KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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From Kaiser Health News - Latest Stories:

Kaiser Health News Original Stories

10 Ways Medicaid Affects Us All

Medicaid was created in 1965 as a program for the poor. Today, it helps 74 million people — more than 1 of every 5 people in the U.S. You or someone you know likely benefits. (10/5)

Political Cartoon: 'Blind Side?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Blind Side?'" by Clay Bennett, Chattanooga Times Free Press.

Here's today's health policy haiku:

NAME THAT HEIR

The guessing game is
Starting: Who will replace Price?
D.C. is buzzing.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Summaries Of The News:

Medicaid

CHIP Funding Measure Passes Through Committees, But It's Not Smooth Sailing Ahead For Bill

The provisions Republicans want to add to reauthorize funds for the Children's Health Insurance Program rankle Democrats, which might mean a bitter fight over of the popular program. Meanwhile, states are bracing for the worst.

The New York Times: Bill To Rescue Children’s Health Program Hits Snag In House
Legislation to rescue the Children’s Health Insurance Program sailed through a Senate committee on Wednesday, but touched off a partisan conflict in the House, diminishing hopes that the popular program would be quickly refinanced. Funding for the program expired on Sunday, and state officials said they would soon start notifying families that children could lose coverage if Congress did not provide additional money. It was impossible to say when Congress might pass a bill and send it to President Trump. (Pear, 10/4)

The Associated Press: Parties Fight Over Funding Children's Health Insurance
The House Energy and Commerce Committee approved the measure on a party-line 28-23 vote. The program covers 8.9 million low-income children, and a renewal of funds for it seems virtually inevitable. But four days after the program's federal funding expired, the bill's problems were underscored as Democrats opposed GOP plans for financing the extension and a related community health center bill. The GOP cuts include trimming a public health fund established under former President Barack Obama's health care law and making it harder for people buying individual health coverage to avoid paying premiums. (Fram, 10/4)

Modern Healthcare: House, Senate Committees Pass CHIP Bill Proposals 
During the House panel's markup hearing Wednesday, Democrat members slammed a Republican proposal to partially pay for CHIP by charging higher Medicare premiums to seniors earning more than $500,000. The Senate version of the bill does not suggest an offset to fund the program. "Here we are with a partisan bill that asks for coverage of children on the backs of seniors," said Rep. Diana DeGette (D-Colo.). The suggestion could derail CHIP altogether, warned Rep. Anna Eshoo (D-Calif.), who noted that other bills circling in Congress, including proposed tax cuts, don't suggest how they will be funded. But some Republicans maintained that higher Medicare premiums for wealthy beneficiaries likely wouldn't be a hardship. (Dickson, 10/4)

The Hill: Children’s Health-Care Bill Faces New Obstacles
Bipartisan negotiations over an extension of children’s health insurance are veering off course, raising doubts that legislation can be passed quickly. Senate Democratic Leader Chuck Schumer (N.Y.) played hardball on Wednesday, saying a fix for ObamaCare that is being negotiated by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) should be attached to the children’s health funding bill. (Sullivan, 10/4)

Morning Consult: Grassley Pressing To Include Drug Pricing Measures In CHIP Reauthorization
Sen. Chuck Grassley, a senior member and former chairman of the powerful Senate Finance Committee, is pressing GOP leaders to tackle high drug prices in a critical bill to renew funding for the Children’s Health Insurance Program. Grassley (R-Iowa), who has tried for years to advance legislation targeting rising prescription drug costs to little avail, is pushing two bills as potential offsets for CHIP funding. Both measures have some bipartisan support, but neither has advanced in previous congressional sessions amid fierce pushback from the pharmaceutical industry. (Reid, 10/4)

The Wall Street Journal: States Worry Federal Funding For Children’s Health Program Won’t Come In Time
Several states have drawn up contingency plans that involve capping enrollment and possibly taking steps to shut down their programs should funding not come through in time. Last week, Utah became the first state to request federal permission to wind down its program if Congress doesn’t renew funding by the end of the year. Utah’s program serves 19,000 children, and the state is also home to Senate Finance Committee Chairman Orrin Hatch (R-Utah) who oversees CHIP in Congress and is an influential supporter of the program. (Hackman, 10/4)

N.H. Panel Likely To Suggest Keeping Medicaid Expansion But Is Looking For Cost Cutting Steps

The 15-member Commission to Evaluate the Effectiveness and Future of the Premium Assistance Program has until Dec. 1 to submit its report to the Legislature. Meanwhile, Kansas is waiting on federal officials to approve a waiver request so that the state can design a new program for implementation in 2019.

New Hampshire Union Leader: Commission Faces Deadline For Decision On Medicaid Expansion
A legislative commission set up to evaluate the future of expanded Medicaid in New Hampshire will likely recommend that the program continue past its current expiration date of Dec. 31, 2018, but the lingering question is in what form. “The charge to the commission was to look at whether Medicaid expansion is working, and I think 50,000 people are benefiting, hospital uncompensated care has gone down significantly, and employers have access to a healthier population,” said state Sen. Jeb Bradley, R-Wolfeboro, “so I think you can make an argument that it’s working well. But there is also an argument that it’s one of the causes of the individual market premium increases, and we’ve got to try to resolve that.” (Solomon, 10/4)

Concord Monitor: Commission Explores Managed Care Medicaid System In New Hampshire
Members of a Medicaid study commission are exploring shifting the state’s Medicaid expansion population onto a managed-care model, a potentially transformative proposal intended to address predicted future premium spikes. At a meeting Wednesday, the commission, chaired by Senate Majority Leader Jeb Bradley, heard from executive directors of local managed care organizations and deliberated on whether New Hampshire should join other states in adopting the model. Managed care is a system by which states contract with specialized providers – MCOs – to accept Medicaid patients at a fixed rate per patient. The providers administer medical services within a network of hospitals and physicians, much like insurance. (DeWitt, 10/5)

KCUR: As Deadline Nears, Kansas Still Waiting For Federal Approval Of KanCare Extension 
Kansas officials say there is little chance that more than 400,000 Kansans who depend on the state’s Medicaid program will see their services interrupted. They say they are confident federal officials will approve a critical waiver request before an end-of-the-year deadline. “We’ve met all the requirements, so I would expect approval to be coming very soon,” said Michael Randol, director of the division of health care finance at the Kansas Department of Health and Environment. (McLean, 10/4)

Capitol Hill Watch

House Budget Plan Calls For Deep Cuts To Medicaid, Overhaul Of Medicare

But Republicans are not actually planning to impose any of those cuts which are limited to nonbinding promises. Meanwhile, angry Republican donors are sitting on their wallets until lawmakers actually accomplish something.

The Associated Press: House GOP Eyes Budget Passage That Is Key To Tax Debate
Republicans are focused on cutting taxes instead of deficits as they look to power a $4.1 billion budget plan through the House on Thursday. The 2018 House GOP budget promises deep cuts to social programs and Cabinet agency budgets but its chief purpose is to set the stage for action later this year on a comprehensive Republican overhaul of the U.S. tax code. The tax overhaul is the party’s top political priority as well as a longtime policy dream of key leaders like Speaker Paul Ryan. The plan calls for more than $5 trillion in spending cuts over the coming decade, including a plan to turn Medicare into a voucher-like program for future retirees, slash Medicaid by about $1 trillion over the coming decade, and repeal the “Obamacare” health law. (Taylor, 10/5)

The Hill: Senate Dems Allege Budget Cuts Over $470B From Medicare 
Senate Democrats say Republicans plan to slash Medicare spending by more than $470 billion in the proposed budget resolution, breaking a campaign promise by President Trump not cut Medicare. According to a new report prepared for Democrats on the Senate Budget Committee, the budget would cut Medicaid by more than $1 trillion and Medicare by more than $470 billion. (Weixel and Ellis, 10/4)

The Hill: AARP Urges House To Reject Medicare Budget Cuts
The AARP is calling on the House to reject potential cuts to Medicare, Medicaid and food stamps in the current budget resolution. In a letter sent to lawmakers Wednesday, AARP CEO Jo Ann Jenkins said the proposals in the budget that could result in cuts to Medicare, or change it to a defined contribution model, should be rejected. (Weixel, 10/4)

Politico: Angry GOP Donors Close Their Wallets
Republicans are confronting a growing revolt from their top donors, who are cutting off the party in protest over its inability to get anything done. Tensions reached a boiling point at a recent dinner at the home of Los Angeles billionaire Robert Day. In full view of around two dozen guests, Thomas Wachtell, a retired oil and gas investor and party contributor, delivered an urgent message to the night’s headliner, Senate Majority Leader Mitch McConnell: Just do something. (Isenstadt and Debenedetti, 10/5)

In other news from Capitol Hill —

The Hill: House Democrats Plead For Right Of Residents To Sue Nursing Homes
In the wake of nursing home deaths cause by Hurricane Irma, House Democrats are asking the Centers for Medicare and Medicaid Services to let nursing home residents take facilities to court over allegations such as abuse. Over the summer, CMS announced it intended to change the rule under President Obama that banned nursing homes accepting Medicare or Medicaid funds from requiring a third party to settle disputes. (Roubein, 10/4)

Stat: IBM Lobbying Blitz Seeks To Shield Watson Supercomputer From Regulation
Like any new technology, Watson poses unknown risks; for example, what if its advice is wrong and harms a patient? But IBM argues that its machine doesn’t need to be regulated because it’s different from other medical devices. It’s not like a pacemaker or a CT scanner, so the company shouldn’t have to prove to the government that it’s safe and effective. Now, as federal regulators prepare to weigh in on that issue, a STAT examination shows the lengths to which IBM has gone to shield its prized machine from government scrutiny. (Ross and Swetlitz, 10/4)

Future Of Abortion Bill In Senate May Be Next Flash Point For Filibuster Debate

With a 60-vote threshold, the House-passed proposed ban on abortions after 20 weeks is not expected to pass in the Senate -- a political situation that is expected to garner President Donald Trump's ire. In other news on abortion, Rep. Tim Murphy (R-Penn.) will not seek re-election after revelations that he urged his mistress to seek an abortion despite his political opposition to the procedure.

Politico: Abortion Fight May Draw Trump’s Filibuster Wrath
Senate Republicans want to follow the House and vote to ban abortions after 20 weeks. But doing so would likely reopen an internecine fight over the filibuster with the lower chamber — and the president. Sen. Lindsey Graham (R-S.C.) on Thursday will reintroduce his bill to ban abortions nationwide after 20 weeks of pregnancy, which failed on the Senate floor two years ago, 54-42. It’s sure to fail again if Senate Majority Leader Mitch McConnell brings it up. (Everett, 10/5)

The Washington Post: GOP Rep. Tim Murphy Won't Seek Reelection After Reports He Asked Woman To Get Abortion
Rep. Tim Murphy of Pennsylvania, an opponent of abortion, will not be seeking reelection at the end of his current term, ending speculation about his future a day after a news report claimed the married Republican had asked a woman with whom he had an extramarital affair to get an abortion. “After discussions with my family and staff, I have come to the decision that I will not seek reelection to Congress at the end of my current term,” Murphy, 65, said in a statement. (Hui and DeBonis, 10/4)

Politico: Embattled GOP Rep. Tim Murphy To Retire
Rep. Tim Murphy of Pennsylvania announced Wednesday that he will retire at the end of his term, after allegations that the married Republican lawmaker, who opposes abortion rights, asked his mistress to terminate a pregnancy. Murphy admitted several weeks ago to an affair with forensic psychologist Shannon Edwards — news that came to light during the woman’s divorce proceedings with her husband. (Bade, Schneider and Bresnahan, 10/4)

Health Law

Many Americans Don't Know If ACA Is Law Of Land Or Not, Adding Challenges To Enrollment Season

There's a lot of confusion about where the Affordable Care Act stands after Republicans tried all year to repeal it and President Donald Trump talks about its imminent death. So getting people to sign up for coverage, or even know they can, is going to be a struggle this year.

Reuters: Obamacare Sign-Up Challenge: Proving The Law Is Not Dead
More than two thousand miles away from the healthcare debate in Washington, President Donald Trump's threats to let Obamacare collapse are sowing confusion about its fate and dampening 2018 enrollment expectations. The uncertainty here in Arizona, echoed in interviews across the country, shows that even though they have not been able to repeal former President Barack Obama's signature healthcare law, the Republican effort to undermine it is gaining traction. (Gershberg and Tobin, 10/4)

The Hill: ObamaCare Groups: If Trump Won’t, We Will 
Advocacy groups that support the Affordable Care Act are taking matters into their own hands. With the Trump administration cutting back on advertising and outreach, outside groups are mobilizing for a massive, nationwide campaign for the next ObamaCare enrollment period. They say it’s up to them to get the word out. (Hellmann, 10/5)

In other health law news —

Politico Pro: Alexander, Murray Struggle With State Flexibility In Obamacare Deal
Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) are still trying agree on how states can alter insurance market rules, which was always expected to be the most controversial element of the deal. Republicans are insisting on giving states “meaningful flexibility” on some of the health law’s requirements in exchange for funding Obamacare’s cost-sharing program for two years. (Haberkorn, 10/4)

Los Angeles Times: Two Measures To Boost Obamacare In California Signed Into Law By Gov. Jerry Brown
Gov. Jerry Brown signed two measures Wednesday to help Californians who buy health insurance under Covered California, the state's Obamacare marketplace. The measures ensure a longer enrollment period and continued treatment for some patients even if their insurer leaves Covered California. The first measure, AB 156 by Assemblyman Jim Wood (D-Healdsburg), was spurred by a Trump administration policy that established a 45-day window for shoppers on Obamacare marketplaces to buy new insurance policies for the coming year. (Mason, 10/4)

Georgia Health News: Study: ACA May Be Factor In Improved HPV Vaccination Rates
Because multiple doses of the vaccine are needed, and they can be up to $200 a pop, HPV vaccination rates have traditionally been lower than other recommended vaccinations. But the ACA’s prevention and wellness mandates may have changed that, says study author Rosemary Corriero, MPH and Oak Ridge Institute for Science and Education fellow in the CDC’s Immunization Service Division. (Hensley, 10/4)

Pharmaceuticals

Hurricane Reveals Just How Much America Relies On Puerto Rico For Its Pharmaceutical Supply

Officials have a real fear that there will be shortages of drugs for maladies such as childhood leukemia and HIV. The island has become one of the world’s biggest centers for pharmaceutical manufacturing. Meanwhile, the threat of illness lingers with the floodwaters even as medical supplies are dwindling.

The New York Times: Hurricane Damage In Puerto Rico Leads To Fears Of Drug Shortages Nationwide
Federal officials and major drugmakers are scrambling to prevent national shortages of critical drugs for treating cancer, diabetes and heart disease, as well as medical devices and supplies, that are manufactured at 80 plants in hurricane-ravaged Puerto Rico. Pharmaceuticals and medical devices are the island’s leading exports, and Puerto Rico has become one of the world’s biggest centers for pharmaceutical manufacturing. Its factories make 13 of the world’s top-selling brand-name drugs, from Humira, the rheumatoid arthritis treatment, to Xarelto, a blood thinner used to prevent stroke, according to a report released last year. (Thomas and Kaplan, 10/4)

The Wall Street Journal: In Puerto Rico, Health Concerns Grow Amid Lack Of Clean Water, Medical Care
In the aftermath of Hurricane Maria, many Puerto Ricans are grappling with growing health concerns due to a lack of reliable access to medical care, supplies and clean water. Maggie Reuteman, a volunteer registered nurse with the Red Cross in Puerto Rico, said some patients on oxygen are rationing their supply, fearing they won’t get more in time. That could lead to respiratory infections like pneumonia, if patients can’t breathe properly and fluid builds up in the lungs, she said. (Hernandez, 10/4)

The Hill: Hurricane Maria Worsens Puerto Rico's Water Woes 
Some 55 percent of Puerto Ricans still don’t have access to drinking water as of Saturday, and concerns are rising over the potential for waterborne illnesses. Prior to the storm, though, the island had the worst rate of drinking water violations of any state or territory, a result of outdated infrastructure, pollution and underinvestment, experts said. "With the hurricane taking out so much of the island's drinking water infrastructure, we're again seeing the very harsh reality of what years of underinvestment and a failure to address this problem can result in,” Adrianna Quintero, the director of partner engagement for the Natural Resources Defense Council, said. (Roubein, 10/4)

NBC News: Puerto Rico’s Hospitals Still in Triage Mode, 2 Weeks After Maria
Two weeks after Hurricane Maria ravaged this island, doctors and nurses are still in nonstop triage, working furiously to save lives and ease pain while struggling to contend with power outages, hospital evacuations, dwindling supplies and even crime outside their doors. "The hospitals are still in crisis," said Dr. Ubaldo Santiago, director of emergency services for several San Juan hospitals and clinics. "Many are still working on generators. It's tough, and the doctors are giving their maximum." Santiago said he has twice had to evacuate the Hospital San Francisco in San Juan, the capital, because of generator failures. (Silva and Gamboa, 10/4)

In other news —

Health News Florida: Open Enrollment Extension In States Hit By Hurricanes
The federal government is expanding the length of the open enrollment period for Medicare and Obamacare health insurance policies in Florida and other states impacted by disaster. December 31 is now the deadline for people in counties where disasters were declared following Hurricanes Harvey, Irma and Maria. (Aboraya, 10/4)

Early Approval Of Generic MS Drug Signals Big Changes For Teva And Other Drugmakers

Teva had lobbied the Food and Drug Administration to reject Mylan's generic version of its Copaxone multiple sclerosis medication. In other drug industry news: an experimental drug is found to work on a mutant gene; advocates await Calif. Gov. Jerry Brown's decision on a drug pricing bill; and Cleveland Clinic's CEO wants supporters of a drug pricing ballot measure in Ohio to stop using his image.

Stat: What Are The Implications Of A Generic Teva MS Drug? Here's What The Wags Say
In a surprise move, U.S. regulators approved a generic version of Teva Pharmaceutical’s (TEVA) Copaxone multiple sclerosis drug earlier than investors expected. And the decision portends big changes not only for Teva — Copaxone is a key contributor to its sales and profits — but also for generic companies more broadly, as far as some Wall Street wags are concerned. The approval creates a heightened challenge for Teva, which is already in disarray. (Silverman, 10/4)

Stat: A Drug With The Power To Mute Defective Genes Raises Hopes — Cautiously
The experimental drug has startling powers: It can turn down a mutant gene in a patient’s body, stopping the production of proteins that cause a terribly painful rare disease. A crucial, late-stage clinical trial showed that the drug works — and that it’s safe. And now the biotech company behind it, Alnylam, is poised to bring this first-of-its-kind therapy to market. (Keshavan, 10/5)

NPR: Gov. Brown To Sign Or Veto Controversial Drug Price Law
Insurers, hospitals and health advocates are waiting for Gov. Jerry Brown to deal the drug lobby a rare defeat, by signing legislation that would force pharmaceutical companies to justify big price hikes on drugs in California. "If it gets signed by this governor, it's going to send shock waves throughout the country," said state Sen. Ed Hernandez, a Democrat from West Covina, the bill's author and an optometrist. "A lot of other states have the same concerns we have, and you're going to see other states try to emulate what we did." (Dembosky, 10/4)

Administration News

Behind The Scenes: How The Tom Price Story Unfolded

Politico reporters describe what went into tracking former HHS Secretary Tom Price's use of chartered jets. In other news, House Democrats want details on White House adviser Kellyanne Conway's trips.

Politico: How We Found Tom Price’s Private Jets
The first tip came from a casual conversation with a source back in May: Health and Human Services Secretary Tom Price was using private jets for routine travel, possibly in violation of federal travel rules that allowed such flights only when commercial options weren’t available. But it was a tip and little else – no times, no names of charter services and not even a schedule from a notoriously secretive cabinet secretary. (Diamond and Pradhan, 10/4)

The Hill: Cummings Demands Documents About Conway's Flights With Price
The top Democrat on the House Oversight Committee wants details from the White House about any private jet trips counselor Kellyanne Conway took with former Health and Human Services (HHS) Secretary Tom Price. In a letter to Conway, Rep. Elijah Cummings (D-Md.) asked for documentation related to all of the private, noncommercial, or military flights she’s taken since joining the Trump administration. (Weixel, 10/4)

Public Health And Education

Being Taken To Level 1 Trauma Center Can Boost Survival Rate By Up To 30 Percent

Las Vegas only has one of these "gold standard" centers, but it's not the only big city to have so few. Experts say that in situations such as Sunday's mass shooting what matters most is not the number of high-level centers, but the degree of coordination across a region's medical network.

USA Today: Is Your Area Prepared In The Event Of Mass Casualties, Disaster?
While the entire state of Nevada has only one Level 1 trauma center, determining whether it or other cities can cope with a disaster like Sunday's Las Vegas shooting rampage there depends on more than mere numbers. Health care systems' ability to treat mass injuries and casualties depend upon the number and type of hospitals, their capacity and preparedness and system wide plans to coordinate the response, emergency care experts say. (O'Donnell, 10/4)

Kaiser Health News: Las Vegas Faced A Massacre. Did It Have Enough Trauma Centers?
Las Vegas is not only a glittering strip of casinos and hotels but a fast-growing region with more than 2 million residents — and one hospital designated as a highest-level trauma center. The deadly shooting Sunday that killed at least 59 and sent more than 500 people to area hospitals raised questions about whether that’s enough. (Appleby and Galewitz, 10/4)

NPR: Why Counting Gunshot Victims In Las Vegas Is Challenging
Dr. Christopher Fisher was working at Sunrise Hospital and Medical Center just off the Las Vegas strip on Sunday evening when the patients starting arriving. "It did look a bit like a war zone, can't say that it didn't," he remembers. "Frantic families, blood in the hallways." People came in so grievously injured and so many at a time that Fisher, who is the medical head of trauma services for the hospital, and his colleagues used markers, writing directly on patients, to do triage. (Hersher, 10/4)

The Washington Post: Why Blood Donations Spiked After Las Vegas Mass Shooting
It happens after every disaster, whether natural or human-made. Before the floods recede or the crime tape is removed, hundreds will line up to donate their blood. Less than 24 hours after the mass shooting in Las Vegas, a line of people twisted from a blood center around several city blocks. According to one woman's tweet, it took seven hours or more to get to the front of the line. Time and time again it's the same story. When two bombs shredded scores of runners and fans at the 2103 Boston Marathon, media outlets reported that some participants who had crossed the finish line kept running — right to Massachusetts General, around the corner, to donate blood. (Nutt, 10/4)

Stat: Nevada's Mental Health System Was In Dire Straits. Then Came Las Vegas
Nevada’s mental health system was already overstretched before the carnage on Sunday night at a country music festival here. Now, thousands of victims, survivors, and their loved ones — as well as first responders and local workers who witnessed the horror — are expected to need mental health services in the coming weeks and months. ... Nevada ranked last in the U.S. by measures of access to mental health care in a report released last year by the nonprofit group Mental Health America. Mental health professionals in the state said they’re routinely forced to turn patients away or add them to the end of long waiting lists. (Robbins, 10/4)

In Effort To Slow Opioid Epidemic, Cigna Drops Coverage For OxyContin

Instead, the insurer will cover Xtampza ER, which it calls an “oxycodone equivalent with abuse deterrent properties." In other news on the nation's drug crisis: federal officials look to Buffalo's opioid crisis intervention court as a potential model; a Texas county is the latest to sue drug companies for their alleged role in the epidemic; researchers turn to virtual reality for pain solutions; and more.

Stat: Cigna Says It Won't Cover OxyContin Prescriptions Through Employer Plans
The health insurer Cigna on Wednesday announced it will no longer cover OxyContin prescriptions for customers on its employer-based health plans, the second major announcement in two weeks from an industry group billed as an effort to slow the opioid epidemic. Cigna also announced its intent to reduce opioid use among its consumers by 25 percent by 2019. Insurance consumers who have started OxyContin use for cancer or hospice care are exempt from the policy change. (Facher, 10/4)

NPR: Experimental Court In Buffalo Takes New Path With Opioid Addicts
There's about 10 feet between Judge Craig Hannah's courtroom bench and the wooden podium where a defendant stands to be arraigned here in Buffalo City Court. But for 26-year-old Caitlyn Stein, it has been a long, arduous 10 feet. "This is your first day back! Good to see you!" Judge Hannah says as he greets her. (Westervelt, 10/5)

Houston Chronicle: Texas County Sues Drug Companies Amid Opioid Crisis 
A Texas county is suing pharmaceutical companies over their role in the opioid epidemic. The suit, filed on Sept. 29 by a Dallas lawfirm on behalf of Upshur County, is the first of its kind in Texas, and joins a growing number of legal actions taken by governments amid a worsening national health crisis related to painkillers. It accuses more than a half-dozen pharmaceutical companies and their affiliates of using "now-debunked studies" to push for more access to powerful painkillers. (Downen, 10/4)

Texas Tribune: East Texas County Sues Drug Companies, Alleges Role In Opioid Crisis
An East Texas county is suing a slew of prescription painkiller manufacturers and distributers in federal court, accusing them of fueling an opioid addiction epidemic that has gripped communities across the nation — in part by allegedly inflating the drugs' benefits in treating chronic pain and downplaying the addiction risks. (Malewitz, 10/4)

PBS NewsHour: Twitter Chat: Americans Are Pessimistic About The Opioid Crisis. What Does That Mean For A Solution?
A recent PBS NewsHour/Marist poll showed that Americans consider opioid addiction a “serious and growing” problem. And they don’t foresee the crisis improving without intervention. The poll, released in partnership with the Marist Institute for Public Opinion, also showed Americans are largely split on who is to blame for the epidemic — the government, the healthcare field or pharmaceutical companies — and are even less sure who should be responsible for solving the crisis. (Strum, 10/4)

'Tobacco Nation': Deep South, Midwest States Lag Behind Rest Of U.S. In Cutting Smoking Rates

"It looks more like a part of the developing world than it looks like the United States of America," Robin Koval, president of the Truth Initiative which released the report, says of the 12 states. In other public health news: blood pressure, a mysterious illness, domestic violence and rare genetic diseases.

Bloomberg: These U.S. States Still Smoke More Than Any Others
The average smoking rate in the U.S. has declined significantly over the past several decades. That’s the good news. The bad news is that a group of 12 contiguous states in the Deep South and Midwest is lagging behind. Referred to as “Tobacco Nation” in a new report from the Truth Initiative, an anti-smoking group, the region consists of Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Tennessee and West Virginia.  In those states, 22 percent of adults smoke, compared with 15 percent in the rest of the U.S., giving the area the highest concentration of smokers in the nation. (Kaplan, 10/4)

The New York Times: Saunas May Be Good For Blood Pressure
A Finnish study suggests that regular sauna visits can reduce the risk for high blood pressure. The study, in the American Journal of Hypertension, included 1,621 middle-aged men with normal blood pressure who were followed for an average of 25 years. During that time, 251 developed hypertension. (Bakalar, 10/3)

Kaiser Health News: Moms Of Children With Rare Genetic Illness Push For Wider Newborn Screening
Kerri De Nies received the news this spring from her son’s pediatrician: Her chubby-cheeked toddler had a rare brain disorder.She’d never heard of the disease — adrenoleukodystrophy, or ALD — and she soon felt devastated and overwhelmed. “I probably read everything you could possibly read online — every single website,” De Nies said as she cradled her son, Gregory Mac Phee. “It’s definitely hard to think about what could potentially happen. You think about the worst-case scenario.” (Gorman, 10/5)

State Watch

State Highlights: Texas Health Officials' Salaries Draw Fire; Most Conn. Hospitals In The Black, But Still Feel Like They're Struggling

Media outlets report on news from Texas, Connecticut, Michigan, California, Arizona, Oregon, Massachusetts, Georgia, Illinois, New Hampshire and Ohio.

Dallas Morning News: Executives Have Received Big Pay Raises At Social Services Agency That's Under Fire 
Under Gov. Greg Abbott, more and more top officials at Texas' social services superagency command big salaries. Not counting staff physicians, the Health and Human Services Commission has 11 administrators making $200,000 a year or more. A decade ago, there were none. When Abbott took office in January 2015, there were just three. Over the past 13 months, 10 top commission officials have received five-digit raises — of between $10,000 and $72,000 apiece, according to a review by The Dallas Morning News of open records. Most of the huge pay bumps, if not all, resulted from promotions. (Garrett, 10/5)

The CT Mirror: More CT Hospitals End 2016 In The Black But Fiscal Picture Mixed
Twenty of the 28 hospitals in Connecticut had positive total margins — meaning they were in the black — in the 2016 fiscal year, up from 17 the year before, according to a report by the state Office of Health Care Access. Despite the clear majority with positive margins, however, some hospitals still struggled in the fiscal year that ended on Sept. 30, 2016. (Rigg, 10/5)

The Associated Press: Ex-Official: Legionnaires’, Flint Water Were Thorny Issues
Michigan’s former head of disease control said Wednesday that an outbreak of Legionnaires’ disease in the Flint area was a sensitive topic at the same time that Gov. Rick Snyder’s administration was being challenged over water quality in the poor city. Corinne Miller returned to the witness stand at a key court hearing involving her former boss, Nick Lyon, the head of the Department of Health and Human Services. He’s charged with involuntary manslaughter in the death of an 85-year-old man who was treated for Legionnaires’ six months before he succumbed to congestive heart failure in 2015. (10/4)

The Associated Press: Michigan Lawmakers Vote To Preemptively Ban Soda, Food Taxes
Michigan lawmakers voted Wednesday to prohibit local taxes on food, drinks and gum in a pre-emptive strike against any municipality that might consider levying a tax on soda and other sugary and artificially sweetened items. No local government in Michigan is now considering such a tax. But majority Republicans said it is possible, pointing to Philadelphia and the Chicago area as places with soda taxes. Similar taxes have been approved in San Francisco and Oakland, California. (Eggert, 10/4)

Los Angeles Times: San Diego Hepatitis Outbreak Continues To Grow: 481 Cases
Add 20 more cases and 22 more hospitalizations to San Diego County’s ever-growing hepatitis A outbreak.Tuesday afternoon the county Health and Human Services Agency raised the number of the outbreak’s confirmed cases to 481 from 461 and hospitalizations to 337 from 315. The death count associated with the outbreak, which started in November 2016, remained at 17 for a second straight week. (Sisson, 10/4)

Arizona Republic: Arizona's Foster-Care Complaint Now A Class-Action Lawsuit
U. S. District Court Judge Roslyn Silver granted class-action status in the litigation, filed 2 ½ years ago against the state, on behalf of a number of foster children. ... In August, 900 children entered the system when they were removed from their homes due to allegations of abuse and neglect, according to the Department of Child Safety. (Pitzi, 10/3)

The Washington Post: A Mother Refused To Follow A Court Order To Vaccinate Her Son. Now She’s Going To Jail.
A Michigan woman will spend seven days in jail after she defied a judge’s order to have her 9-year-old son vaccinated. Rebecca Bredow was sentenced for contempt of court Wednesday, nearly a year after an Oakland County judge ordered her to have her son vaccinated. Bredow had been given until Wednesday to get her son the medically allowed amount of vaccination, which would be up to eight vaccines. But the Detroit area mother, citing her religious beliefs, had refused to do so. (Phillips, 10/4)

The Oregonian: State Fails To Protect Frail Residents From Potential Harm, Audit Finds 
A state-funded program that aims to help elderly low-income people and those with disabilities get care to stay in their homes has failed to fully protect them from potential harm, an audit by the Secretary of State's Office said Tuesday. The report said the Oregon Department of Human Services should take "immediate action" to improve oversight to guarantee "the safety and well-being" of those using the consumer-employed provider program. (Terry, 10/4)

The Washington Post: Prosecutors Slammed For ‘Lack Of Moral Compass,’ Withholding Evidence In Widening Mass. Drug Lab Scandal
Twice in recent years, chemists used by the state of Massachusetts to test drugs in criminal cases committed massive misconduct in their testing, affecting tens of thousands of cases. And twice, prosecutors in Massachusetts failed to act promptly to notify most defendants of the problem. Instead, the prosecutors have taken years to seek justice for the defendants affected by the bad drug testing in both episodes, causing some people to wrongly spend years in prison. (Jackman, 10/4)

Chicago Sun Times: Little Company Of Mary Hospital To Join Rush System 
Little Company of Mary Hospital will join the Rush system under a nonbinding letter of intent announced Wednesday by officials of the two health care organizations. Little Company of Mary Hospital is an Evergreen Park, Ill. community hospital with 272 beds. The hospital is one of 12 locations in the south and southwest suburbs. It employs more than 2,000 employees. Little Company would remain a Catholic ministry, the organizations said. (Ruminski, 10/4)

Houston Chronicle: Four Houston-Area Hospitals Reach $8.6M Settlement Over Ambulance-Swapping Allegations 
The U.S. Justice Department has reached an $8.6 million settlement with a hospital company following whistleblower allegations that four of the company's Houston-area hospitals pressured ambulance companies into swapping cheap rides for some patients in exchange for lucrative opportunities to shuttle other patients, federal authorities confirmed. The hospitals area all affiliated with the Hospital Corporation of America, based in Nashville, which agreed to the settlement, according to a Justice Department announcement on Wednesday. (Banks, 10/4)

New Hampshire Union Leader: Police Probe Claims Against Suspended Physician
Claremont police have launched an investigation into sexual assault allegations against Dr. Eric Knight, the Claremont physician whose license was quickly suspended last month once a former patient told her allegations of unwanted sex to state medical investigators. Claremont Police Chief Mark Chase said he started the investigation after receiving material about Knight in the mail from the New Hampshire Board of Medicine. He stressed the investigation will take time. (Hayward, 10/4)

San Jose Mercury News: San Jose Sobering Center Opens With High Hopes
Santa Clara County’s newest stab at reducing public drunkenness — a state-of-the-art “sobering station’’ — opened its doors in a room in county’s Reentry Center for former inmates, across from a police parking lot. Beginning with Sunnyvale, Campbell and the sheriff’s office, officers can drop off severely intoxicated but otherwise mellow people to dry out — at what officials hope will be a cheaper cost to taxpayers than an emergency room or jail. (Kaplan, 10/4)

Editorials And Opinions

Thoughts On A Washington Agenda: CHIP Funding, Medicare's Safety Net, Medicaid And The ACA

Writers around the country offer some insights into Washington's efforts on health policy.

The Houston Chronicle: Renew CHIP Even Though Kids Don't Make Campaign Donations
Maybe Congress thinks that kids won't need to see the doctor. Asthma cases will clear up, tumors will spontaneously go into remission and sick days from school will become a thing of the past. That must be what's going on up in Washington, because we can't think of any other reason why Congress would have let the Children's Health Insurance Program expire at the end of last month. The federal-state insurance program helps guarantee that kids in low- and middle-income families don't go without important health care. (10/4)

The Baltimore Sun: Congress Can't Even Handle Health Care For Kids
The fate of the Affordable Care Act may be deeply divisive, but there’s one aspect of the health care system that retains broad support across the political spectrum — the Children’s Health Insurance Program. ... But Congress is so screwed up that, as of last weekend, it allowed the program to expire. A bipartisan deal was in the works in the Senate, but Republicans in both chambers got distracted by yet another attempt to repeal the Affordable Care Act, and the deadline to re-authorize funding for CHIP passed on Saturday. (10/3)

Arizona Republic: CHIP Funding Vote In Congress Puts 22,000 Arizona Kids At Risk
Our leaders allowed funding for the Children’s Health Insurance Program – in Arizona, we call it KidsCare – to expire on Saturday, the end of the federal budget year. While many states have enough in reserve to cover until next summer, Arizona is among 10 states set to run out of money by the end of the year, according to the Kaiser Family Foundation. (Laurie Roberts, 10/4)

The Hill: Unjust GOP Budget And Tax Plan Cuts The Safety Net For Seniors
Tomorrow the House will vote on its 2018 budget resolution. Leadership says it has the votes to pass. That’s unfortunate, as it signifies that a majority of House Republicans favor a Robin Hood-in-reverse budget that cuts programs for the poor and elderly to give tax cuts to the rich. ... One has to wonder why, at a time of the worst wealth and income inequality since the 1920s, the party in power wants to shower the top 1 percent and profitable corporations with tax breaks — paid for by slashing safety net programs. (Max Richtman, 10/4)

Forbes: Better Medicare For Those With Chronic Disease
The Senate has quietly and unanimously passed a bill that would improve some Medicare benefits for people with chronic disease. The measure would do many good things but the most important is this: It would take important steps toward breaking down the wall between medical treatment and non-medical supports and services in Medicare, beginning a process that would make it much easier for frail seniors to receive the right care when they need it. (Howard Gleckman, 10/4)

Chicago Tribune: Medicaid Still A Target Of Health Care Reform
Despite its importance to so many people, Medicaid has always been the health system's stepchild. Many doctors and dentists have avoided taking Medicaid patients saying the program didn't pay enough. Until recently, editors haven't been keen to feature stories about Medicaid believing that their audience was not interested in reading about people most likely to be on the program — the poor, the disabled, kids, and seniors who needed it to pay for their nursing home care. ... So what is this program that affects so many and will undoubtedly surface again either later this year or next as a political football? (Trudy Lieberman, 10/4)

Forbes: Iowa, Where The ACA Is Failing Massively, Tries A Creative But Unlawful Fix
The inherent architectural problems of the Affordable Care Act, coupled with the failure of the Trump administration to prop it up vigorously, has left the individual health insurance market in shambles in many states. One of the states suffering greatly is Iowa. The plan Iowa has developed to salvage its insurance market -- the Iowa Stopgap Measure -- suffers three major flaws, however. (Seth Chandler, 10/4)

Viewpoints: Puerto Rico's Public Health Crisis; Make School Lunches Free; The Noble Fruit Fly

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

NBC News: After Hurricane Maria, Let’s Avoid A Man-Made Disaster In Puerto Rico
Since Maria leveled the island, under a third of its residents have a sporadically working phone. Fewer than half of the hospitals are open. The majority of the island still lacks electricity, running water or food. People are spending hours in line to get gas to fill up their cars or diesel if they have generators. Others spend hours in line in front of supermarkets, trying to find water and something to eat. And lastly, many others are in towns still unable to communicate with anyone in the island, much less the rest of the world. Although it is our hope that this urgent situation can be quickly resolved, it is possible that this could be the beginning of a dire public health crisis for the island. (Jaime Farrant, 10/2)

Des Moines Register: Why School Lunches Should Be Free To All
Teachers noticed when some students at Southview Middle School in Ankeny were not eating lunch. When those teachers found out negative balances in lunch accounts were to blame, they started a fundraiser and donated about $1,500. Such initiative and generosity deserve recognition. It should serve as an example to all of us. Yet charity should not be necessary when it comes to school lunch. (10/4)

The New York Times: Another Nobel Prize For The Fruit Fly
Five Nobel Prizes have now been awarded to science originating from fruit fly research. ... Learning about human health from fruit flies may sound like a stretch — indeed, Sarah Palin mocked it during the 2008 presidential campaign — but it exemplifies a type of scientific inquiry called “basic research.” ... Unfortunately, investment in this important work is under threat. This year, President Trump proposed budget cuts of 22 percent for the National Institutes of Health and 11 percent for the National Science Foundation. These two institutes fund most basic biological research in the United States. Congress pushed back, but some congressmen question the value of this kind of work, calling instead for funding that directly looks for cures for human disease. (David Bilder, 10/4)

The New York Times: Sex, Sanctimony And Congress
Our topic for today is hypocrisy. The scene is — where else? — Congress. This week the House of Representatives voted 237 to 189 to make it a crime for a doctor to perform an abortion on a woman who has been pregnant more than 20 weeks. Victory for the anti-choice forces. One of whom was apparently very interested in maintaining all options when he thought his own girlfriend was expecting. Meet Tim Murphy, a Republican congressman from the Pittsburgh suburbs. ... Murphy is a co-sponsor of the anti-abortion bill. (Gail Collins, 10/4)

Los Angeles Times: Bill Would Limit Access To Critical Medications And Aid For Californians
California families are struggling to afford the cost of their healthcare and many are being forced to make tough decisions about whether to take their medications or pay for rent, food, or other day-to-day expenses. A bill currently on the governor’s desk would make things worse by limiting access to critical coupons — assistance that could mean the difference between life and death for vulnerable patients. (Dr. Gustavo Alvo, 10/4)

Stat: 12-Step Meetings Should Stop Shunning Medication-Assisted Therapy
These programs are making the opioid crisis worse by making recovery from opioid addiction harder than it already is. By turning their backs on people like me on medication-assisted therapy to kick opioid addictions, these programs are prolonging addiction and contributing to overdose deaths. (Elizabeth Brico, 10/4)