- Kaiser Health News Original Stories 3
- Texas Clinics Busting Traditional Silos Of Mental And Physical Health Care
- Tennessee-Based Pain Management Group To Close Clinics Amid Financial Turmoil
- Vulnerable Rural Hospitals Face Quandaries Over Questionable Billing Schemes
- Political Cartoon: 'All In This Together?'
- Supreme Court 2
- Three Federal Judges Top Trump's Short List For Supreme Court Nominee With Decision Expected This Week
- Slew Of Abortion Cases Working Way Up To Supreme Court With Possible Petition Coming As Early As This Fall
- Government Policy 1
- Outcry Over Family Separations At Border Puts Agency Into Major PR Spin Control: 'HHS Is Aware Of Every Child'
- Pharmaceuticals 1
- Drug Companies Announce Hefty Price Increases In Move Critics Say Is Tone Deaf In Current Landscape
- Women’s Health 2
- HPV Test More Sensitive To Precancerous Cell Changes Than Widely Used Pap Smear, Study Finds
- Glitches At Embryo Storage Clinics Spark Movement To Increase Oversight Of Facilities
- Opioid Crisis 1
- The 'Opioid War Casualties': Intense Crackdown On Drugs Cuts Off Access To Patients With Chronic Pain
- Public Health And Education 1
- One-Two Punch Of Combining Antibiotics Could Help Combat Ever-Increasing Drug Resistance
- State Watch 1
- State Highlights: States Begin To Relax Regulations Around Telemedicine; Spike In Bacterial Disease In Puerto Rico Following Hurricane 'Extraordinary'
- Editorials And Opinions 3
- Different Takes: Stronger Ruling Than Roe V. Wade Could Save Abortion; Permissive Abortion Laws Must Go
- Perspectives: Make Methadone Clinics Available To Help Break Opioid Addiction, Save Lives From Overdose Deaths
- Viewpoints: The Health Law Is Working, According To Trump's Figures; Why Punish People With Pre-Existing Conditions?
From Kaiser Health News - Latest Stories:
Efforts to provide care that integrates physical and mental health services are spreading, partly because untreated mental health conditions negatively affect physical health and escalate health care costs. (Caroline Covington, 7/5)
The CEO of Comprehensive Pain Specialists was indicted in April. Now the group is closing clinics across several states. (Fred Schulte, 7/3)
Two Missouri hospitals handed over their operations to a private company that has vastly increased the money the hospitals bring in through their laboratories, even though the lab tests are not done on-site. (7/3)
Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'All In This Together?'" by Signe Wilkinson .
Here's today's health policy haiku:
THE OTHER SIDE OF AN EPIDEMIC
Chronic pain patients
Become casualties in
War on opioids.
If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.
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Summaries Of The News:
According to sources, the frontrunners for Justice Anthony Kennedy's spot are: Anthony Brett Kavanaugh of Maryland, of the D.C. Circuit; Raymond Kethledge of Michigan, of the Sixth Circuit; and Amy Coney Barrett of Indiana, of the Seventh Circuit. President Donald Trump and Vice President Mike Pence are reported to have spoken with some of the contenders.
The Wall Street Journal:
Trump Winnows Down Supreme Court Picks, Focusing On Three
President Donald Trump’s search for a Supreme Court justice to succeed Anthony Kennedy is focusing on a trio of federal judges, with a decision expected this week in anticipation of an announcement on Monday, people familiar with the search said. Following a brisk round of interviews Monday and Tuesday, the three front-runners at this late stage in the president’s search are all U.S. appeals court judges: Brett Kavanaugh of Maryland, of the D.C. Circuit; Raymond Kethledge of Michigan, of the Sixth Circuit; and Amy Coney Barrett of Indiana, of the Seventh Circuit. (Nicholas and Radnofsky, 7/4)
Trump Touts Upcoming Supreme Court Pick
President Donald Trump on Tuesday promised that his supporters would love his nominee for the Supreme Court and knocked liberals for calling to abolish U.S. Immigration and Customs Enforcement. “I think you’re going to be very impressed,” Trump said during a dinner for U.S. troops at The Greenbrier resort here. (Restuccia, 7/3)
The Associated Press:
AP Source: Pence Has Met With Supreme Court Contenders
Vice President Mike Pence has met with some of the contenders for the Supreme Court vacancy created by Justice Anthony Kennedy's retirement, The Associated Press has learned. The meetings took place in recent days, according to a person familiar with the search process. The person did not specify which candidates Pence met with and spoke on condition of anonymity Wednesday to describe the private search process. (7/5)
Some of the lawsuits challenge the reasons to allow a woman to get an abortion, while others debate the method a physician could use. And many of them could be turned into a broader discussion about overturning Roe v. Wade. Meanwhile, because of those ramifications, the open Supreme Court seat is ramping up the heat during an already charged midterm season.
New Supreme Court Justice Could Weigh In On Abortion Quickly
President Donald Trump’s pick for the Supreme Court won’t have to wait long to make a potentially historic decision on abortion rights. A slew of abortion-related cases are working their way through lower courts, dealing with questions about when abortions should be allowed, or which procedures doctors can perform to terminate a pregnancy. Any of these could become opportunities for the justices to address fundamental questions about the legal right to abortion in the United States, putting Roe v. Wade in the Supreme Court’s sights. (Haberkorn, 7/3)
Abortion Rights Group Targets Susan Collins In First Supreme Court Ad Buy
An abortion rights group leading the fight on the left against President Trump's next Supreme Court nominee announced its first ad buy Tuesday targeting Sen. Susan Collins (R-Maine), who is expected to be a key vote in the confirmation battle. NARAL Pro-Choice America announced full page print ads and "homepage takeovers" of four Maine newspapers and websites: the Portland Press Herald, Kennebec Journal/Morning Sentinel, Bangor Daily News and Lewiston Sun Journal. The ads begin Wednesday. (Hellmann, 7/3)
The Associated Press:
Court Vacancy Makes Abortion Politics A Midterm Priority
Democrats and Republicans once largely agreed that the upcoming midterm elections would hinge on the economy, health care and President Donald Trump's popularity. Not anymore. A Supreme Court vacancy has pushed abortion to the forefront of election year politics, with both supporters and opponents suggesting that the emotional issue could drive more voters to the polls. That's especially true in states like Iowa, where Republicans have enacted restrictive measures on abortion in the past two years. (Beaumont and Rodriguez, 7/5)
Trump’s Supreme Court Search Unleashes Fierce Politicking
President Donald Trump’s commitment to select from a widely publicized list of Supreme Court candidates may have helped win him the White House — but it has also injected unprecedented politicking into the selection process for the next justice. Much of the jockeying has centered on D.C. Circuit Court Judge Brett Kavanaugh, who is the preferred choice of White House counsel Don McGahn, according to two Republicans close to the White House. McGahn’s backing helped Kavanaugh secure a spot on Trump’s existing Supreme Court list last November, when the president added five names. (Johnson, 7/4)
The Washington Post:
Liberal Democrats Mount Campaign Against Trump’s Supreme Court Nominee By Targeting Two Republican Senators
Liberal political strategists hope to block President Trump’s next Supreme Court nominee by replaying a strategy they used to help defeat the Republican effort to repeal the Affordable Care Act last year. The multimillion-dollar plan of advertising and grass-roots activism will focus heavily on convincing two Republican defenders of the ACA, Sens. Lisa Murkowski (Alaska) and Susan Collins (Maine), to buck the president again by denying his first choice to replace retiring Justice Anthony M. Kennedy. Trump plans to reveal his selection Monday. (Scherer, 7/4)
Mass. Lawmakers Aim To Ensure Abortion Remains Legal Even If US Supreme Court Upends Roe V. Wade
Abortion-rights advocates and Massachusetts legislative leaders are moving to repeal a 19th-century state law that criminalizes abortion, acting out of concern that the US Supreme Court may overturn its Roe v. Wade ruling. ... The bill, formally an act Negating Archaic Statutes Targeting Young Women, would eliminate the state’s unenforced abortion ban, along with other old laws on contraception that have since been invalidated by Supreme Court decisions. (Miller, 7/4)
Despite Republicans' efforts to chip away at the law, experts say, "The market is in a better position now than it has ever been since the exchanges have opened."
The New York Times:
Obamacare Is Proving Hard To Kill
As health insurers across the country begin filing their proposed rates for 2019, one thing is clear: The market created by the Affordable Care Act shows no signs of imminent collapse in spite of the continuing threats by Republicans to destroy it. In fact, while President Trump may insist that the law has been “essentially gutted,” the A.C.A. market appears to be more robust than ever, according to insurance executives and analysts. A few states are likely to see a steep spike in prices next year, but many are reporting much more modest increases. Insurers don’t appear to be abandoning markets altogether. In contrast to last year, regulators are not grappling with the prospect of so-called “bare” counties, where no carrier is willing to sell A.C.A. policies in a given area. (Abelson, 7/3)
In other news on the health law —
Agents And Brokers Flee ACA Exchanges Despite Trump Administration Support
The number of registered brokers and agents who help people sign up for coverage through the federal ACA insurance exchange continued to decline in 2018, despite the CMS' efforts to encourage their participation by making it easier for them to sign up customers during open enrollment. The number of agents and brokers participating in the Affordable Care Act open enrollment for 2018 dropped 24.8% to 49,100 from more than 65,300 during open enrollment for 2017 coverage, according to a CMS report released Monday. Since open enrollment for 2016 coverage, the number of registered agents and brokers has fallen by 38.3%. (Livingston, 7/3)
The Star Tribune:
Subsidies Drive Consumer Decisions On ACA Coverage
As premiums spiked in 2017, the market where people buy their own health insurance saw a significant decline in enrollment among those who don't qualify for federal subsidies. That is the conclusion of a new federal report that finds the number of unsubsidized individual-market enrollees in the U.S. dropped last year by about 1.27 million people, or roughly 20 percent. (Snowbeck, 7/3)
Although HHS didn't write the separation policy, it has become enmeshed in the public relations nightmare for its role of housing the children separated from their parents at the border. Meanwhile, officials try to cut down on lawmakers' unannounced visits to the detention centers.
HHS Enters Damage-Control Mode Over Family Separations
President Trump's “zero tolerance” immigration policy has left the Department of Health and Human Services (HHS) scrambling to contain what’s quickly becoming a public relations nightmare. While HHS didn't write the policy, the agency is responsible for implementing the most controversial aspect: housing the children separated from their parents at the U.S.-Mexico border. (Weixel, 7/3)
HHS Tries To Clamp Down On Unannounced Lawmaker Visits To Child Detention Centers
The Department of Health and Human Services is urging lawmakers to schedule visits to detention centers housing migrant children instead of showing up at the facilities unannounced. In a letter sent Tuesday to Senate Judiciary Committee Chairman Chuck Grassley (R-Iowa) and House Judiciary Committee Chairman Bob Goodlatte (R-Va.), the agency asked the lawmakers to help coordinate congressional visits to HHS-funded detention facilities. (Weixel, 7/3)
In a state that leans Republican, Democrats hope to use the latest efforts to add restrictions to Kentucky's Medicaid program as a rallying point for their congressional candidate, Amy McGrath, who is running against U.S. Rep. Andy Barr. Meanwhile, Kansas Gov. Jeff Colyer says he'll still pursue work requirements even after Kentucky's waiver was blocked by a judge.
The Associated Press:
Medicaid Becomes Latest Sparring Issue In Congressional Race
U.S. Rep. Andy Barr said Tuesday that Kentucky's efforts to put work requirements on many Medicaid recipients would be in their best interests, leading them toward self-sufficiency and away from reliance on the government health insurance program. That stance could elevate health care as a flashpoint in a congressional race that Democrats think gives them their best chance to gain a seat this year in a state that has trended heavily toward Republicans. It puts the GOP incumbent at odds with his opponent in Kentucky's 6th District, Democrat Amy McGrath, who says she values encouraging people to work but cautions that a work requirement shouldn't be used punitively. (Schreiner, 7/3)
The Associated Press:
Judge's Ruling Slows Plans For Medicaid Work Requirement
The Trump administration's drive to wean poor people from government benefits by making them work has been slowed down by a federal judge. U.S. District Judge James E. Boasberg framed a fundamental question: Are poverty programs meant to show tough love or to help the needy? Boasberg last week halted Kentucky's first-in-the-nation experiment with Medicaid work requirements, ruling that the Trump administration glossed over potential coverage losses. (Alonso-Zaldivar, 7/4)
Kentucky Dentists Say Kids Wrongly Denied Care Over Medicaid Cuts
Kentucky Gov. Matt Bevin’s (R) decision to cut Medicaid benefits for thousands of adults in the state has created confusion, in some cases reportedly resulting in dentists wrongly denying care to patients. Dentists told Kentucky’s Courier-Journal that they have had to deny care to some patients, including children, who incorrectly appeared in the state’s computer system as having lost coverage, even though they are supposed to be exempt from the cuts. (Chalfant, 7/4)
Colyer: Kansas Will Pursue Medicaid Work Rules Despite Court Ruling
Kansas Gov. Jeff Colyer says he will continue to push for a Medicaid work requirement despite a recent court order blocking a similar policy in Kentucky. Last week, U.S. District Judge James Boasberg, an Obama appointee in the District of Columbia, questioned whether the Trump administration had adequately considered the consequences of Kentucky’s work requirement before reversing longstanding federal policy to approve it. (McLean, 7/3)
Cleveland Plain Dealer:
Kentucky Ruling On Medicaid Work Requirement Could Stall Ohio's Waiver
"My guess is the administration might pause in approving other waivers, including Ohio's, until the Kentucky decision gets figured out," said Rea Hederman, executive director of the Economic Research Center and vice president of policy at The Buckeye Institute, a right-leaning think tank. "I will be a little surprised if they continue to approve the waivers as they have been."CMS first will likely either appeal the Kentucky ruling or revise its approval of the waiver, he said. (Christ, 7/3)
In other Medicaid news —
The Associated Press:
Governor Says Hospital Tax Could Cover Medicaid Expansion
Maine's Republican governor is publicly laying out a proposed tax hike on hospitals to pay for voter-approved Medicaid expansion. Gov. Paul LePage's office says Medicaid expansion will offset a tax hike by decreasing charity care and bad debt. Maine's hospital tax rate is 2.23 percent, and Rabinowitz said Maine could go up to six percent. Maine Hospital Association lobbyist Jeffrey Austin previously told The Associated Press that Maine hospitals pay $100 million in annual taxes and would oppose an increase. (7/4)
Missouri Adds New Medicaid Leverage For Managed-Care Companies
Tension between managed-care contractors and Medicaid-reliant hospitals is boiling in Missouri, where the state is docking Medicaid payments for providers who don't join one of the three managed-care networks. Missouri's move, which went into effect July 1, has sparked an outcry from hospitals, who frame it as the state tipping its hand in what are often fraught negotiations with payers. The new regulation imposes a 10% fee-for-service cut on any provider who doesn't opt into the networks run by Centene, which does business in Missouri as Home State Health Plan, UnitedHealthcare and WellCare. Twelve of the state's 160 hospitals have not yet joined at least one of three plans' networks. (Luthi, 7/3)
Iowa Awards Medicaid Contract To Company With $23 Million In Fines
A newspaper investigation found that a company chosen to manage Iowa’s newly privatized Medicaid system has a history of alleged mismanagement and at least $23 million in fines in more than a dozen states. The Des Moines Register reported that Iowa Total Care, a Centene subsidiary, was awarded a state Medicaid contract in May despite scoring nearly 14 points lower on its evaluation than when Iowa rejected its application in 2015. (Stoddard, 7/5)
Public and congressional anger is high when it comes to drug costs, but price tags continue to rise. Meanwhile, CVS Health pushes back against HHS Secretary Alex Azar's comments that the company is standing in the way of lower costs.
Trump Promised Drug Makers Would Lower Their Prices, But Not All Did
On May 30, President Trump promised that “some” of the big drug makers would announce “voluntary, massive drops in prices” in two weeks. But not everyone in the pharmaceutical industry got the memo. Since last Friday, two large purveyors — Pfizer (PFE) and Teva Pharmaceuticals (TEVA) — both took hefty price hikes on numerous medicines, as did several other companies. (Silverman, 7/3)
CVS Health CEO 'Surprised' By Azar's Comments On Drug Prices
CVS Health says it is not standing in the way of lower drug prices, pushing back on comments Health and Human Services Secretary Alex Azar made last week. Larry Merlo, president and CEO of CVS Health, wrote in a letter to Azar that he was "surprised" to hear him say pharmacy benefit managers (PBMs) — companies that manage insurance plans for employers and insurers — are standing in the way of lower drug prices in order to protect their bottom lines. (Hellmann, 7/3)
And in other pharmaceutical news —
The Washington Post:
The Health 202: 'Gag Clauses' Mean You Might Be Paying More For Prescription Drugs Than You Need To.
Using your insurance plan isn’t always the cheapest way to buy prescription drugs. But your pharmacist might be banned from telling you that. Lawmakers on both sides of the aisle are seeking ways to stop a practice that can keep customers from saving money at the drugstore counter. “Gag clauses” buried in the fine print of pharmacy contracts — and imposed by pharmacy benefit managers (PBMs) — prevent many pharmacists from telling customers when the cash price for a medicine may be less expensive than their insurance co-pay unless the customers directly ask. Ending “gag clauses” is just one option as Republicans and Democrats attempt to find ways to lower the skyrocketing cost of prescription drugs — both a problem for the health-care system and a political headache for both parties. (Firozi, 7/5)
Biotech's New Big Idea For Making Cancer Immunotherapy Work Better
The drug industry has made a mint on immunotherapies for cancer, but those game-changing treatments don’t work for most people’s tumors. That has set in motion a scientific gold rush, as biotech companies search for molecules they can add to those drugs to turn them into universal therapies. The latest promising candidate is TGF-beta, a thorny collection of proteins that regulates a host of bodily functions. Among them is the process by which the immune system decides to either attack cancerous growths or let them pass idly by. (Garde, 7/5)
Most medical groups have been recommending both tests, but now some experts suggest the HPV test alone is sufficient. Almost all cervical cancers are caused by the human papillomavirus.
The Washington Post:
HPV Test Is Better Than Pap Smear At Detecting Precancerous Cervical Changes, Study Says
A test for HPV detects precancerous changes of the cervix earlier and more accurately than the Pap smear, according to a large clinical trial published Tuesday. The randomized, controlled study — the kind of trial considered the “gold standard” of research — showed that the human papillomavirus test is more sensitive than the Pap smear, a widely used test that has been a standard part of women's preventive health care for decades but has drawbacks. (McGinley, 7/3)
Study: HPV Tests Outperform Pap Smears In Testing For Cervical Cancer
The FDA in 2014 approved the first HPV test, which tests vaginal and cervical secretions (which can be gathered with a swab) for the presence of HPV. The new study, called the HPV FOCAL trial, compared the HPV test with traditional Pap smear screening among 19,000 Canadian women over four years. It adds to a body of research suggesting that HPV testing might be more accurate. "In our world this study is going to be a pretty big deal, in a good way," says Dr. Kathleen Schmeler, a gynecologic oncologist at the University of Texas MD Anderson Cancer Center. (Watson, 7/3)
And in other women's health news —
Kansas City Star:
Debate Over Abortion Rights Roils Missouri Democrats
Annie Rice shocked a room full of Democrats over the weekend when she suggested the state party should amend its platform to include a provision permitting its members to support a right-to-work law in Missouri. “Everyone was staring at me like I had three heads for suggesting this,” said Rice, an alderwoman in St. Louis and a member of the committee that helped draft the platform. Rice had no intention of actually amending the platform. She vehemently opposes right-to-work and withdrew the amendment before any vote was taken. (Hancock, 7/5)
Dallas Morning News:
Planned Parenthood Of Greater Texas Now Offers HIV-Prevention Drugs, Hormone Therapy
Planned Parenthood of Greater Texas wants Texans to know that all of its health centers have started offering drugs critical to reducing the spread of HIV. These medications, known as PrEP, or pre-exposure prophylaxis, and PEP, or post-exposure prophylaxis, reduce a person’s chances of contracting the AIDS virus. The service comes as public health experts are still searching for solutions to improve access to the medication among groups that have historically lacked HIV-related care. (Perez and Lambert, 7/4)
Assisted reproduction is largely self-regulated in the United States, and many lawmakers in the past have shied away from the potentially politically fraught issue. But that may change following a clinic's mishap earlier this year.
The Washington Post:
Embryo Storage Bill Seeks Oversight Of Fertility Centers And Penalties For Those That Violate Safeguards
The loss of 4,000 eggs and embryos at the University Hospitals Fertility Clinic in suburban Cleveland in March was, according to a preliminary investigation, largely preventable. The Ohio Department of Health found the facility had issues with record keeping of temperatures and liquid nitrogen levels in their cryotanks and had only one designated point of contact for problems related to the tanks. Ohio state Sen. Joe Schiavoni (D) is working on legislation he hopes will help prevent such disasters in the future and introduce penalties for fertility clinics that violate the new safeguards. (Cha, 7/5)
The New York Times:
Lots Of Successful Women Are Freezing Their Eggs. But It May Not Be About Their Careers.
“Freeze Your Eggs, Free Your Career,” announced the headline of a Bloomberg Businessweek cover story in 2014. It was the year that Facebook and then Apple began offering egg freezing as a benefit to employees. Hundreds of think pieces followed, debating the costs and benefits of “postponing procreation” in the name of professional advancement. In the years since, many more women across the world have frozen their eggs. Many are highly educated. But the decision may have very little to do with work, at least according to a new study. In interviews with 150 American and Israeli women who had undergone one cycle, career planning came up as the primary factor exactly two times. Instead, most women focused on another reason: they still hadn’t found a man to build a family with. (Murphy, 7/3)
States that are enacting regulations on opioids have, in theory, built in ways for people with chronic pain to continue getting the medication they need. But patients say that's not what's happening.
Chronic Pain Patients Say Their Needs Ignored In Opioid Epidemic
Chronic pain patients and the groups that represent them say the escalating government response to opioid addiction ignores their need for the painkillers and doctors who will prescribe them, leaving some out of work, bedridden and even suicidal. Tough state laws on prescribing that took effect Sunday, Centers for Disease Control and Prevention (CDC) dosage guidelines and state and federal charges against doctors who prescribe opioids are an overreaction to addiction, according to several dozen people with unremitting pain who contacted USA TODAY. (O'Donnell and Chu, 7/2)
With antibiotic drug resistance on the rise, those in the medical field are looking for ways to outsmart bacteria. In other public health news: vaccines, walking drunk, testosterone, exercise, probiotics and more.
As Drug Resistance Grows, Combining Antibiotics Could Yield New Treatments
Combining certain antibiotics could help them pack a one-two punch against harmful bacteria, according to a new study published Wednesday in Nature. Nassos Typas and his colleagues at the European Molecular Biology Laboratory in Germany tested 3,000 different combinations of antibiotics with each other or with drugs, food additives, and other compounds on three common types of bacteria that infect humans. (Thielking, 7/4)
Did Pandemic Flu Vaccine Trigger An Increase In Narcolepsy Cases?
Nearly a decade on from the 2009 influenza pandemic, scientists are still trying to solve what is proving to be an intractable medical mystery: Did some of the vaccines used to protect against the new flu virus trigger an increase in narcolepsy cases? A major attempt to unravel the mystery — a study that’s still in the publication pipeline — did not find evidence that vaccines containing a boosting compound called an adjuvant sparked a rise in cases of narcolepsy, a serious but rare sleep disorder. (Branswell, 7/5)
Walking Drunk Can Be Deadly
Whether they’re emptying out of bars, going home from football watch parties, or trying to get across the highway, drunken walkers are dying in traffic crashes nationwide at alarming numbers. A third of pedestrians killed in crashes in 2016 were over the legal limit, according to the National Highway Traffic Safety Administration. That’s nearly 2,000 people — up more than 300 since 2014. (Bergal, 7/5)
Los Angeles Times:
An Extra Dose Of Testosterone Increases Men's Preference For High-Status Luxury Goods, Study Says
An extra shot of testosterone, it seems, makes a man act like an animal. You know the type: one of those male birds who unfurls some of his most spectacular feathers when the ladies are around, or the buck who uses his crown of antlers to advertise his virility. In short, an animal prone to making showy displays of his power, beauty or wealth to win mates, gain allies and intimidate competitors. (Healy, 7/4)
The New York Times:
Exercise May Aid In Weight Loss. Provided You Do Enough.
Can working out help us to drop pounds after all? A provocative new study involving overweight men and women suggests that it probably can, undercutting a widespread notion that exercise, by itself, is worthless for weight loss. But the findings also indicate that, to benefit, we may need to exercise quite a bit. (Reynolds, 7/4)
The Other Victims: First Responders To Horrific Disasters Often Suffer In Solitude
The day a gunman fired into a crowd of 22,000 people at the country music festival in Las Vegas, hospital nursing supervisor Antoinette Mullan was focused on one thing: saving lives. She recalls dead bodies on gurneys across the triage floor, a trauma bay full of victims. But “in that moment, we’re not aware of anything else but taking care of what’s in front of us,” Mullan said. Proud as she was of the work her team did, she calls it “the most horrific evening of my life” — the culmination of years of searing experiences she has tried to work through, mostly on her own. (de Marco, 7/5)
The New York Times:
Probiotics May Be Good For Your Bones
A probiotic supplement could be good for your bones, a new study suggests. Researchers studied 90 women, 75 to 80 years old, all generally healthy but with low bone mineral density. They measured their bone density at the start of the study, and then randomly assigned them to a placebo or to two daily doses of freeze-dried Lactobacillus reuteri, an intestinal tract microbe that occurs naturally in many, but not all, people. (Bakalar, 7/3)
Carbon Dioxide Increase Could Lead To Nutritional Deficiencies And Disease
The rising level of carbon dioxide in the atmosphere means that crops are becoming less nutritious, and that change could lead to higher rates of malnutrition that predispose people to various diseases. That conclusion comes from an analysis published Tuesday in the journal PLOS Medicine, which also examined how the risk could be alleviated. In the end, cutting emissions, and not public health initiatives, may be the best response, according to the paper's authors. (Chisholm, 7/3)
The New York Times:
It’s Time For A Chemistry Lesson. Put On Your Virtual Reality Goggles.
There was a time when biochemists had a lot in common with sculptors. Scientists who had devoted their lives to studying a molecule would building a model, using metal and a forest of rods to hold up the structure of thousands of atoms. “Slow work, but at the end you really know the molecule,” said Michael Levitt, who shared the Nobel Prize in Chemistry in 2013. These days simulations on screens have replaced such models, sacrificing some of their tactile value while gaining the ability to show movement. But what if you could enter a virtual reality environment where the molecules lie before you, obeying all the laws of molecular physics as calculated by supercomputers, and move them around in three dimensions? (Greenwood, 7/3)
Media outlets report on news from Connecticut, Puerto Rico, Missouri, Maryland, California, Colorado, Pennsylvania, Texas, Florida, Arizona, Ohio, Kansas and Tennessee.
States Expand Telemedicine To Allow Prescribing Of Controlled Substances
Legislators are beginning to open up new avenues for providers to use telemedicine to prescribe medications, a move that's indicative of growing acceptance of virtual care as a way to improve access. On Sunday, Connecticut became the latest state to allow providers to prescribe controlled substances through telemedicine for treating psychiatric disabilities and substance use disorder. Seven other states have recently passed similar laws allowing the prescription of controlled substances via telemedicine. (Arndt, 7/3)
CNN/Center for Investigative Journalism:
Records Suggest Puerto Rico Saw A Leptospirosis 'Outbreak' After Hurricane Maria -- But Officials Won't Call It That
Puerto Rico's own records list so many cases of the bacterial disease leptospirosis that officials should have declared an "epidemic" or an "outbreak" after Hurricane Maria instead of denying that one occurred, according to seven medical experts who reviewed previously unreleased data for CNN and the Centro de Periodismo Investigativo (CPI).A Puerto Rico mortality database -- which CNN and CPI sued the island's Demographic Registry to obtain -- lists 26 deaths in the six months after Hurricane Maria that were labeled by clinicians as "caused" by leptospirosis, a bacterial illness known to spread through water and soil, especially in the aftermath of storms. That's more than twice the number of deaths as were listed in Puerto Rico the previous year, according to an analysis of federal records. (Sutter and Pascual, 7/3)
A Promise To Bail Out Rural Hospitals May Be Risky
The only hospital serving the community of rural Callaway County, Mo. — Fulton Medical Center — was set to shut down last September. When staff arrived one afternoon for a potluck goodbye party, they were met with an unexpected guest, Jorge Perez, a management consultant from Florida. He announced he'd just bought the hospital, and planned to keep it open. When Perez spoke about the takeover four days later to a packed city council chambers in Fulton, Mo., he got a standing ovation. (Margolies and Sable-Smith, 7/3)
The Baltimore Sun:
MedStar Union Memorial Fails Preliminary Accreditation Due To Problems With Its Inpatient Dialysis Center
MedStar Union Memorial Hospital was denied preliminary accreditation by the Joint Commission because of problems with its inpatient dialysis center that posed safety problems for patients. A spokeswoman for the Joint Commission said in an email that a May 18 survey of the hospital, located on East University Parkway, found a condition that “posed a threat to patients or other individuals served.” (Tkacik and McDaniels, 7/3)
Newsom Tamps Down Expectations For Single Payer In California
Gavin Newsom, favored to be California's next governor, is campaigning on a progressive vision of single-payer health care whose viability could pose a major test ahead of the 2020 elections for Democrats wrangling over how to enshrine universal health coverage. ...He isn't shying away from that goal, which is increasingly popular with the activated progressive wing of the party but is proving a tough sell because of the exorbitant cost. (Colliver and Pradhan, 7/3)
Porter Adventist Suspends Transplant Operations, Forcing 232 Patients To Find Another Hospital
Porter Adventist Hospital has suspended organ transplant procedures for six to 12 months as it reassesses and retools its program with the help of the Florida Hospital Transplant Institute. Porter, which provides kidney, pancreas and liver transplants, is one of three hospital in the region offering organ replacements, along with the University of Colorado Hospital and Presbyterian/St. Luke’s Medical Center. ISvaldi, 7/3)
San Francisco Chronicle:
California’s Mandatory-Vaccination Law Survives Court Test
California did not violate freedom of religion or the right to an education when it required virtually all public and private school students to be vaccinated against contagious illnesses in 2016, a state appeals court says. ...The law was prompted by an outbreak of measles in 2014 that was traced to youngsters at Disneyland who had not been vaccinated. (Egelko, 7/3)
The Philadelphia Inquirer:
Why Philly Is A Particularly Bad Place To Get Bedbugs
All cities have bedbugs, but Philadelphia is the only one of the 10 most populated municipalities without clear rules for who is responsible or how to report complaints. Attempts to create a policy have gone nowhere because the city has balked at adding bedbug inspections to an already hefty caseload of complaints, and advocates for property owners made it clear they don’t want to be on the hook for expensive exterminations. (Terruso, 7/5)
Kaiser Health News:
Texas Clinics Busting Traditional Silos Of Mental And Physical Health Care
Kerstin Taylor fought alcohol and substance abuse problems for two decades. She periodically sought help through addiction and psychiatric treatments to stay sober, but she continued to relapse. That unrelenting roller coaster, and the emotional and mental fallout, left her with little energy or resources to take charge of her overall health. Taylor, 53, has asthma and doctors told her she was at risk of developing diabetes.“I wasn’t doing anything to help myself,” she said about her physical health. (Covington, 7/5)
Tampa Bay Times:
This Health Care Startup Closed. Millions In Taxpayer Money Is Gone. Now What?
It’s been two weeks since health care IT company CareSync Inc. shuttered, leaving the patients who used its services in the lurch and nearly 300 employees scrambling for new jobs. The closure came with little warning, just days after a buyer tentatively agreed to purchase the Tampa company. (Denham and Carollo, 7/5)
Undercover Testers Find Discrimination At Assisted-Living Facilities
At least 14 operators of assisted-living and nursing facilities in Arizona unlawfully discriminate against prospective residents who are deaf, according to a federal lawsuit filed by the Southwest Fair Housing Council. The suit follows nearly two years of undercover inquiries. Testers enlisted by the non-profit contacted large-scale facilities in the Phoenix and Tucson areas requesting accommodations for a fictional deaf grandfather. (Polletta, 7/4)
Cleveland Plain Dealer:
Signatures Submitted For Initiative To Improve Dialysis Care In Ohio
Advocates have submitted more than 475,000 signatures to election officials to put an issue on the Nov. 6 ballot that seeks to improve patient care at dialysis clinics. Supporters of the issue need 305,591 signatures from registered voters, according to a news release from the Service Employees International Union District 1199. (Remington, 7/4)
Kansas City Star:
Children’s Mercy Patient Data Stolen In Email Phishing Scam
Personal data from more than 60,000 individuals may have been compromised as part of an email phishing scam that targeted Children’s Mercy Hospital employees. The emails sent to employees gave the appearance they were from a trusted source and often contained links to a phony login page on a fake website, the hospital said. (Ryan, 7/3)
Kaiser Health News:
Tennessee-Based Pain Management Group To Close Clinics Amid Financial Turmoil
One of the largest pain management groups in the Southeast is closing multiple clinics amid worsening financial troubles and a federal criminal investigation that targeted its former chief executive. This week, Tennessee-based Comprehensive Pain Specialists advised patients and employees about clinic closures, leaving patients scrambling to find new doctors willing to prescribe them opioids, according to a report on WSMV television. (Shulte, 7/3)
Kansas City Star:
KU Campus To Go Tobacco-Free On July 1
University of Kansas students and staff can no longer use tobacco or vaping products on school grounds under a new policy pushed by health-conscious students and embraced by administrators looking to stay competitive. State law already banned smoking inside and immediately outside campus buildings. (Bergen, 7/3)
Each week, KHN's Shefali Luthra finds interesting reads from around the Web.
The New York Times:
Dead Of AIDS And Forgotten In Potter’s Field
The bodies reached Hart Island on a ferry like all the others, in spare wooden boxes and bound for ignominious mass internment off the coast of the Bronx where New York City buries its unclaimed dead by the hundreds in long, shallow trenches. But when these 17 bodies arrived in 1985, the island’s hardened crews, used to burying dozens of indigent people per week, recoiled. These were different. They had died from a widely feared nascent disease called AIDS, a highly contagious illness with a skyrocketing death toll. (Kilgannon, 7/3)
Victims Blame FDA For Food-Recall Failures
People had been getting sick from eating I.M. Healthy Original Creamy SoyNut Butter for more than two months when Peter Ebb, a 59-year-old Boston lawyer and health enthusiast, went for a run and then ate his usual gluten-free English muffin smeared with soy nut butter. Later that morning — March 6, 2017 — Ebb saw a message from Amazon, which had sold him the nut butter, that the manufacturer had recalled it for contamination by E. coli bacteria. Ebb threw away a protein drink he had made with the soy nut butter, but didn’t worry too much. The Food and Drug Administration warning that was linked to the email was worded very cautiously: Though serious illnesses might result, even potentially leading to death, “most healthy adults can recover completely within a week.” (Haughney, 7/4)
Power Causes Brain Damage
If power were a prescription drug, it would come with a long list of known side effects. It can intoxicate. It can corrupt. It can even make Henry Kissinger believe that he’s sexually magnetic. But can it cause brain damage? When various lawmakers lit into John Stumpf at a congressional hearing last fall, each seemed to find a fresh way to flay the now-former CEO of Wells Fargo for failing to stop some 5,000 employees from setting up phony accounts for customers. (Useem, 7/1)
Polio Eradication: A Vaccine We Don’t Even Use Anymore Is Spreading The Virus
The global push to immunize children against polio has been an incredible success, reducing polio cases by 99.9 percent. But there’s a lingering obstacle to a polio-free world: A scant number of people who got one version of the vaccine before it was phased out in 2016 carry a variant of the polio virus that was in that vaccine and has since mutated. The mutated virus can now be passed around in areas where few people have been vaccinated, sickening some along the way. (Belluz and Resnick, 7/4)
One Sentence With 7 Meanings Unlocks A Mystery Of Human Speech
Ruth Nall is a talented talker. Always has been. When she was a child, her mother taught her to enunciate her words when she spoke, which she did often and at length. So wordy was she that, in grammar school, her friends nicknamed her "Yakky Roo," partly for her ace Yakky Doodle impersonation, but also for her loquaciousness. I know this because Nall, who these days teaches high school kids, told me so, in a pleasantly wide-ranging conversation about her participation in a study led by UCSF Health neurosurgeon Edward Chang. (Gonzalez, 6/28)
The Weird, Ever-Evolving Story Of Your DNA
In 1555, Holy Roman Emperor Charles V announced his plans to abdicate, and his 28-year-old son, Philip II, became the king of Spain the following year. The throne was Philip’s natural—hereditary—right. The Habsburg dynasty, to which Charles and Philip belonged, had raised strategic matrimony to an art form, using marriage bonds among relations distant and close to seize control over much of Europe. Power came with a price, however: severe, recurring mental and physical problems. Charles’s mother was Joan the Mad; his son Philip was said to be “of weakly frame and of a gloomy, severe, obstinate, and superstitious character.” Philip’s descendant Charles II was 4 before he could talk and 8 before he could walk. He died in 1700, not yet 40, childless and sterile. Geneticists have calculated that he was more inbred than he would have been had his parents been siblings. After his death, the Spanish Habsburg dynasty collapsed, crushed under the weight of a heredity that as yet had no name. (Comfort, 7/1)
Opinion writers express views on anti-abortion and abortion right movements.
Attacking Roe V. Wade Means Going Through Planned Parenthood V. Casey, Too
Roe v. Wade is doomed. So says Washington's latest conventional wisdom. Given the likelihood that President Donald Trump will complete the most conservative Supreme Court majority in generations with his choice to succeed retiring Justice Anthony Kennedy, the forecast makes sense. But conventional wisdom is so frequently wrong (remember Election Day 2016?) that every eruption is worth a second look. As usual, there's plenty to see. (David Von Drehle, 7/4)
The Washington Post:
Let Roe Go
How can someone who calls herself pro-choice oppose Roe v. Wade? Let me count the ways. The decision itself is a poorly reasoned mess. It failed to mount a convincing case that the Constitution contains language that can be read as guaranteeing a woman’s right to abort her pregnancy. Nor have the subsequent courts that amended and extended Roe managed to come up with a constitutional justification; it’s all “emanations and penumbras” and similarly float-y language that did little to convince opponents that Roe v. Wade was a good or necessary ruling. Even many liberal supporters of a constitutional right to abortion have voiced concerns about the way the Burger Court got us there; those critics include Justice Ruth Bader Ginsburg. (Megan McArdle, 7/3)
The New York Times:
Senators Collins And Murkowski: It’s Time To Leave The G.O.P.
Just hours after Supreme Court Justice Anthony Kennedy announced his retirement, media legal analysts and commentators began forecasting what this will mean for women’s reproductive freedom. On CNN: “Roe v. Wade is doomed.” Huffington Post: “It’s time to prepare for life without nationwide legal abortion.” Reuters: “a death knell for Roe v. Wade.” Or, as one commenter remarked, invoking Dylan, “looks like it’s all over now, baby blue.” I share the despair, but have we forgotten something? Republicans have a one-vote majority in the Senate. Their number includes two female moderates, Susan Collins and Lisa Murkowski, both of whom support abortion rights, and one of whom — Ms. Collins — has already declared this week that she would not support a candidate hostile to Roe v. Wade. (Susan Faludi, 7/5)
The Washington Post:
Amy Coney Barrett Would Pose A Clear And Present Danger To Abortion Rights
No Supreme Court nominee is a completely safe bet. No one — not even the nominee himself or herself — knows for certain how he or she would rule on a particular case until the moment arises. When the Supreme Court explicitly weighed overturning Roe v. Wade and eliminating constitutional protection for abortion rights in 1992, for instance, Justice Anthony M. Kennedy provided the fifth vote to prevent that outcome. But Kennedy’s vote in an abortion case three years earlier made that position surprising — including, perhaps, to the justice himself. And yet: Of all the potential Supreme Court nominees that President Trump is considering, the one who seems most inclined to undo Kennedy’s work and overturn Roe as completely and quickly as possible is Amy Coney Barrett, a 46-year-old newly minted (last November) federal appeals court judge. (Ruth Marcus, 7/4)
The Washington Post:
Calm Down. Roe V. Wade Isn’t Going Anywhere.
If Chicken Little and Cassandra had a baby, they’d name him Jeffrey Toobin. Anyone watching CNN lately has probably heard Toobin’s prediction that if a conservative fills the Supreme Court seat left vacant by departing Justice Anthony M. Kennedy, abortion is dead.No more reproductive choice; no more equal protection for the LGBTQ community; no more fun for anybody, except Jesus and his acolytes. The effect has been an unloosing of hysteria upon the land. Democrats began tearing their garments and gnashing their teeth as they foresaw 24/7 Christian broadcasting and Charlton Heston reruns. Republicans, always sore winners, fired their guns in the air, swatted Hillary Clinton piñatas and — I’m not sure this part is true — square-danced till way past dark. (Kathleen Parker, 7/3)
Opinion writers express views about how to address the opioid epidemic.
It's Time For Methadone To Be Prescribed As Part Of Primary Care
Opioid use disorder, which claims 115 lives a day by overdose in the United States, is a complex, chronic medical condition, but one that can be successfully treated with proven medications. And yet, one of the oldest and most effective medications to treat this disorder — methadone — is out of reach for many people, largely due to outdated federal laws. Of the three medications approved by the Food and Drug Administration to treat opioid use disorder, federal law relegates only methadone to be dispensed in separate clinics apart from the general health care system. It’s not unusual for methadone clinics to be in out-of-the-way locations and often inaccessible by public transportation, especially in rural and suburban communities. When individuals trying to break an addiction to opioids can’t get to a methadone clinic on a daily basis, they can’t get treatment. (Jeffrey Samet, Michael Botticelli and Monica Bharel, 7/5)
New England Journal of Medicine:
Primary Care And The Opioid-Overdose Crisis — Buprenorphine Myths And Realities
Despite widespread awareness of the opioid-overdose crisis, the epidemic continues to worsen. In 2016, there were 42,249 opioid-overdose deaths in the United States, a 28% increase from the previous year. According to the National Center for Health Statistics, life expectancy in the United States dropped in 2016 for the second consecutive year, partly because of an increase in deaths from unintentional injuries, including overdoses. It was the first 2-year decline since the 1960s. How can we be making so little progress? In part, the overdose crisis is an epidemic of poor access to care. One of the tragic ironies is that with well-established medical treatment, opioid use disorder can have an excellent prognosis. Decades of research have demonstrated the efficacy of medications such as methadone and buprenorphine in improving remission rates and reducing both medical complications and the likelihood of overdose death. Unfortunately, treatment capacity is lacking: nearly 80% of Americans with opioid use disorder don’t receive treatment. (Sarah E. Wakeman, M.D., and Michael L. Barnett, 7/3)
Why Aren't Doctors Stepping Up To Treat People With Opioid Addictions?
Dear Doctor, Please help me understand why so few of you have chosen to treat people with opioid addictions. I’ve been following the topic of opioid addiction for years. It is one of the most common themes for First Opinion submissions. Authors routinely point to the importance of medication-assisted therapy, the standard of care for individuals with opioid addiction (a term that those in the know tell me I should replace with opioid use disorder). That means treatment with methadone, buprenorphine, naltrexone, or combinations of these — medications you could prescribe if you wanted to. (Patrick Skerrett, 7/5)
New England Journal of Medicine:
Moving Addiction Care To The Mainstream — Improving The Quality Of Buprenorphine Treatment
More than 40,000 Americans died from opioid overdoses in 2016 — more than the number killed in motor vehicle accidents. The stunning increase in overdose deaths since the 1990s has revealed a pervasive lack of capability to meet the need for treatment in the 2.1 million Americans who have an opioid use disorder. Since less than one fifth of people with opioid use disorder receive addiction treatment, recent national initiatives have understandably focused on increasing access to care, and especially access to medications, for addiction treatment. Even when patients do obtain treatment, however, they often experience care as fragmented and difficult to navigate. These challenges exist worldwide but are particularly acute in the United States, given the magnitude of opioid-related injury and death rates in this country and the historical marginalization and underfunding of addiction care. Payers and health systems can help move treatment to the mainstream, and increase the proportion of patients who recover, by expanding the pool of clinicians who treat opioid use disorder, improving measurement of treatment quality, and linking payment to outcomes. Like HIV/AIDS or diabetes, opioid use disorder is a chronic condition that can be managed using medication as a component of care. (Brendan Saloner, Kenneth B. Stoller, and G. Caleb Alexander, 7/3)
Shut The Back Door To America’s Opioid Epidemic
As a former U.S. Senator and attorney general for New Hampshire, I’ve witnessed first-hand the devastating impact of opioid addiction in our communities. At pharmacies, opioid prescriptions are purchased one of two ways, using health insurance or with cash. Several initiatives by Pharmacy Benefit Managers (PBMs), the middlemen who administer pharmacy benefits for health insurance plans, have limited the supply of opioids that can be purchased by using health insurance. These efforts include limiting to seven days the supply of opioids dispensed for certain acute prescriptions for patients who are new to therapy and limiting the daily dosage of opioids dispensed based on the strength of the opioid. While helpful, these steps are insufficient and leave a back door wide open for opioid abuse and so-called pill mills by providing little or no limits on cash purchases. This is how the back door works. People pay cash for prescriptions because they lack insurance coverage or because they want to circumvent health insurance controls. Cash prices for prescription drugs are set at artificially high markups, often as much as ten times more than the prices paid for the same drugs by health insurance plans. To gain modest discounts to inflated cash prices, cash purchasers turn to prescription coupons known as “cash discount cards.” Even as PBMs limit access to opioids for patients using insurance, they issue cash discount cards that make opioid purchases easier to buy and more profitable for them. Prescription cash discount cards are heavily promoted in doctors’ waiting rooms, on television and on the Internet. (Kelly Ayotte, 7/3)
Editorial pages look at these and other health issues.
Los Angeles Times:
Trump's Own Figures Show That Obamacare Is Working Well For The Vast Majority Of Enrollees
Overall, according to the figures released by the agency, 10.6 million Americans had signed up for ACA coverage by February and paid their first month’s premium. That was about 3% ahead of the 10.3-million enrollment at the same moment in 2017, the agency said. The increase came in the face of Trump administration policies that would have the effect of discouraging enrollment. (Michael Hiltzik, 7/3)
Americans Deserve Affordable Health Care
When I was 27, I woke up one morning with no vision in my left eye. I went to the doctor, and I’ll never forget sitting on the examination table, anxiously awaiting my diagnosis. What he told me would change my life forever: “Ellen, you have MS.”Multiple Sclerosis is a lifelong disease that attacks your central nervous system. For many, it can result in a wheelchair-bound life. I thought in that moment that my life might be over. ...This month, Trump’s Department of Justice has announced that it won’t defend ACA provisions that protect people with pre-existing conditions. This move is a moral outrage and a cruel and unnecessary punishment for people like me—people who need good health care to give them a chance for a healthy, productive life. It also means that insurers could charge older patients much higher premiums, both in the individual market and for small business employees. It threatens the insurance that we all access, whether employer-provided or through an exchange. (Ellen Lipton, 7/5)
Student-Led Mental Health Groups Are Important — With Supervision
It’s no secret that college students have increasingly been reporting more mental health difficulties, including suicidal thoughts. Because university counseling centers and staff sometimes struggle to care for all the students in need, the students themselves have formed mental health support groups. While there’s a lot to celebrate in regards to student-led mental health help initiatives across college campuses, such groups can have drawbacks, particularly if not overseen or supported by mental health professionals in some way. (Joan Cook, 7/3)
The Washington Post:
It Ain’t Broke Yet, But Federal Disability Insurance Still Needs Some Big Fixes
Every so often, the federal government’s financial performance surprises on the upside. Recent case in point: new data in the annual report of the Social Security trustees showing unexpected resiliency in the Social Security Disability Insurance (SSDI) program. Just three years ago, in July 2015, the Obama administration warned that the program’s reserves were so low that it might not be able to cover expected benefits in 2016. Now, the trustees say the program will be solvent until 2032. Declining disability insurance receipts may be one reason that labor force participation by “prime-age” workers, those between the ages of 25 and 54, has ticked up from 80.6 percent in September 2015 to 81.8 in May 2018. (7/2)
Los Angeles Times:
Rules For Gay Blood Donors Are Based On Outdated Fear, Not Science
In my senior year I helped organize a blood drive in my high school gymnasium. I felt newly mature as I signed the consent form; the idea that my transient discomfort potentially could help save a life inspired me, and I committed to making blood donation a habit. When I received my American Red Cross Donor Card weeks later indicating that I was “O-negative” – a universal donor – I became all the more motivated.I’m now, years later, a physician who sees patients benefit from transfusions every day, from children with sickle cell disease to adults with leukemia. My husband sees blood products being put to work even more dramatically on his shifts in the emergency department, as they’re rapidly infused into trauma patients. When there’s no time for matching blood types, it’s O-negative blood like mine that is pumped into these patients’ veins. (C. Nicholas Cueno, 7/5)
The New York Times:
Americans Are Having Fewer Babies. They Told Us Why.
Americans are having fewer babies. At first, researchers thought the declining fertility rate was because of the recession, but it kept falling even as the economy recovered. Now it has reached a record low for the second consecutive year. Because the fertility rate subtly shapes many major issues of the day — including immigration, education, housing, the labor supply, the social safety net and support for working families — there’s a lot of concern about why today’s young adults aren’t having as many children. So we asked them. (Claire Cain Miller, 7/5)