KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Kaiser Health News Original Stories

Preexisting Conditions And Continuous Coverage: Key Elements Of GOP Bill

The Republican health plan would require insurers to offer coverage to people who have preexisting medical conditions. But if states opt to allow insurers to charge sick people more than healthy ones, people who have been more than 63 days without coverage could see significantly higher insurance costs. (Michelle Andrews, 5/16)

Segregated Living Linked To Higher Blood Pressure Among Blacks

Blood pressure for African-Americans who moved permanently out of segregated areas into medium-segregation locations decreased on average nearly 4 points while those who went to low-segregation locales dropped almost 6 points, a 25-year study finds. (Carmen Heredia Rodriguez, 5/15)

Political Cartoon: 'Part And Parcel?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Part And Parcel?'" by John Deering.

Here's today's health policy haiku:


Mick takes on drug costs
Not with more competition,
But with price-setting.

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:

Health Law

Preexisting Conditions Took Spotlight In House Debates, But Medicaid Moves To Center Stage In Senate

Senators are searching for trade-offs in an effort to save the health law's Medicaid expansion.

The New York Times: Medicaid Expansion, Reversed By House, Is Back On Table In Senate
Senate negotiators, meeting stiff resistance to the House’s plans to sharply reduce the scope and reach of Medicaid, are discussing a compromise that would maintain the program’s expansion under the Affordable Care Act but subject that larger version of Medicaid to new spending limits. With 62 senators, including 20 Republicans, coming from states that have expanded Medicaid under the Affordable Care Act, the House’s American Health Care Act almost certainly cannot pass the Senate. (Pear, 5/15)

POLITICO Pro: Senate Republicans Aim For Medicaid Compromise In Repeal Talks 
Sens. Rob Portman and Pat Toomey have been trying to strike a compromise that bridges disagreements between Republican moderates who want to keep Medicaid expansion and conservatives who want to rapidly eliminate it and rein in spending. The two senators have discussed proposals to significantly alter the Medicaid provisions of the House’s Obamacare repeal bill, which capped the program's funding and phased out its expansion. (Pradhan, 5/15)

Meanwhile, moderates from both sides of the aisle came together on Monday to talk health care —

The Associated Press: Senate Moderates Hold Bipartisan Health Care Talks
Moderate senators from both parties met Monday to explore whether they can work on bipartisan legislation overhauling the nation's health care system. The evening session came as Republican senators have begun closed-door meetings aimed at crafting a GOP bill scuttling much of President Barack Obama's health care law. (5/15)

The Hill: Senators Huddle In Capitol To Explore Bipartisan Path On ObamaCare 
A bipartisan group of senators met in the Capitol on Monday night to discuss whether there is a bipartisan way forward on healthcare reform. The meeting was organized by Sens. Susan Collins (R-Maine) and Bill Cassidy (R-La.), who have put forward a more centrist healthcare plan that would allow states to keep much of ObamaCare in place if they choose. While senators said the meeting was preliminary and just discussing ideas broadly, the push for a bipartisan solution could potentially emerge as an alternative to the Republican-only repeal and replace approach from leadership. (Sullivan, 5/15)

Health Industry, Shunted To Sidelines In House Negotiations, Eager For A Chance At The Senate

Meanwhile, under the reconcilliation process that Republican lawmakers are using to dismantle the Affordable Care Act, each provision they change has to be directly related to the budget. But Sens. Ted Cruz (R-Texas) and Rand Paul (R-Ky.) argue that the rules aren't set in stone.

Bloomberg: Shut Out By House GOP, Industry Pins Health Bill Hopes On Senate 
The health-care world is gearing up for a lobbying offensive to persuade Republican U.S. senators to address their problems with an Obamacare replacement that was conceived in the House in a virtual vacuum. Insurers, doctors, patient groups and most health-care experts are pinning their hopes on the Senate being more receptive after House Republicans -- led by Speaker Paul Ryan -- deliberately avoided discussing their plans with the main groups that would be affected by repealing the 2010 law. (House, Edney and Edgerton, 5/16)

Politico: Cruz, Paul Want To Go ‘Nuclear’ On Obamacare Repeal
Conservative GOP Sens. Ted Cruz and Rand Paul are pushing to test the limits of how much of Obamacare can be repealed under Senate rules, setting up a potential “nuclear” showdown. The firebrands want to overturn long-standing precedent for what can be done under reconciliation, the fast-track budget process the GOP is using to dismantle the Affordable Care Act. They argue Republicans are allowing stale Senate norms to tie their hands and are forfeiting a chance to completely abolish the law. (Haberkorn and Kim, 5/16)

Roll Call: Trump Feels ‘Very Strong’ About House Health Bill
The White House fired a shot across the Senate’s bow Monday, signaling President Donald Trump feels “very strong” about the health overhaul passed by the House. Several Senate groups, including one composed of Republicans and Democrats, are holding talks about how to alter the House measure or craft an entirely new bill. But just as senators return to Washington to get back to work, Press Secretary Sean Spicer walked a tightrope about what Trump wants them to pass. (Bennett, 5/15)

In related news, a look at the Wisconsin high-risk pool that House Speaker Paul Ryan (R-Wis.) uses to counterattack criticisms of the concept; what the deal is with preexisting conditions and continuous coverage; Trump administration rhetoric; and how efforts to improve the uninsured rate have stalled —

Milwaukee Journal Sentinel: Paul Ryan Touts Wisconsin High-Risk Insurance Pool To Counter Attacks On House Bill
U.S. House Speaker Paul Ryan (R-Wis.) has touted Wisconsin’s former high-risk insurance pool to counter concerns that some of those people could be priced out of the market under the health care bill recently passed by the House. The state’s Health Insurance Risk-Sharing Plan, known as HIRSP, was considered a model. But it was an exception, not the norm — and it worked only for people who could afford insurance in the first place. (Boulton, 5/15)

Boston Globe: Maine Health Care Advocates Demand To Know: Where’s Bruce?
Representative Bruce Poliquin was hard to find the week after casting his vote in Washington to repeal the Affordable Care Act and slash Medicaid spending. So when 30 or so unhappy Mainers descended on his district office in this old mill town, they brought a 5-foot-tall poster version of the Republican lawmaker and stood it in front of the building where they say the real Poliquin will not meet with them. (McGrane, 5/15)

Kaiser Health News: Preexisting Conditions And Continuous Coverage: Key Elements Of GOP Bill
Before he was diagnosed with head and neck cancer in 2015, Anthony Kinsey often went without health insurance. He is a contract lawyer working for staffing agencies on short-term projects in the Washington, D.C., area, and sometimes the 90-day waiting period for coverage through a staffing agency proved longer than the duration of his project, if coverage was offered at all. When Kinsey, now 57, learned he had cancer, he was able to sign up for a plan with a $629 monthly premium because the agency he was working for offered group coverage that became effective almost immediately. (Andrews, 5/16)

WBUR: OMB Director Says GOP Health Bill Shouldn't Cover Diabetics Who Eat Poorly 
Mick Mulvaney, director of the Office and Management and Budget, told a Stanford University forum that the GOP health care bill should cover some pre-existing conditions, but not others. Asked about late night comedian Jimmy Kimmel's statement that "no parent should ever have to decide whether they can afford to save their child's life," Mulvaney said that he agreed, but "that doesn't mean that we want to take care of the person, or should be required to care of the person, who sits at home, drinks sugary drinks, and doesn't exercise, and eats poorly and gets diabetes." (Young, 5/15)

The Associated Press: Gov't Report: Efforts To Reduce US Uninsured Stalled In 2016
After five consecutive years of coverage gains, progress toward reducing the number of uninsured Americans stalled in 2016, according to a government report that underscores the stakes as Republicans try to roll back Barack Obama's law. The Centers for Disease Control and Prevention estimated that 28.6 million people were uninsured last year, unchanged from 2015. The uninsured rate was 9 percent, an insignificant difference from 9.1 percent in 2015. (Alonso-Zaldivar, 5/16)

In Latest Move To Roll Back Health Law, Administration Dismantles Small-Business Marketplace

Relatively few people will actually be affected by the decision, but it shows the direction in which the administration wants to go.

The Washington Post: Trump Administration To Dismantle Small-Business Part Of ACA Marketplaces
The Trump administration said Monday that it will dismantle part of the Affordable Care Act that created online insurance marketplaces for small businesses and tried to foster a greater choice of health plans for their workers. Moving to end the ACA’s small-business enrollment system by 2018 represents the first public step by the Health and Human Services Department to implement an executive order President Trump signed his first night in office, directing agencies to ease regulatory burdens of the health-care law. (Goldstein, 5/15)

The Wall Street Journal: White House Closes A Health-Care Enrollment Option
Under the ACA, employers with as many as 50 workers could sign up for small-group plans through the Small Business Health Options Program, often called SHOP, where some employers could qualify for tax credits to lower premiums. As the exchange was originally envisioned, small employers could use the platform to make contributions to their employees’ health coverage, allowing workers to pick which plans they preferred. But the health law’s small-business tax credits proved insufficient to attract a large number of employers to the SHOP exchange, and most small-business owners shunned the federally run marketplaces in favor of working with private brokers. (Hackman, 5/15)

Morning Consult: CMS To Let Small Businesses Bypass Obamacare Marketplace
Firms could still be eligible to utilize the 2010 law’s Small Business Tax Credit, even if the plan was obtained outside the SHOP marketplaces, said Sabrina Corlette, a professor at Georgetown University’s Center on Health Insurance Reforms. “What the feds are trying to do here is say: ‘Even though there’s no real SHOP because we can’t get any carriers to participate, you can still get the small business tax credit,’” she said in a phone interview. (Reid, 5/15)

Administration News

Trump's Abortion 'Gag Rule' Will Block $8.8B In Aid To Fight Malaria, AIDS And Other Diseases

With the rule in place, any foreign nongovernmental group that wants American money for any of its health activities must promise not to “promote abortion as a method of family planning.”

The New York Times: Trump To Expand Funding Ban Tied To Abortion Overseas
The Trump administration said on Monday it would vastly expand the so-called global gag rule that withholds American aid from health organizations worldwide that provide or even discuss abortion in family planning. The new policy could disrupt hundreds of clinics in Africa and around the world that fight AIDS and malaria. It affects about $8.8 billion in global health funding, up from about $600 million during the administration of President George W. Bush. (Harris and Sengupta, 5/15)

The Washington Post: Trump Expansion Of Abortion ‘Gag Rule’ Will Restrict $8.8 Billion In U.S. Aid
Senior administration officials confirmed Monday that Trump’s version will impact $8.8 billion for programs, including those related to AIDS, malaria and child health. About $6 billion of that supports programs for HIV/AIDS services, primarily in Africa, as part of the President’s Emergency Plan for AIDS Relief established in 2003. Another program that could be hit hard is the President’s Malaria Initiative, started under George W. Bush and expanded under Barack Obama. Defense Department grants related to global health security will also be impacted. The new policy, which is being called “Protecting Life in Global Health Assistance,” affects any organization deemed to promote abortion “as a method of family planning” through abortion counseling, referrals, lobbying or public information campaigns. Trump has said taxpayer dollars should not be used for this purpose. (Cha and Morello, 5/15)

The Wall Street Journal: Health Sector Prepares For Antiabortion Policy’s Impact On HIV/AIDS Fight
How the new policy will affect the U.S. war on HIV/AIDS overseas will depend in part on which foreign nongovernmental organizations sign the new clause to receive PEPFAR funding, a senior State Department official said. The official said that the detailed data PEPFAR regularly collects on the use of its funding would be watched closely for signs that its reach is either being restricted or expanding. “Secretary [Rex] Tillerson wanted to assure that we are carefully following implementation to be able to see if there is an unforeseen impact on our delivery of services,” the senior State Department official said. “These are lifesaving service-delivery programs that need to be performing at the highest level.” (McKay, 5/16)

Cleveland Plain Dealer: Anti-Abortion Groups Praise New Trump Policy Further Restricting Foreign Aid On Abortion Grounds 
Anti-abortion groups praised a Trump administration policy announced Monday that will vastly expand abortion-related foreign aid restrictions by blocking money from more organizations. Past implementations of the Mexico City policy affected $500 to $600 million in yearly funds administered by the State Department and U.S Agency for International Development (USAID). The State Department's new "Promoting Life in Global Health Assistance" policy will affect $8.8 billion administered by all federal departments or agencies. (Eaton, 5/15)

Credentials Of Trump's Anticipated Choice To Be USDA 'Chief Scientist' Questioned

ProPublica reports that Sam Clovis, who is expected to be named undersecretary of the agency's department that manages research on everything from climate change to nutrition, has never taken a graduate course in science. In other Trump administration news, the Cleveland Clinic plans to continue to hold its annual Florida fundraiser at Mar-A-Lago, despite some complaints.

ProPublica: Trump’s Expected Pick For Top USDA Scientist Is Not A Scientist 
The USDA’s research section studies everything from climate change to nutrition. Under the 2008 Farm Bill, its leader is supposed to serve as the agency’s “chief scientist” and be chosen “from among distinguished scientists with specialized or significant experience in agricultural research, education, and economics.” But Sam Clovis — who, according to sources with knowledge of the appointment and members of the agriculture trade press, is President Trump’s pick to oversee the section — appears to have no such credentials. (Huseman, 5/12)

Stat: Cleveland Clinic Plans To Return To Trump's Mar-A-Lago For Fundraiser
The Cleveland Clinic intends to return to President Trump’s Palm Beach home for its annual Florida fundraiser, despite calls from some within the hospital’s community to stay away. ... The Cleveland Clinic has held a fundraiser at the Mar-a-Lago club for the past eight years, but this year’s event came soon after Trump’s January executive order on immigration, which prevented a Cleveland Clinic doctor from returning to the country, prompting protests and calls for the February fundraiser to be moved or canceled. (Swetlitz, 5/15)


Former Insurance Executive Details How Companies 'Rigged' Medicare Payments

In an interview with The New York Times, former UnitedHealthcare official Benjamin Poehling talks about his allegations that Medicare Advantage plans would list patients as very sick to get better federal payments. In other Medicare news, some groups representing health care providers are asking federal officials to give more consideration to the process of removing Social Security numbers from Medicare ID cards and John Oliver uses his show to skewer a dialysis provider.

The New York Times: A Whistle-Blower Tells Of Health Insurers Bilking Medicare
When Medicare was facing an impossible $13 trillion funding gap, Congress opted for a bold fix: It handed over part of the program to insurance companies, expecting them to provide better care at a lower cost. The new program was named Medicare Advantage. Nearly 15 years later, a third of all Americans who receive some form of Medicare have chosen the insurer-provided version, which, by most accounts, has been a success. But now a whistle-blower, a former well-placed official at UnitedHealth Group, asserts that the big insurance companies have been systematically bilking Medicare Advantage for years, reaping billions of taxpayer dollars from the program by gaming the payment system. (Walsh, 5/15)

Modern Healthcare: Medicare ID Overhaul Sparks Fears Of Patients Being Denied Care
Providers warned the CMS on Thursday that its plan to remove Social Security numbers from Medicare ID cards could cause patients to be denied care. The American Medical Association, American Academy of Family Physicians and several other provider groups on Thursday called on the CMS to undergo a formal rulemaking process before changing Medicare ID cards so providers can weigh in on the transition plan. (Dickson, 5/15)

Stat: John Oliver Riffs On Dialysis Controversies On 'Last Week Tonight'
After imploring viewers to not press the “Dear God Literally Anything Else” button on their remotes, comedian John Oliver devoted most of Sunday’s “Last Week Tonight” to the for-profit dialysis industry. The segment focused on one of the country’s largest providers, DaVita, which has settled lawsuits about kickbacks to physicians, Medicare billing discrepancies, and the overuse of a medication. (Oliver also spends some time ruminating about DaVita CEO Kent Thiry’s personal eccentricities, such as making dramatic entrances riding a bicycle or horse while wearing a medieval costume.) (Sheridan, 5/15)

The Washington Post: John Oliver On Kidney Dialysis, Taco Bell And Death
Megallan Handford, a former DaVita nurse who claims he was fired for trying to unionize its employees, told Oliver the company's focus “was all about numbers,” sometimes at the expense of patient safety. “When I was working at DaVita, the priorities for transitioning patients was to get them on dialysis and get the next patient on as soon as possible,” Handford told Oliver. “You would have sometimes 15, maybe 25 minutes to get that next patient on the machine, so you were not properly disinfecting.” (Wang, 5/15)


For Medicaid Enrollees In Maine, Concerns Grow About Possible Cuts In Funding

Families that depend on the federal-state health care program for low-income residents fear that changes championed by congressional Republicans could undermine coverage, especially for people with disabilities and seniors who need long-term care. Also, Illinois officials are preparing to shake up which companies provide managed care services for the state's Medicaid program.

Maine Public: Already Financially Stressed, Maine Caregivers Fear Medicaid Cuts In AHCA
Under the Republican-backed health care plan passed by the U.S. House earlier this month, the federal Medicaid program would undergo a major overhaul. States would receive a fixed amount of money for the program, versus the open-ended federal support they now get. Supporters of the American Health Care Act say the change would control spending and give states more flexibility. But opponents argue that it will result in cuts to care. In terms of sheer numbers, low-income children and adults account for most of the people enrolled in Medicaid. But that’s not where most of the program’s costs go to — they go to people like Evan Klane of Fairfield. ... When Evan was born 26 years ago, he experienced birth trauma. (Wight, 5/15)

Chicago Tribune: 4 Insurers Out Of Running For Rauner's Medicaid Overhaul 
Illinois Medicaid beneficiaries are about to see a major shake-up of the program, with several insurers now out of the running to be part of Gov. Bruce Rauner's overhaul plan. On Monday, the state released a list of insurers that responded to a request for proposals to be part of Rauner's re-imagined Medicaid managed care program. In Medicaid managed care, private insurers administer Medicaid benefits, whereas the state administers benefits in traditional Medicaid. (Schencker, 5/15)


Drugmakers Would Be Required To Notify HHS, Justify Price Hikes Under New Bill

The companies would have to provide manufacturing, R&D, marketing costs, as well as net profits associated with the drugs. In other pharmaceutical news, consolidation and how it's led to higher drug prices; direct-to-consumer ads and their role in pushing drugs; and what happens when a patient's body turns against the drugs trying to save them.

Stat: Bipartisan Bill Will Be Reintroduced To Make Pharma Justify Price Hikes
A bipartisan group of lawmakers will re-introduce a bill on Tuesday that would require drug makers to justify their pricing and provide a breakdown of their expenses before raising prices on some medicines. Under the Fair Drug Pricing Act, companies will have to notify the US Department of Health and Human Services and submit a report 30 days before they increase the price of certain drugs that cost at least $100 by more than 10 percent in one year, or 25 percent over three years. The bill is being co-sponsored by Senator Tammy Baldwin (D-Wis.), Senator John McCain (R-Ariz.), and US Representative Jan Schakowsky (D-Ill.) (Silverman, 5/15)

Modern Healthcare: Consolidation Spurs Drug Price Spikes 
More consolidation among healthcare distributors and pharmacy benefit managers has led to higher drug prices, according to a new article. The major players in both the distribution market and the PBM sector dominate their markets, the article published Monday in JAMA said. As the firms grew, prices for prescription drugs swelled, the article found. (Kacik, 5/15)

Kaiser Health News: Overwrought Marketing? Ads, Not Research, Create Some Pharma Best-Sellers
An overhead light drawing attention to his face, actor Danny Glover starts to cry, dropping his head into one hand — then, he abruptly switches over to deep belly laughs, before resuming a straight face. “When I act, if I do this it’s totally in my control,” he says, getting to the point: “But for someone with pseudobulbar affect, choosing to cry or laugh may not be your decision. ”The 60-second TV advertisement, which ran widely late last year, concerns a neurological condition known by the acronym PBA, characterized by inappropriate, uncontrolled outbursts of laughing or crying. (Appleby, 5/16)

The New York Times: When The Immune System Thwarts Lifesaving Drugs
The miracle treatment that should have saved Becka Boscarino’s baby boy almost killed him. Doctors diagnosed her newborn son, Magglio, with Pompe disease, a rare and deadly genetic disorder that leads to a buildup of glycogen in the body. Left untreated, the baby would probably die before his first birthday. (Kolata, 5/15)

Meanwhile, Politico investigates lawmakers' investments in a certain biotech company that was caught up in the controversy surrounding Health and Human Services Secretary Tom Price's nomination —

Politico: Reckless Stock Trading Leaves Congress Rife With Conflicts
Even a looming scandal wouldn’t deter some of Congress’ most eager stock traders. Rep. Tom Price (R-Ga.), President Donald Trump’s nominee to be Health and Human Services secretary, was under siege, the harsh lights of a Senate hearing upon him. News reports showed he had bought shares in a tiny biotechnology company while sitting on committees that could influence the firm’s prospects. A colleague, Rep. Chris Collins (R-N.Y.), had tipped him off to the investment. (Severns, 5/14)

Women’s Health

Texas May Become Litmus Test For Banning Medicaid Funds For Planned Parenthood

After refusing federal Medicaid money so that it could ban Planned Parenthood from its family planning program, Texas is asking for the money back. If it's granted, it could be a green light for other states to do the same.

The New York Times: Texas Seeks Medicaid Money It Gave Up Over Planned Parenthood Ban
Four years after Texas gave up millions of dollars in federal Medicaid funds so it could ban Planned Parenthood from participating in a family planning program for low-income women, the state is asking the Trump administration for the money back. The request presents an important early test for the administration of President Trump, who recently appointed an anti-abortion official to oversee federal family planning programs. Under President Obama, federal health officials would not allow Medicaid funds to flow to the Texas program after it excluded Planned Parenthood, because federal law requires states to give Medicaid beneficiaries their choice of “any willing provider.” (Goodnough, 5/15)

The Associated Press: Texas Tests Trump Administration Over Abortion Providers
The stakes potentially extend far beyond Texas. Abortion-rights groups worry that if Texas succeeds, other conservative states will also cut off Planned Parenthood and put clinics in jeopardy. "There is a new administration, and we're looking at what opportunities may exist for us," said Carrie Williams, a spokeswoman for the Texas Health and Human Services Commission. (Weber, 5/15)

Health IT

Experts Race To Patch Vulnerable Health Networks Following Massive International Cyberattack

Some medical devices were infected, but primarily the latest attack reinforced the need to correct any weaknesses in medical cybersecurity systems.

The Wall Street Journal: International Cyberattack Affects Some Corners Of U.S. Health Care, Including Medical Devices
The international cyberattack that swept the globe has had some impact on the U.S. health-care system, as hospital systems scramble to prevent its further spread. On a conference call with health-care organizations Monday, U.S. federal officials said several medical devices had been infected with the ransomware that proliferated across dozens of countries, but declined to identify the devices, according to a person on the call. The Department of Health and Human Services, which organized the call, referred questions to Homeland Security, which didn’t immediately respond to a request for comment. (Evans, 5/15)

Los Angeles Times: WannaCry Cyberattack: When A Hack Shuts Down A Hospital, Who's To Blame?
It's one thing to fall victim to a burglar. It's another to realize the thief got in because you left the front door wide open. The distinction could lead to difficult legal battles for organizations affected by the WannaCry cyberattack, which crippled an estimated 300,000 of the 2 billion Windows computers worldwide in recent days, slowing factories, canceling surgeries, eating homework assignments and shuttering gas stations. (Dave and Peltz, 5/15)

In other health IT news —

Kansas City Star: Children's Mercy App Helps With Pediatric Decisions
Children’s Mercy Hospital has teamed with a local tech company to develop a smartphone app that can help doctors and nurses spot the scary cases. Russell McCulloh, an infectious disease specialist at the hospital, presented the CMPeDS: Pediatric Decision Support app to an international audience last week at the Pediatric Academic Societies Meeting in San Francisco. (Marso, 5/15)

Public Health And Education

With Opioid Crisis Continuing To Escalate Cherokee Nation Takes Drug Distributors To Court

This first-of-its-kind lawsuit takes on companies such as CVS Health, Walgreens and Wal-Mart and alleges that they did not properly monitor prescription drugs. Meanwhile, New York health officials have issued new warnings for the western part of the state regarding a weekend spike in overdose deaths associated with various drug combinations of fentanyl.

WBUR: Cherokee Nation Takes Drug Distributors To Tribal Court
As the nation’s opioid addiction and overdose crisis grows, the Cherokee Nation is launching the first-ever lawsuit against drug distributors that will be litigated in a tribal court. The suit takes on companies including pharmacies CVS Health, Walgreens and Wal-Mart, and drug distributors Cardinal Health, Inc. and McKesson Corporation, alleging that they didn’t properly monitor prescription painkillers, which eventually "flooded" every Cherokee county. (Young, 5/15)

Up To 59 Percent Of Nursing Home Residents Could Be 'Colonized' With Superbugs

The group is particularly susceptible to the dangerous germs. In other public health news: pesticides, sunscreen, teeth, c-sections, genetic testing and more.

The Wall Street Journal: The Bug Problem In Nursing Homes
There’s a bug problem in some nursing homes, and it’s not what you think. Residents of long-term care facilities are vulnerable to drug-resistant infections known as superbugs and can easily spread the deadly germs to others. (Lagnado, 5/15)

The Wall Street Journal: Where Kids Aren’t Allowed To Put On Sunscreen: In School
The Sunbeatables curriculum, designed by specialists MD Anderson Cancer Center, features a cast of superheroes who teach children the basics of sun protection including the obvious: how and when to apply sunscreen. There’s just one wrinkle. Many of the about 1,000 schools where the curriculum is taught are in states that don’t allow students to bring sunscreen to school or apply it without a note from a doctor or parent and trip to the nurse’s office. (Reddy, 5/15)

The Washington Post: The Painful Truth About Teeth
As the distance between rich and poor grows in the United States, few consequences are so overlooked as the humiliating divide in dental care. High-end cosmetic dentistry is soaring, and better-off Americans spend well over $1 billion each year just to make their teeth a few shades whiter. Millions of others rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth. Unable to afford expensive root canals and crowns, many simply have them pulled. Nearly 1 in 5 Americans older than 65 do not have a single real tooth left. (Jordan and Sullivan, 5/13)

Consumer Reports: Your Biggest C-Section Risk May Be Your Hospital
The most common major surgery performed in the U.S isn’t to remove an appendix or replace a knee. It’s to deliver babies by cesarean section, or C-section. Roughly one out of every three babies born in this country—or about 1.3 million children each year—are delivered this way, instead of vaginally. Yet the vast majority of women prefer to deliver vaginally, according to a January 2017 study in the journal Birth. So what’s going on? (Haelle, 5/16)

San Francisco Chronicle: A New Era For Genetic Testing, Especially In Pregnancy 
A year and a half ago, few health insurers would cover a noninvasive prenatal test — which draws blood from a pregnant woman to analyze fetal DNA — unless the pregnancy was considered high-risk, which usually meant the woman was over 35. The test, which screens for chromosomal abnormalities linked to genetic disorders like Down syndrome, seemed less essential for women with average- or low-risk pregnancies. Today, at least 30 major U.S. insurers — including Anthem, Cigna and more than a dozen Blue Cross Blue Shield affiliates nationwide — cover the test for average-risk single-gestation pregnancies, expanding access to millions more people. (Ho, 5/15)

The Washington Post: She Thought She’d Pulled Hip Muscles, But Six Doctors Couldn’t Diagnose Her Pain
As she rose from the dinner table one night in February 2016, Annie Karp winced as she felt a penetrating ache deep in her hips. Unable to straighten up for a minute or two, she took small steps toward the medicine chest in her parents’ Florida home in search of an over-the-counter painkiller. Karp assumed she had pulled several muscles during an overzealous workout earlier in the day. (Boodman, 5/15)

The New York Times: Red Meat Increases Risk Of Dying From 9 Diseases
The more red meat you eat, the greater your risk of dying from one of nine diseases, according to a new report. Researchers studied more than 536,000 men and women ages 50 to 71, tracking their diet and health for an average of 16 years. They recorded intake of total meat, processed and unprocessed red meat (beef, lamb and pork), and white meat (poultry and fish). (Bakalar, 5/15)

San Jose Mercury News: Early Menopause May Impact Women’s Heart Disease Risk
Women who entered menopause at an earlier age or who never gave birth may be at higher risk for heart disease, according to a new study by UC San Francisco researchers. In a study of more than 28,000 women without heart disease over an average of 13.1 years, researchers found that while only 5.2 percent of the women were hospitalized for heart failure during the study, those who never gave birth were 2.75 times more likely to develop diastolic heart failure. (Seipel, 5/15)

Kaiser Health News: Segregated Living Linked To Higher Blood Pressure Among Blacks
For African-Americans, the isolation of living in a racially segregated neighborhood may lead to an important health issue: higher blood pressure. A study published Monday in JAMA Internal Medicine suggested blacks living in such areas experienced higher blood pressure than those living in more diverse communities. Moving to integrated areas was associated with a decrease in blood pressure, and those who permanently stayed in localities with low segregation saw their pressure fall on average nearly 6 points. (Heredia Rodriguez, 5/15)

State Watch

State Highlights: Blue Cross Blue Shield Of KC Asks Mo. Regulators For Filing Deadline 'Flexibility'; Harken Health Shuts Down In Ill., Ga.

Media outlets report on news from Missouri, Illinois, Georgia, Wisconsin, Texas, Kansas, California, Louisiana, Minnesota, Massachusetts, Ohio and Florida.

Kansas City Star: Blue Cross Blue Shield Of KC Requests Obamacare Filing Flexibility 
A spokeswoman for Blue Cross Blue Shield of Kansas City said Monday the company has “requested flexibility” from the Kansas Insurance Department on a deadline to file plans to sell on the Affordable Care Act exchange next year. The company’s decision not to file by Monday’s midnight deadline casts uncertainty on 2018 “Obamacare” coverage options for people in two eastern Kansas counties and 30 western Missouri counties. (Marso, 5/15)

Chicago Tribune: Insurer Harken Health Shutting Doors
Insurer Harken Health is closing its doors in Illinois and Georgia, ending an experiment to combine health insurance and care. The insurer, which operates five health clinics in Chicago, Skokie and Des Plaines, began selling plans in Illinois and Georgia in 2015. A subsidiary of UnitedHealthcare, Harken offered its members unlimited free doctor visits at its health centers, which also offer wellness programs, such as acupuncture, yoga and meditation. (Schencker, 5/15)

Milwaukee Journal Sentinel: Doctors' Fees In Milwaukee Area 41% Higher Than National Average, Study Says
By one important measure, doctors in the Milwaukee area are paid 41% more than the estimated national average for the services they provide, a new study says. The same was true across much of eastern Wisconsin: Fees paid to doctors by employers' health plans in the Sheboygan area were 63% above the national average, ranking them the highest among the 61 markets included in the study by the Health Care Cost Institute. (Boulton, 5/15)

Stat: Texas Leans Into Unproven Stem Cell Treatments, To The Dismay Of Scientists
HB 810 is one of three bills being considered in the Texas Legislature that would make it easier for sick people to try unproven therapies at their own risk, and cost. Springer’s bill would allow clinics offering unapproved stem cell treatments to treat patients in Texas. HB 661 would permit people with chronic illness to get therapies in early-stage clinical trials — not just terminally ill patients, as the state’s current “right-to-try” law does. And HB 3236 would allow companies to charge patients for unproven therapies. (Joseph, 5/16)

St. Louis Public Radio: Missouri Budget Cuts Family Planning Funds For Uninsured Women, Restricts Provider Choice
Missouri is poised to strip additional providers from a state-run program that provides family planning services for uninsured women. The budget lawmakers are sending to Gov. Eric Greitens contains a provision that prohibits hospitals and clinics from participating in the Missouri Women's State-Funded Health Services Program if the organization also provides abortion services, as defined by a state law for sexual education in schools. (Bouscaren, 5/15)

KCUR: As Kansas Foster Care System Sets Records, Advocates Call For More Family Services
Family preservation services — including training for parents, referrals for food assistance and other support — are designed to promote that healing. According to DCF, most families that receive preservation services succeed: About 82 percent of families who participated statewide were able to avoid having a child removed from the home. But many at-risk families don’t receive preservation services, and some people who have worked for years in the social services system say the lack of help is pushing more children into foster care. (Wingerter, 5/15)

Modern Healthcare: Kaiser Hits $1 Billion Operating Gain In Q1 
Kaiser Permanente Monday posted a record $1 billion operating gain in its first quarter, just days after holding its largest-ever bond offering. The Oakland, Calif.-based health plan and hospital giant eclipsed the $1 billion barrier on revenue of $18.1 billion. That compared with an operating gain of $701 million on revenue of $16.3 billion in the year-earlier quarter. The 5.5% operating margin in the first quarter beat the strong 4.3% operating margin from the year-earlier period. (Barkholz, 5/15)

New Orleans Times-Picayune: This Man Went To An In-Network ER In New Orleans. Why Did He Get A $1,360 Doctor's Bill? 
What happened to [Steve] Fair is known as "balance billing," an increasingly common practice in our nation's convoluted health care system. Rather than staff their own ERs, many hospitals around the country hire physicians employed by staffing companies like Schumacher, experts say. Insurance companies then pay these contract physicians a pre-negotiated rate for their hospital services. Because they have no contract with the insurer, however, these doctors don't have to accept the negotiated rate as their total fee. Instead, they go after patients for the full amount. Since the prices of most medical procedures are hidden from view, doctors have no incentive to lower them.  (Lipinski, 5/15)

Minnesota Public Radio: Minnesota Measles Outbreak Spreads To Le Sueur County
Minnesota health officials say the number of measles cases rose by four over the weekend and the highly contagious disease has now moved into a southern Minnesota county. Two new cases of measles were discovered in Le Sueur County, the Minnesota Department of Health reported Monday in its daily measles tally. (Zdechlik, 5/15)

Boston Globe: Disabled Homeless Girl At Center Of Fight Over Housing Policy 
Cristal is a 2-year-old girl born with spina bifida, a condition that has required multiple surgeries and left her with limited sensation in her lower extremities.Over the past month, she has endured long, uncomfortable commutes between the Lowell homeless shelter where the state is housing her family and frequent appointments with her medical providers in Boston, according to recent court filings... The case illustrates the human dimension of one of thorniest entitlement program debates facing Massachusetts as Baker works to reduce the number of homeless families in motels at state expense to zero. (Miller, 5/15)

California Healthline: California Bill Would Protect Patients’ Access To Their Chosen Family Planning Providers
As national Republican leaders continue to try to defund Planned Parenthood, California and other states are considering steps to protect access to family planning services. California legislators have introduced a bill that would lock into state law a federal rule that allows Medicaid patients to see family planning providers of their choice. The bill is designed to preserve Californians’ access to Planned Parenthood and other reproductive health clinics should federal officials drop the rule. (5/16)

Boston Globe: Walmart Settles Discrimination Lawsuit On Spousal Benefits For Same-Sex Couples 
A federal judge approved a $7.5 million settlement Monday in a class-action lawsuit against Walmart that found the retail giant violated gender-discrimination laws for years when it denied spousal benefits to same-sex couples. The lawsuit was filed on behalf of a New Bedford woman by the advocacy group GLAD. The settlement was based in large part on US Supreme Court rulings affirming the rights of same-sex couples to marry and, in an earlier ruling, their entitlement to federal spousal benefits. (Valencia, 5/15)

Cincinnati Enquirer: Transgender Lawsuit Settled, Cincinnati Public Library Now Covers Transgender Surgery
Rachel Dovel didn't mean to become a crusader for transgender rights. But the library employee found herself cast in that role last year when the library's health insurance refused to pay for her gender confirmation surgery - and the library's board wouldn't budge. She underwent surgery in December - and Monday she and her legal team announced she settled a lawsuit against the Public Library of Cincinnati and Hamilton County. (Coolidge, 5/15)

Boston Globe: Newburyport Hospital Joining Beth Israel Deaconess-Lahey Merger
Beth Israel Deaconess Medical Center and Lahey Health have enlisted another hospital in their campaign to create a stronger rival to Partners HealthCare, the market leader. Anna Jaques Hospital of Newburyport said Monday that it plans to join the Beth Israel Deaconess-Lahey merger, which was announced in January after years of on-again, off-again talks. (Dayal McCluskey, 5/15)

Boston Globe: Spaulding To Cut 35 Jobs
Spaulding Rehabilitation Network, part of the Partners HealthCare network, is slashing 35 jobs to cut costs. The cuts come as the entire Partners network embarks on a three-year initiative to rein in spending and become more efficient. (Dayal McCluskey, 5/15)

Health News Florida: Orlando Air Quality Prompts Warning For People With Asthma
The Environmental Protection Agency is warning that the Orlando area’s air quality is not healthy for sensitive groups. That means people with asthma and lung disease, as well as the elderly and children, should cut down on prolonged or heavy exercise outside. They recommend keeping asthma medication nearby. (Aboraya, 5/15)

Editorials And Opinions

A Hard Look At GOP Repeal-And-Replace Efforts: Examining Who Is Left Behind; Defending The House Vote

Opinion writers and stake holders offer their takes on the current health policy debate.

Cincinnati Enquirer: Health Care Bill Approved By House Leaves Too Many Behind
Simply put, the status quo on health care is unsustainable. ... Congress has the responsibility to fix this mess and lower health care costs. At the same time, these changes must be made in a way that doesn’t leave people behind. ... After the House of Representatives passed its bill, I said I could not support it as currently constructed because it does not do enough to help those currently receiving coverage, including the 700,000 Ohioans who receive health care through expanded Medicaid, especially those who are receiving treatment for drug addiction. Our state is in the midst of an unprecedented drug crisis right now. About half of all expanded Medicaid dollars spent in Ohio go to mental health and substance abuse treatment – much of that driven by the opioid epidemic. (Sen. Rob Portman, 5/15)

Los Angeles Times: Trump And Congress Are About To Take An Ax To Children's Healthcare
We’ve said it before and we’ll say it again: In the ridiculous mess that is the American healthcare system, there’s one indisputable success — children’s health coverage. Over the last two decades, the uninsured rate for children under 18 has fallen from 14% to less than 5%. Today that achievement is under threat as never before. “We’re at real risk of moving backward,” says Joan Alker, executive director of the Center for Children and Families at Georgetown University. That’s because children’s healthcare in the U.S. is heavily dependent on three public programs, Medicaid, the Affordable Care Act, and the Children’s Health Insurance Program, or CHIP. (Michael Hiltzik, 5/15)

San Antonio Press-Express: Coverage Mostly Fit For The Healthy 
There is a petition-driven movement — sure to fail — to strip members of Congress of their health care coverage. We don’t have the heart to deny people the coverage they need to keep themselves and their families healthy, even if they are making a minimum of $174,000 annually. But we understand the argument. (5/15)

The Washington Post: I Was Arrested For Asking Tom Price A Question. I Was Just Doing My Job.
I was arrested last week after asking Health and Human Services Secretary Tom Price a question about the American Health Care Act while he walked toward a meeting in the West Virginia State Capitol. He didn’t respond, so I asked a few more times, holding my phone out to record the reply he didn’t make. The criminal complaint accused me of a misdemeanor — “willful disruption of governmental processes” — and said I was “aggressively breaching the secret service agents.” I wasn’t. I went to the capitol to do my job and ask a question — not looking for trouble or intending to disrupt some state process. But for asking a question, the capitol police took my phone, handcuffed me, fingerprinted me and sent me off in an orange jumpsuit. (Dan Heyman, 5/16)

The Washington Post: A Congressman Said Making A Man Get Maternity Insurance Was ‘Crazy.’ A Woman’s Reply Went Viral.
Between rounds of jeering that interrupted his every sentence, Rep. Rod Blum (R-Iowa) took a little more than two minutes to explain what else he'd like to change about the Obama-era health-care law now that he has voted for the GOP's partial repeal of the Affordable Care Act. “Get rid of some of these crazy regulations that Obamacare puts in,” Blum suggested at an Iowa town hall meeting Monday, “such as a 62-year-old male having to have pregnancy insurance.” The crowd yelled all the louder. (Avi Selk, 5/15)

Austin American-Statesman: Keeping Our Promise
House Republicans have long promised to repeal and replace Obamacare, and earlier this month, we delivered. After voting more than 60 times to repeal and replace Obamacare, I supported the American Health Care Act when it passed the House of Representatives on May 4. (John Carter, 5/16)

Arizona Republic: Our Turn: Businesses Have A Stake In Health
With President Trump’s reaffirmed commitment to passing health-care reform, lawmakers have a fresh chance to overcome recent setbacks and modernize the American health care system. The business community remains committed to helping our leaders expand access to coverage, improve quality of care and reverse the rise of health-care costs.​ We applaud the members of the House who worked diligently to put together the American Health Care Act (AHCA). (Thomas Donohue, 5/15)

Modern Healthcare: Healthcare Lobbyists Wait To See If Senate More Pliable Than House On ACA Repeal
Healthcare industry groups are guardedly hopeful they will have more influence on the Senate's healthcare overhaul bill than they had on the House bill passed earlier this month. That's not saying much, given how House Republicans shut them out. And it's far from a sure thing, because Senate GOP leaders hope to push through their legislation rapidly to clear the way for passing a major tax overhaul in late summer or fall. (Harris Meyer, 5/15)

Viewpoints: 'Biomedical Ecosystem' Requires Care; How Smart Phones Could Revolutionize Medical Care

A selection of public health opinions from around the country.

Boston Globe: Nurturing The Biomedical Ecosystem
There is no better example of the power of the innovation produced by this biomedical ecosystem than Massachusetts, which is the envy of the world. ... But like any ecosystem — on a local or national scale — care is required. If we nurture and support it through continued NIH funding, meaningful intellectual property protections and appropriate rewards for breakthrough innovations, great things will happen for patients, the health care system and our economy. If we don’t, the opportunity in front of us to cure the next wave of serious diseases will be lost. (Jeffrey Leiden and David Torchiana, 5/16)

RealClear Health: Paging Dr. Siri
Smart-phone apps are about to revolutionize medical care. These technologies can predict when cancer patients are about to relapse, detect rare side effects of experimental drugs, and prod patients to maintain healthy behaviors. Pharmaceutical firms could temper widespread concerns about high drug prices by incorporating these technologies into treatment regimens. Doing so would unlock the full potential of existing treatments. It would result in healthier patients and lower medical spending. (Vidya Ramesh and Sandip Shah, 5/15)

The Wall Street Journal: Trump And Christie’s First Steps To Solving The Opioid Crisis
President Trump has tapped New Jersey Gov. Chris Christie to tackle America’s opioid crisis—a complicated task to say the least. Because the root cause of rising addiction and overdose is still unclear, any government response must be flexible and nuanced. The single biggest question regarding the opioid epidemic remains: Is it driven mainly by patients who become addicted to their prescriptions? Or are recreational users the underlying cause? This is difficult to figure out. Among the many heartbreaking personal anecdotes, hard data is scant and contradictory. (Josh Bloom and Alex Berezow, 5/15)

The Des Moines Register: Anti-Abortion Law Disrespects Women, Tramples On Rights
Now Iowa is left to deal with the aftermath of the 2017 legislative session. For understaffed state government, that means writing administrative rules, changing policies and enforcing new laws. State attorneys will try to muster a legal defense for Senate File 471, a morally indefensible Republican-crafted statute that imposes significant restrictions on access to abortion. (5/15)

Sacramento Bee: California Must House Its Mentally Ill 
A report by the nonpartisan Stanford Justice Advocacy Project finds that 30 percent of California state inmates receive treatment for serious mental disorders, a 150 percent increase since 2000. ... Sen. Jim Beall, D-San Jose, one of the few current members of the Legislature to take an interest in the issue, is carrying Senate Bill 142 to require that judges consider a defendant’s mental health history when imposing sentences and provide counties incentives in the form of payments if they can find ways to reduce the number of mentally ill felons they send to state prison. ... For the bill to work, however, there must be places to house people in need. Too few humane options exist. (5/15)

The Kansas City Star: Secondhand Smoke’s Hidden Risks For Kids
With the recent push to increase the tobacco tax in the state of Kansas by a dollar or more per pack of cigarettes, citizens should remember that this issue is not just about reducing the number of people who smoke and improving their health. It is also about the children who are involuntarily exposed to tobacco smoke. (David A. White, 5/15)

Los Angeles Times: No Sanctuary For Marijuana In California
When Californians approved Proposition 64 to legalize marijuana in California last November, it was no secret that the drug would remain illegal under federal law. But that fundamental contradiction seemed manageable at the moment .... Now, however, we have President Trump, who seems to have forgotten his laissez faire stance on marijuana, and Atty. Gen. Jeff Sessions, who comes from the “Reefer Madness” school of law enforcement. Proponents of Proposition 64 ... rightly worry that the federal government may decide to crack down on cannabis operators even if they fully comply with state rules. It’s understandable that state lawmakers want to resist potential federal intervention. But a proposal to make California a so-called sanctuary state for marijuana is not the way to go. (5/16)

Stat: An End To Pandemics Is Within Reach, But We Must Redouble Efforts Now
At the end of May, World Health Organization member states will convene their annual meeting in Geneva and elect a new director-general. This leadership transition at WHO unfolds at a defining moment, when shifting demographics are forging a new global public health landscape. Competing priorities — from non-communicable diseases to universal health coverage and polio eradication — will drive the agenda. But perhaps none is more suited to the health mandate of a community of nations as the existential threat of a pandemic. When the new director-general takes the helm on July 1, at the top of his or her list should be a focused and targeted approach to ending the pandemic era. (Daniel Schar, 5/15)