership's goal is to get ahead of epidemics instead of always just reacting after they've already begun to spread.

The Washington Post: New Global Coalition Launched To Create Vaccines, Prevent Epidemics
The partnership will be called the Coalition for Epidemic Preparedness Innovations, or CEPI. It grew out of the lessons from the world’s woeful lack of preparedness for the 2014 Ebola epidemic in West Africa, which killed more than 11,000 people and caused at least $2.2 billion in economic losses in the three hardest-hit countries. As a result of that and the current Zika epidemic in the Americas, a global consensus has steadily grown among an array of governments, public health leaders, scientists and vaccine industry executives that a new system is needed to guard against future health threats. (Sun, 1/18)

The Wall Street Journal: New Initiative Aims To Develop Epidemic-Targeting Vaccines
“Ebola showed how unclear it was who should step up and how and when,” said Bill Gates, co-chair of the Bill & Melinda Gates Foundation, which is contributing $100 million for the first five years. Other funders are the Wellcome Trust, with $100 million, as well as the governments of Norway, Japan and Germany. India and the European Commission are also planning donations. (McKay, 1/18)

DEA Falls Short In Answering Opioid Enforcement Questions, Senators Say

A Washington Post report shows that beginning in 2013, DEA lawyers at headquarters started to delay and block enforcement efforts against large opioid distributors and others, requiring investigators in the field to meet a higher burden of proof before they could take action. In other news, a Stat reporter goes behind the scenes at a DEA drug lab, an opioid maker settles a lawsuit over aggressive marketing and the medical license of a doctor known as the "Candy Man" is permanently suspended.

Stat: Inside A DEA Drug Lab, A Race To Identify Dangerous New Opioids
At the lab, run by the Drug Enforcement Agency, chemists are analyzing these drugs and trying to identify them. More and more, they’re discovering new, deadlier varieties of opioids concocted overseas and sold on the street in the US. As the chemical compositions of these drugs are manipulated, they can become far more powerful. Fentanyl, a common synthetic opioid, is up to 100 times more potent than morphine and many times that of heroin. (Hogan, 1/19)

New Hampshire Union Leader: Opioid Maker Settles Lawsuit Over Fentanyl Spray 
Insys Therapeutics Inc. of Chandler, Ariz., will pay the state $2.9 million to settle allegations that it aggressively marketed its opioid Subsys, a fentanyl spray approved for cancer patients, to New Hampshire residents. Additionally, it will pay $500,000 to the New Hampshire Charitable Foundation to be used for preventing and remediating problems related to abuse, misuse or misprescribing of opioid drugs in the state. The settlement comes as New Hampshire struggles with the highest per-capita fentanyl death rate in the country. As of Dec. 12, 2016, 369 people died from drug overdoses and 269 of them, or 72 percent, involved fentanyl. (Grossmith, 1/18)

Reveal: Wisconsin Doctor Known As “Candy Man” Stripped Of Medical License 
The former chief of staff of the Tomah Veterans Affairs Medical Center has agreed to permanently surrender his license to practice medicine in Wisconsin, closing a two-year investigation into his narcotic prescription practices. The VA had already fired David Houlihan, after he was exposed as the “Candy Man” in a January 2015 investigation from Reveal from The Center for Investigative Reporting. We reported that veterans treated at the Tomah VA showed up to appointments stoned on painkillers and muscle relaxants, dozed off and drooled during therapy sessions, and burned themselves with cigarettes. (Glantz, 1/18)

Health Officials Raise Red Flags About Spread Of Antibiotic-Resistant Tuberculosis

The strain of the bacteria is primarily transmitted by an infected person. Today's other public health stories report on toxic lead levels, duplicative cancer studies and the U.S. obesity epidemic.

Stat: Spread Of Highly Drug-Resistant Tuberculosis Sparks Concerns
A new study reveals that strains of tuberculosis that evade most of the drugs typically used to treat the bacterial infection have been spreading in South Africa, which already has a high rate of tuberculosis infection. Extensively drug-resistant tuberculosis — known by the short form XDR TB — is highly concerning to health authorities because of the way tuberculosis spreads. Infected people expel bacteria from their lungs when they cough, sneeze, even speak. The bacteria can float for hours under the right conditions, infecting people who breathe them in. (Branswell, 1/18)

Stat: EPA Pick Is Unclear About Toxic Lead Levels. So Are Scientists
Scott Pruitt, the Oklahoma attorney general picked by President-elect Donald Trump to lead the Environmental Protection Agency, immediately drew blowback during his confirmation hearing on Wednesday for saying that he “hasn’t looked into the scientific research” on precisely how much lead exposure is unsafe for children. Critics slammed Pruitt’s response as an uninformed and dangerously naive perspective on a critical environmental health issue. But, in fact, Pruitt’s not alone in his uncertainty on this question. There’s an ongoing debate among scientists and regulators about how much lead is too much for kids to have in their bodies. (Robbins, 1/18)

NPR: Scientists Troubled: 'Identical' Cancer Studies Produce Different Results
The first results from a major project to measure the reliability of cancer research have highlighted a big problem: Labs trying to repeat published experiments often can't. That's not to say that the original studies are wrong. But the results of a review published Thursday, in the open-access journal eLife, are a sobering reminder that science often fails at one of its most basic requirements — an experiment in one lab ought to be reproducible in another one. (Harris, 1/18)

State Watch

State Highlights: One-Third Of Colo. Hospitals Opting Out Of Aid-In-Dying Law; Calif.'s Bold Stem Cell Initiative Has Fallen Flat

Outlets report on health news from Colorado, California, Virginia, Massachusetts, Minnesota, Kansas, Missouri, Connecticut, Michigan, Maryland, Ohio and Arizona.

Stat: Catholic Hospitals Are Opting Out Of Colorado's Aid-In-Dying Law
Nearly one-third of Colorado’s hospitals are refusing to offer terminally ill patients the option of physician-assisted suicide — even though voters last fall overwhelmingly approved a ballot initiative legalizing the practice. And two of the state’s biggest health care systems, both faith-based, appear poised to bar their doctors from providing such services to patients at any of their facilities, under any circumstances — potentially running afoul of the new aid-in-dying law. (Graham, 1/19)

Stat: California Stem Cell Agency Has Funded Just A Trickle Of Clinical Trials
It’s been more than a decade since California launched an unprecedented experiment in medical research by direct democracy, when voters created a $3 billion fund to kick-start the hunt for stem cell therapies. The bold plan, a response to federal funding limits for embryonic stem cell research, was sold with a simple pitch: The money would rapidly yield cures for devastating human diseases such as Parkinson’s and ALS. That hasn’t happened. A major reason, a STAT examination found, is that the California Institute for Regenerative Medicine has been slow to move promising experimental therapies into clinical trials. (Piller, 1/19)

Denver Post: “Common Sense” Proposal Announced To Check Backgrounds Of Colorado Nurses And Doctors 
Supporters pushing a proposal to bring Colorado in line with most other states by requiring fingerprint-based criminal background checks for doctors, nurses and other health-care professionals say such checks are a key component of ensuring public safety...In addition to impacting those seeking a new health-care license, the new system also would send automatic alerts to state health-care licensing boards whenever a licensee is arrested. Those boards would have the power to revoke an existing license based on those alerts if a transgression is identified that’s a revocable offense, such as rapes or violent felonies. (Osher, 1/18)

Richmond Times Dispatch: Hospitals Encourage 'Do No Harm' Approach To COPN Reform In Virginia
Considering the vast uncertainty hovering over the future of health care at the federal level, Virginia’s hospitals are asking the state’s lawmakers to take a “do no harm” stance on state health policies. During a news conference at the General Assembly Building on Wednesday, the Virginia Hospital & Healthcare Association encouraged legislators to restrain themselves during this year’s session, particularly regarding Certificate of Public Need, or COPN, reform. (Demeria, 1/18)

WBUR: Tough Reception For Baker In Bid To Control Health Care Costs 
Many employers, especially those in the health industry, agree that Gov. Charlie Baker has a problem. In the past five years, roughly 500,000 workers and their children who used to be on a company insurance plan have switched to government-funded free or subsidized coverage. That shift is busting the state budget, where almost 40 percent of spending this year will be on MassHealth. (Bebinger, 1/18)

The Star Tribune: Group Seeks New Rules On Use Of 'Granny Cams' In Minnesota Nursing Homes
Families seeking to prevent abuse or neglect of their loved ones in nursing homes by using hidden cameras, or “granny cams,” would face more restrictions under recommendations issued this week by a state work group. The 17-member group was asked to advise the Legislature on ways to regulate the growing use of hidden cameras and other electronic surveillance equipment in senior care facilities, while balancing privacy rights with efforts to deter abuse. (Serres, 1/18)

The CT Mirror: Nonprofits Say Privatizing Social Services Could Save CT $1.3B
Hoping to stave off cuts in the next state budget, nonprofit social service providers said privatizing an array of services for the intellectually disabled and mentally ill could save more than $1.3 billion in total over the next three years. The Connecticut Community Provider Alliance also released an industry poll showing 80 percent of nonprofit agencies anticipate laying off staff if state funding is cut by 10 percent or more. And while some municipal leaders and social services advocates have called for Gov. Dannel P. Malloy and the legislature to consider tax hikes to help close the $1.4 billion hole in the coming fiscal year, the alliance stayed out of the tax debate. (Phaneuf, 1/18)

Detroit Free Press: Today Marks 1,000 Days Since Flint Had Clean Drinking Water
One thousand days ago, the city of Flint shut off the tap to the Lake Huron water they had been receiving from the Detroit Water and Sewage Department and began drawing and treating water from the Flint River. That was April 25, 2014. And it was also the beginning of the Flint water crisis, another tragic chapter in the tumultuous history of Michigan's once-thriving industrial center. (Manzullo, 1/19)

The Baltimore Sun: Proposal Would Let Employees Use Tax-Free Health Accounts For Fitness Costs
Known as the PHIT Act, for Personal Health Investment Today, the proposal would enable workers to put up to $2,000 in health savings or flexible spending accounts to use toward fitness club fees, sports equipment, youth sports league fees, event registration costs and other activities. Individual expenses would be capped at $250, with some exceptions, such as for home fitness equipment. (Mirabella, 1/18)

Boston Globe: After Massachusetts Raised Its Cigarette Tax, Smuggling Exploded, Study Finds 
A new study has concluded that nearly 30 percent of all the cigarettes smoked in Massachusetts in 2014 were smuggled into the state, a drastic increase that apparently followed a tax hike on cigarettes. Researchers at the Mackinac Center for Public Policy, a Michigan think tank, found that cigarettes illegally brought into Massachusetts jumped to 29.3 percent of all those smoked in 2014, up from 12 percent in 2013, the seventh-highest rate among states and largest year-over-year increase of any state. They hypothesized that the spike in black market sales resulted from an increase in the state’s tax on cigarettes from $2.51 per pack to $3.51 per pack in 2013. (Adams, 1/18)

Denver Post: Colorado GOP Lawmakers Criticize Suicide-Proofing Bathrooms At Mental Health Hospitals As “Wasteful” Spending 
A request for $235,109 to make nine bathrooms at a state mental-health hospital suicide-proof is prompting outrage from Republican lawmakers who suggest it is evidence of wasteful government spending. The reaction to the proposal in the context of a $28 billion budget illustrates the intensity of the spending battles expected in the 2017 session as Colorado lawmakers negotiate a deal to find more money for big-ticket priorities, such as a potential $500 million bond to improve roads and transit. (Brown, 1/18)

Columbus Dispatch: Flu Widespread Across Ohio
Flu cases are widespread across the state, with hospitalizations for flu-like symptoms almost doubling to 287 during the first week of January, according to the Ohio Department of Health. "Influenza-like illness is now widespread throughout Ohio for the first time this flue season, and the number of associated hospitalizations are rising," the department said in a written statement. (Bush, 1/18)

Cincinnati Enquirer: Department Of Health: Flu Now 'Widespread' In Ohio
The flu now has tackled the Buckeye State, the Ohio Department of Health reported Wednesday in announcing that influenza now is “widespread.” The state said the number of hospitalizations due to flu are rising: On the first week in January, 287 new cases turned up compared to 157 the week before. There have been 654 total flu-associated hospitalizations since flu season began in October. (Saker, 1/18)

Weekend Reading

Longer Looks: Atul Gawande; Replacing The Health Law; And Diagnosing Concussions

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

The New Yorker: The Heroism Of Incremental Care
Following the Second World War, penicillin and then a raft of other antibiotics cured the scourge of bacterial diseases that it had been thought only God could touch. New vaccines routed polio, diphtheria, rubella, and measles. Surgeons opened the heart, transplanted organs, and removed once inoperable tumors. Heart attacks could be stopped; cancers could be cured. A single generation experienced a transformation in the treatment of human illness as no generation had before. It was like discovering that water could put out fire. We built our health-care system, accordingly, to deploy firefighters.... But the model wasn’t quite right. If an illness is a fire, many of them require months or years to extinguish, or can be reduced only to a low-level smolder. The treatments may have side effects and complications that require yet more attention. Chronic illness has become commonplace, and we have been poorly prepared to deal with it. (Atul Gawande, 1/15)

Vox: Here’s How Donald Trump Could Replace Obamacare Without Courting Disaster
Republicans have a problem: The promises they’ve made about what their Obamacare replacement plan will do are impossible to keep. Over the weekend, Donald Trump told the Washington Post that his plan would provide “insurance for everybody” with “much lower deductibles.” Oh, and don’t worry about the cost. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it,” he said. “That’s not going to happen with us.” There is simply no way, within the GOP paradigm of private insurance, lower taxes, and less regulation, to make that work. But perhaps he doesn’t need to. (Ezra Klein, 1/17)

ProPublica: Dysfunction Disorder 
It is impossible to say precisely just how influential mental health assessments are in any individual Family Court case. Family Court proceedings are open to the public, but most case files, judicial decisions and trial transcripts are secret. Even lawyers who say their clients were harmed by decisions made with Montego’s input are reluctant to share details, in large part because of confidentiality rules governing attorney-client relationships, as well as fear of retribution by ACS or Family Court judges. What is indisputable is that Family Court cases are complicated and often life-altering. In the last decade, roughly 450 children have died while their families were known to ACS, many of them under the supervision of Family Court judges reliant to some degree on psychologists like those recruited by Montego. (Joaquin Sapien, 1/17)

WIRED: How A Mere Prick Of The Finger Can Diagnose A Concussion
When your head takes a hit (from an airbag, or a fall, or a 300-pound defensive tackle), your brain is subjected to shear forces that can actually tear it apart from the inside—without any of the structural damage you can see on a CT scan or an MRI. Deep in the brain’s white matter, tissues of different densities pull and strain against each other as they accelerate and decelerate at different speeds. Axons, the long, stretched-out arms of neurons that allow them to talk to each other, get frayed and severed. This is why you might have trouble remembering things or thinking clearly if you get concussed—and why a doctor might ask you to tell them what year it is or who’s the president. (Megan Molteni, 1/17)

The Atlantic: Tragedy Would Unfold If Trump Cancels Bush’s AIDS Program
In 2003, in a move that has been described as his greatest legacy, George W. Bush created a program called PEPFAR—the President's Emergency Plan for AIDS Relief. At the time, more than 20 million people in sub-Saharan Africa were living with AIDS, but only 50,000 had access to antiretroviral drugs that manage the disease and prevent its spread. Now, thanks to PEPFAR, 11.5 million people are on those drugs. For good reason, it has been variously described as a “globally transformative lifeline,” “one of the best government programs in American history,” and something “for all Americans to be proud of.” It seems that some members of President-Elect Trump’s transition team beg to differ. (Ed Yong, 1/17)

The New Yorker: On Health Care, We’ll Have What Congress Is Having
In the fall of 1994, the Clinton Administration’s much debated comprehensive, and complicated, health-insurance bill—known derisively as Hillarycare—died quietly on Capitol Hill. It was a moment that, the Princeton sociologist Paul Starr later argued, would “go down as one of the great lost political opportunities in American history.” But, before the end, talk of another approach kept bubbling up: to allow those Americans who couldn’t get insurance elsewhere to buy a policy that was just as good, and inexpensive, as what members of Congress got. When Senator Edward M. Kennedy, of Massachusetts, said that Americans should get “exactly what we have,” he meant the Federal Employees Health Benefits Program. (Jeffrey Frank, 1/17)

Vox: This Is What Keeps CDC Director Tom Frieden Up At Night
With President-Elect Donald Trump taking office this week, there’s a lot of uncertainty about how the US will handle public health and respond to potential future pandemics.There’s also uncertainty about what will happen to the CDC budget and vaccine coverage rates under a president who spreads vaccine conspiracy theories. And [agency director Tom] Frieden’s own future is currently in limbo, as he submitted his resignation as director on January 20. But when we met Frieden at the CDC offices in Washington, DC, last week, he was optimistic. (Julia Belluz, 1/17)

Editorials And Opinions

Perspectives On Trump And Health Care: Price's Surprises At Hearing; Echoes Of Bernie

As the new president's inauguration nears, opinion writers look at how his health plans are shaping up and the Senate confirmation hearing for Rep. Tom Price, who was named by President-elect Donald Trump to head the Department of Health and Human Services.

Huffington Post: Trump Health Pick Says It’s ‘Imperative’ People Get To Keep Obamacare Coverage
Rep. Tom Price (R-Ga.), President-elect Donald Trump’s choice to run the Department of Health and Human Services, just put down some potentially important markers on health care policy. During a Senate hearing Wednesday, Price said is “absolutely imperative” that people with insurance get to keep their coverage even if Republicans repeal Obamacare. Price also said that, as far as he knows, Trump continues to oppose cuts in Medicare and Medicaid. Making sure nobody loses coverage and maintaining existing funding for Medicaid isn’t consistent with what Republicans, including Price, have said or endorsed in the past. (Jeffrey Young and Jonathan Cohn, 1/18)

The Washington Post: Gauzy Promises To Replace Obamacare Aren’t Enough
In the first of two hearings on his nomination to head the Department of Health and Human Services, Rep. Tom Price (R-Ga.) on Wednesday asked members of the Senate Health, Education, Labor and Pensions Committee to put him at the center of the Obamacare repeal-and-replace effort. To a nation increasingly nervous about the many dangers of ripping up the health law, Mr. Price offered some big promises — but scant reassurance. (1/18)

Health Affairs: First, Do No Harm: A Physician Secretary Of HHS And The Reach Of Hippocrates
If the U.S. Senate confirms the nomination of Representative Tom Price to serve as the 23rd U.S. Secretary of Health and Human Services (HHS) he will be only the third physician to lead that department since its formation in 1953. ... All Americans — and physicians in particular, myself included — are looking to Rep. Price to work closely with Congress to develop a realistic plan for changing the Affordable Care Act in a way that actually improves the law, without interrupting Americans’ access to health insurance coverage and high-quality care. This will be Secretary-Designee Tom Price’s first, and possibly most important, test. (Louis W. Sullivan, 1/17)

Forbes: Why Trump's 'Everybody' Health Plan Sounds Like Bernie's
Trump also has repeatedly said he wants Medicare to bargain for lower drug prices: "The other thing we have to do is create new bidding procedures for the drug industry, because they’re getting away with murder," Trump said. Does this mean that the GOP's long-sought objective to "repeal and replace" the Affordable Care Act and privatize Medicare will include some mechanism for the government to use its single-payer power to get the lowest-possible drug prices? ... allowing the government to lower drug costs by acting like a Wal-Mart -- the biggest buyer gets the best prices -- makes eminent sense. (John Wasick, 1/18)

The Washington Post: How Republican-Style Health-Care Reform Quickly Becomes A Tax Cut For The Richest Of The Rich
The election of Donald Trump with a Republican-majority Congress is proving once again that conservative economic policy largely reduces to cutting taxes, mostly for the rich. But wait a second, aren’t they also wading into health-care reform? They are, and it proves my point. While much attention is reasonably focused on how they’re all repeal with no replace — and how that’s likely to reverse the coverage gains we’ve seen and undermine insurance markets — there’s something else going on here. And that is — you guessed it — a big tax cut for the rich. (Jared Bernstein, 1/18)

Bloomberg: The Once And Future Obamacare Death Spiral
Last year, premium increases came in much higher than the program’s supporters had hoped or expected. A number of observers, including me, worried that we might be at the tipping point, where higher premiums cause healthier people to drop their insurance. When that happens, the average cost of covering the people who remain goes up, so premiums go up … which means that more people drop their insurance … which ultimately means disaster. (Megan McArdle, 1/18)

Health Affairs: How We Can Repeal The ACA And Still Insure The Uninsured
But even if the ACA stays in place, there will still be almost 30 million people without health insurance and another 20 million or so who all too often face deductibles that are unreasonably high for moderate-income families and provider networks that are much too narrow for people with serious medical problems. ... We believe the health care system is desperately in need of reform. But the focus of that reform should not be the Affordable Care Act. The initial goal should be: making sure everyone has access to health insurance that is affordable and that gives them dependable access to medical care. Further, we believe that goal can be accomplished with money already in the system. We don’t need any new taxes or any new spending programs. (Rep. Pete Sessions, R-Texas, Sen. Bill Cassidy, R-La., and John Goodman, 1/18)

National Review: Obamacare Repeal Must Roll Back The Medicaid Expansion
As leaders working on state-based policy solutions across the country, we have seen the impact of Obamacare on our communities up close. That’s why we’ve produced a report, being released today, on the need to unwind the law’s disastrous expansion of Medicaid. ... many people don’t know that most of Obamacare’s coverage gains have come not through those exchanges, but through its new expansion of Medicaid to able-bodied, working-age adults. (Ellen Weaver and Caleb Crosby, 1/19)

The Washington Post: The GOP Plan To Fund Medicaid Through Block Grants Will Probably Weaken It
But many key Republicans are especially interested in changing Medicaid, the nation’s health insurance program for the poor — including Trump, House Speaker Paul D. Ryan (Wis.) and Tom Price (Ga.), Trump’s nominee to head the Department of Health and Human Services. Each of those three has proposed converting Medicaid from a program funded jointly by the federal government and the states into a block grant program. Doing so would send a set amount of money to each state, thus capping total Medicaid spending, and would let each state decide how to disburse those funds. (Ryan LaRochelle, 1/18)

Health Affairs: Interstate Insurance Sales: Wishful Thinking, Or A Viable Policy Option?
Anyone who followed the recent election cycle knows that President-elect Donald Trump made “repeal and replace” a cornerstone of his campaign — referring, of course, to the Affordable Care Act (ACA). He, like Mitt Romney and John McCain did in their respective bids for the presidency, has proposed permitting insurers to sell insurance plans across state lines as a possible alternative to the ACA, or at least as a component of a potential alternative. In this post, we’ll take a look at the possible advantages of allowing interstate insurance sales, as well as the reasons opponents say such a policy simply won’t work. (John Marchica, 1/18)

Viewpoints: New Threat To Antibiotics; Ryan's Attack On Medicare; Carson's Health Role At HUD

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

The New York Times: How To Avoid A Post-Antibiotic World
On Friday, the Centers for Disease Control and Prevention released a disturbing report about the death of an elderly woman in Washoe County, Nev. What killed her wasn’t heart disease, cancer or pneumonia. What killed her were bacteria that were resistant to every antibiotic doctors could throw at them. (Nicholas Bagley and Kevin Outterson, 1/18

Huffington Post: Paul Ryan Is Lying In Order To Destroy Medicare
Medicare works. It’s far more efficient, cost effective, and affordable than private sector health insurance. Not surprisingly, it’s also a lot more popular. It should be extended to all of us. Instead, House Speaker Paul Ryan is working hard to destroy Medicare and force seniors and people with disabilities into the arms of private, for-profit health insurers. Ryan wants to end Medicare as we know it and, instead, simply give seniors and people with disabilities fixed cash stipends to fend for themselves, unprotected, on the private market. (Nancy Altman, 1/18)

The Philadelphia Inquirer: Carson Can Highlight Links Between Housing And Health Care
There are many good reasons to oppose Carson's nomination to lead HUD. He has questioned the agency's mission and previously devalued his own ability to lead a federal department given his lack of government experience. I certainly have significant doubts about his qualifications. Yet, in nominating such an unlikely candidate, President-elect Donald Trump may have inadvertently made a connection that too few policy makers and physicians recognize: Health and housing are inextricably linked. And our inability to successfully assist individuals who are homeless places a significant strain on our public resources. (Manik Chhabra, 1/19)

Los Angeles Times: Solving The Climate Crisis, One Hospital At A Time
With early optimism surrounding the 2015 Paris agreement on climate change now fading into anxiety over potential changes to U.S. environmental policy under a Trump administration, many are looking for new leaders in the fight against global warming. Hospitals should step into the breach. Doing so could both slow climate change and improve healthcare systems globally. (Renzo R. Guinto, 1/18)

The New England Journal of Medicine: Transparency And Trust — Online Patient Reviews Of Physicians
After years of academic debate over the role and value of patient-satisfaction scores and reviews of health care providers, Yelp, the online powerhouse of documenting customer satisfaction, is forcing the issue. With more than 102 million customer reviews to date, 6% of them in the health care arena, Yelp easily dwarfs longer-standing commercial physician-review sites such as Healthgrades and Vitals. (Vivian Lee, 1/20)

The New England Journal of Medicine: Improve Quality, Control Spending, Maintain Access — Can The Merit-Based Incentive Payment System Deliver?
Medicare is poised to overhaul the way it pays for ambulatory care services. The Centers for Medicare and Medicaid Services (CMS) has published a final rule codifying the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which directed CMS to gradually replace fee-for-service reimbursement with value-based payment approaches. MACRA’s bipartisan passage may position it to play an outsized role in federal efforts to improve health care quality, rein in service volume, and control spending growth while not jeopardizing access to care. Can it deliver on these goals? (Eric C. Schneider and Cornelia J. Hall, 1/18)

The New England Journal of Medicine: New Vaccines Against Epidemic Infectious Diseases
Vaccines can prevent outbreaks of emerging infectious disease from becoming humanitarian crises. The WHO recently deemed 11 pathogens as the most likely to cause severe outbreaks in the near future and will regularly update its list. There are feasible vaccine candidates for some of these diseases. When such candidates exist, timely vaccine development can avert global public health emergencies, contain loss of life, and limit social and economic damage. An efficient global system of vaccine research-and-development preparedness is needed. (John-Arne Røttingen, Dimitrios Gouglas, Mark Feinberg, Stanley Plotkin, Krishnaswamy V. Raghavan, Andrew Witty, Ruxandra Draghia-Akli, Paul Stoffels, and Peter Piot, 1/18)