KHN Morning Briefing

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Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Food For Thought'" by Brian, Greg and Mort Walker.

Here's today's health policy haiku:


A sudden surge now.
Get insurance while you can.
Will it go away?

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Summaries Of The News:

Health Law

Obama to Republicans: Wish You Luck Coming Up With A Better Health Plan

“My view is that if they can come up with something better, that actually works ... I’ll be the first one to say that’s great, congratulations,” President Barack Obama said of Republicans' plans to overhaul the health law. But if they don't and millions lose coverage, "we're going to have a problem."

Politico: Obama Dares Trump To Do Better On Obamacare
President Barack Obama said Monday that President-elect Donald Trump is "pragmatic" — and Republicans' plan to repeal and replace Obamacare will test that approach. "Obviously, this has been the holy grail for Republicans: We gotta kill Obamacare," the president said at a post-election press conference. "But now that Republicans are in charge, they gotta take a look" at how the law is saving the government money and benefiting millions of people — both the 20 million covered directly by the law and millions more who receive insurance through employers and are getting extra protections under the health law, whether they recognize it or not. (Diamond, 11/14)

The Hill: Obama Warns GOP On Healthcare: 'Now Comes The Hard Part' 
President Obama said he thinks Republicans' efforts to repeal and replace ObamaCare will get harder now that they have the responsibility of governing. At a press conference Monday, Obama noted that while repealing his signature law has long been a “holy grail” for Republicans, the GOP will have to contend with the real-world consequences such action would have for the 20 million people who gained health coverage under the law. In addition to winning the White House, the GOP also maintained its House and Senate majorities. (Sullivan, 11/14)

Morning Consult: Obama Defends Obamacare Gains as GOP Plots Repeal
President Obama on Monday touted the gains made under the Affordable Care Act and laid out the challenges he thinks face Republicans when they work to repeal the law under President-elect Trump. “My view is that if they can come up with something better that actually works and a year or two after they’ve replaced the Affordable Care Act with their own plan that 25 million people have health insurance and it’s cheaper and better and running smoothly, I’ll be the first one to say that’s great, congratulations,” Obama said. (McIntire, 11/14)

Meanwhile, Sen. Elizabeth Warren, D-Mass., says the compromises that were made while getting the health law through hurt Democrats in 2016 —

Burwell Continues Enrollment Push, Says Health Law Is 'Woven Into The Fabric Of Our Nation'

“The American people don’t want to go back," Health and Human Services Secretary Sylvia Mathews Burwell said.

The Washington Post: Despite Trump's Campaign Pledge, Obamacare Is Woven Into Nation’s Fabric, HHS Secretary Says
The nation's top health official made an appeal Monday morning for the preservation of the Affordable Care Act, insisting that the sprawling health-care law that President-elect Donald Trump is vowing to eliminate is “now woven into the fabric of our nation.” Health and Human Services Secretary Sylvia Mathews Burwell delivered the most extensive remarks of any Obama administration official since last week's election about the future of the law, suggesting that large numbers of Americans signing up now for ACA health plans will make it more difficult for Trump and congressional Republicans to take away that insurance or the federal subsidies that help pay for it. (Goldstein, 11/14)

Morning Consult: In Charge To ACA Advocates, Burwell Says It’s The Law Of The Land
The Department of Health and Human Services is looking past the election to the rest of open enrollment, which will end less than a dozen days after President-elect Donald Trump is inaugurated. HHS Secretary Sylvia Burwell said the law is “now woven into the fabric of our Nation” while addressing enrollment advocates at the White House Monday. “I know that last week was a tough one for many of us. But rest assured, the Affordable Care Act is the law of the land,” Burwell said. “The American people do not want to go back – they want Republicans and Democrats to come together to make the law better.” (McIntire, 11/14)

The Hill: White House Ignores Trump Win In Latest ObamaCare Sign-Up Push 
The Obama administration is publicly ignoring the outcome of last week’s election as it presses ahead with this year's open enrollment for the president's signature healthcare law. At a White House event on Monday, Health and Human Services Secretary Sylvia Mathews Burwell mentioned the election just once in her 20-minute address about ObamaCare signups. “I know that this last week has been tough, but the Affordable Care Act is the law of the land,” Burwell said to a roomful of on-the-ground healthcare advocates. (Ferris, 11/14)

The Baltimore Sun: Maryland Pushes Forward With Obamacare Despite Uncertain Future
Maryland lawmakers and health officials vowed Monday to fight plans by President-elect Donald Trump to dismantle the Affordable Care Act, and said they are moving ahead with enrolling people in health plans. Sen. Ben Cardin, Rep. Elijah E. Cummings and Maryland Health Secretary Van Mitchell were at the University of Maryland, Baltimore on Monday to announce College Enrollment Week, a push to get younger people insured. But talk quickly turned to keeping expansion of health coverage to as many Americans as possible. (McDaniels, 11/14)

Insurers Warn Of Dreaded 'Death Spiral' If Trump Strips Away Individual Mandate

There would be no reason for healthy people to buy insurance, leaving only the sickest consumer base, insurers say. If that happens — and the provision to cover everyone regardless of pre-existing conditions remains — the market would collapse.

The Hill: Insurers Brace For ObamaCare Upheaval 
President-elect Donald Trump says he wants to repeal ObamaCare but keep the protections for people with pre-existing conditions. Achieving that will be easier said than done. Insurance companies warn that requiring them to cover anyone, regardless of their health status, could have disastrous consequences if not paired with the right policies. Without a mandate requiring people to buy coverage, insurers warn, only sick people would have reason to buy coverage. (Sullivan, 11/15)

Kaiser Health News: Despite Anger At Health Law’s Mandate, GOP Plans Could Also Have Penalties
The Affordable Care Act’s requirement that people have health insurance or pay a fine is one of the least popular provisions of the law, and one that Republicans have pledged to eliminate when they repeal and replace Obamacare. But take a look at some of the conservative replacement proposals that are floating around and it becomes clear that the “individual mandate,” as it’s called, could still exist, but in another guise. (Andrews, 11/15)

The New York Times: Health Care Issues Loom In Politics, Payments And Quality
The health care industry was unprepared for the presidential victory of Donald J. Trump, and executives at insurance companies and hospital systems are now uncertain what their business is going to look like in the years ahead. A Trump administration, coupled with a Republican Congress, is likely to lead to a reversal of many of the policies put into place by President Obama, and could mean a repeal of his signature health care law. (Abelson, 11/14)

Kaiser Health News: Some Panic But Others Are Indifferent About Losing Obamacare
The 20 million Americans who have gained health coverage under the Affordable Care Act don’t yet know exactly how the presidency of Donald Trump will change their lives — and reactions to that uncertainty range from anxiety to apathy. “My phone is ringing off the hook,” said Billy Bradford, an insurance broker in Montgomery, Ala. “People are just in panic mode here.” (Gold, 11/15)

Milwaukee Journal Sentinel: Trump Counties Tied To Obamacare
In winning what Republicans see as a mandate to repeal Obamacare, Donald Trump carried the Wisconsin counties that participate in a key part of the health program at higher rates. An analysis by the Milwaukee Journal Sentinel shows that people living in the 59 counties won by Trump enroll in the Affordable Care Act's private health insurance exchange at a higher rate than the 13 mostly urban counties that backed Democrat Hillary Clinton. (Stein, 11/14)

After GOP Election Success, Advocates In Kentucky Fear For Future Of Medicaid Expansion

Nearly half a million state residents gained Medicaid coverage under the federal health law and their coverage is now in play, advocates say. Also, news outlets report on Medicaid developments in Kansas and Ohio.

Louisville (Ky.) Courier-Journal: Trump Victory Worries Ky Medicaid Advocates
Tuesday's election, in which voters swept Republican presidential candidate Donald Trump into office, could threaten care for more than half a million Kentuckians who gained coverage under the law also known as Obamacare that Trump wants to repeal. Gov. Matt Bevin, a Republican and outspoken critic of the law, renewed his attack the day after the election put the GOP — which already controls the state Senate — in charge of the Kentucky House for the first time since 1921. "Obamacare is a disaster. It has been from the time it was rammed down our throats by Democrats," Bevin said in a radio interview Wednesday on Campbellsville's WVLC. "We're rejecting it. It's going to be gone. And it's going to be a good day." (Yetter, 11/12)

Kansas Health Institute: Kansas Medicaid Backlog Concerns Persist During Open Enrollment 
Legislators and federal officials are questioning the size of a backlog of Kansas Medicaid applications and whether it will persist during the open enrollment period for 2017 Affordable Care Act insurance. The backlog began with a computer system switch in summer 2015, but last year’s open enrollment period caused it to balloon as the website referred applicants to Medicaid. Leaders of the Kansas Department of Health and Environment told legislators the agency would be caught up on the applications by the time open enrollment started this year, on Nov. 1. (Marso, 11/14)

Kansas Health Institute: Election Clouds Medicaid Expansion Forecast In Kansas
Medicaid expansion advocates in Kansas say they’ll move forward with legislation despite national election results that signal a repeal of Obamacare. But they are a lot less optimistic about their chances than they were before last week. “There is still significant support in Kansas for expanding KanCare both in the public and among legislators,” said David Jordan, director of the Alliance for a Healthy Kansas, a nonprofit advocacy group formed to push for the expansion of KanCare, the state’s privatized Medicaid program. (McLean, 11/14)

Columbus Dispatch: Ohio Medicaid Chief Resigns As Feds Eye Changes To Health Insurance Program
State Medicaid Chief John McCarthy, who oversaw Gov. John Kasich's overhaul and expansion of the health-insurance program covering nearly 3 million poor and disabled Ohioans, is resigning. The announcement comes less than a week after the victory of President-elect Donald Trump raised uncertainty about the future of the tax-funded Medicaid program, including the 2014 expansion of eligibility that added about 650,000 low-income adults on to the rolls in Ohio. (Candisky, 11/14) Ohio Medicaid Chief Resigns, Will Be Replaced By Former State Rep. Barbara Spears
The man Gov. John Kasich entrusted as the state's first ever director of Medicaid is stepping aside after six years. Medicaid Director John McCarthy is leaving sometime in December to "pursue opportunities in the private sector," Kasich's office said Monday. Former state Rep. Barbara Sears, a Sylvania Republican who previously worked on healthcare and Medicaid legislation, has been tapped to replace him. Sears resigned from the House earlier this year to join Kasich's Office of Health Transformation. (Borchardt, 11/14)


New Medicare List Of Most Expensive Drugs Shows 'Eye-Popping' Price Hikes

Data released by federal officials show the price of an anxiety drug rose 1,264 percent. At the top of Medicare spending is a hepatitis C prescription drug and a form of insulin, which together cost more than $11 billion in 2015.

The Wall Street Journal: Medicare Identifies Which Prescription Drugs Were Costliest In 2015
Medicare released new data identifying prescription medicines that had sharp price increases and those that accounted for its largest total spending in 2015. Medicare spending on Valeant Pharmaceuticals International Inc.’s diabetes drug Glumetza more than quadrupled to $153 million in 2015 from 2014, driven by a total price increase of 381%, according to the data, released by the Centers for Medicare and Medicaid Services. Glumetza prescription unit volume within Medicare declined 7% over the same period. (Walker, 11/14)

Stat: Hepatitis C Medicine The Biggest Drug Cost For Medicare, Medicaid
The latest dive into Medicaid and Medicare prescription drug data shows that the federal health care programs spent more on the Harvoni hepatitis C treatment last year than any other medicine. Medicare Part D spent slightly more than $7 billion on the Gilead Sciences product, while Medicaid coughed up nearly $2.2 billion for the drug, according to data released today by the Centers for Medicare and Medicaid Services. The agency released its latest dashboard, an interactive tool that chose a few dozen drugs for which spending or unit costs rose by notable amounts, as well as those brand and generic medicines that contributed to large program spending overall. (Silverman, 11/14)

CNBC: Drug Price Shock: Feds Reveal How Medication Costs Hit Medicare And Medicaid
New data on drug spending by the nation's two biggest health-coverage programs released Monday shows eye-popping price hikes for a number of medications, as well as steep overall costs for several drugs. Ativan, a drug that is used to treat anxiety, had an average unit cost increase of a stunning 1,264 percent between 2014 and 2015 for Medicaid, the jointly run federal-state health coverage program primarily for poor people, officials revealed. (Mangan, 11/14)

The Washington Post: Drugs For Hepatitis C And Diabetes Drove Medicare Spending In 2015
A hepatitis C treatment and a form of insulin led Medicare drug spending, adding up to more than $11 billion in 2015, according to an update of a federal database that highlights the drugs the government spent the most money on overall and per person -- and which ones had the biggest price increases. Of particular concern is a rise in price of some generics, a class of drugs that are intended to decrease drug prices and spending. (Johnson, 11/14)

USA Today: Some Medicare, Medicaid Drug Prices Soar As Reform Uncertain
Medicaid spending on the drugs that have undergone the greatest price increases soared in 2015, according to federal statistics released Monday that show how much higher drug prices have affected government health care programs. Of the 20 drugs whose prices have increased between 140% and 500% between 2014 and 2015, spending went from $146 million to $486 million, the data from the Centers for Medicare and Medicaid Services (CMS) show. (O'Donnell, 11/14)

And in an early analysis of access to expensive hepatitis C drugs --

Stat: Hepatitis C Drugs Still Being Restricted By State Medicaid Plans
Over the past two years, state Medicaid programs have done a better job of disclosing information about access to hepatitis C medicines and are also making progress in reducing or eliminating restrictions that pose a barrier to treatment, according to a new preliminary analysis. In 2014, 17 states did not make public their criteria for treatment, compared with just seven state programs this year. And in the past two years, 16 state programs cut or dropped restrictions to access based on a patients’ stage of liver disease, which has been a key test for determining treatment. (Silverman, 11/14)

The Fiscal Times: Lawsuits Force States To Give Outrageously Expensive Drugs To Medicaid Patients 
Many states, still reeling from the $100,000 price tag of providing biologic drugs to combat the deadly Hepatitis-C virus, continue to restrict access to the drugs to millions of veterans and low-income residents. However, the preliminary findings of a long-term Medicaid access study released on Monday documented a sharp decline in the number of states that restrict the use of Sovaldi and Harvoni -- the two most effective drugs for treating the disease -- to patients with the most serious advanced stages of liver disease or damage. (Pianin, 11/14)

Capitol Hill Watch

Safety Net Hospitals Urge Congress To Alter Readmissions Penalties In Lame-Duck Session

The hospital group argues that the Medicare formula unfairly dings facilities that primarily serve lower-income patients who are more likely to be readmitted due to factors outside a hospital's control. In other Capitol Hill news, conservative organizations caution lawmakers against adding the CREATES Act to the 21st Century Cures Act.

Modern Healthcare: Hospitals Push Readmissions Fix In Lame-Duck Congress 
Industry lobbyists are putting the pressure on Congress to use the lame duck session to pass a law that would take into consideration the challenges faced by hospitals that predominantly treat low-income patients. America's Essential Hospitals, which represents 275 safety net hospitals around the country has launched a campaign that includes advertisements in CQ Rollcall and Vox.This summer, the House unanimously passed a bill that would require the CMS to account for patient socioeconomic status when calculating readmissions penalties. The Hospital Readmissions Reduction Program (HRRP) aims to reduce preventable readmissions by penalizing hospitals with higher-than-average Medicare readmissions. (Dickson, 11/14)

Morning Consult: Conservative Groups Warn Against Including Bill Targeting Generics In Cures Act
Ten conservative organizations are warning lawmakers against adding a measure they say could cause unnecessary health risks to a medical innovation bill top lawmakers hope to advance before the year ends. The groups, including Americans for Tax Reform, the American Conservative Union and the Center for Medicine in the Public Interest, say adding the CREATES Act to the 21st Century Cures Act could have “many harmful unintended consequences.” The CREATES Act, a bipartisan measure, aims to speed up the process of bringing generic drugs to market, but there are some concerns that the measure would undermine safety protocols for certain drugs that treat life-threatening illnesses. (McIntire, 11/14)


Now Part Of Med School -- Studying The Health Care System

A study by the American Association of Medical Colleges concluded that nearly all medical schools in the country require coursework about the health system and how it is financed. Also in the news, a study by Rand the finds retail clinics haven't triggered a reduction in ER visits for low-acuity illnesses.

Modern Healthcare: Rand Study: Retail Clinics Don't Reduce ER Use For Low-Acuity Conditions 
Some researchers and policymakers had hoped the surge of retail clinics across the country would reduce visits to the emergency department. A new study finds that hasn't been the case. The report, published Monday in the Annals of Emergency Medicine, found ERs in close proximity to retail clinics didn't experience a reduction of visits from patients with low-acuity illnesses like influenza, urinary tract infections and ear aches. The study, conducted by researchers at Rand Corp., was the first to explore the association between the opening of retail clinics and admissions to the ER. About 13.7% of all emergency department visits are for low-acuity conditions, the study notes. (Castellucci, 11/14)

Public Health And Education

Advocates Worry Trump's Solution To Build Wall Ignores Realities Of Opioid Epidemic

Donald Trump has said one way he plans to address the opioid crisis is to build a wall between America and Mexico -- but the leading causes of overdose deaths are prescription pills and alcohol, which would not be affected by a wall. Meanwhile, some companies are taking steps to combat the crisis starting with their employees.

Stat: Donald Trump's America Is Beset By Opioids. What's He Going To Do?
To stop the heroin and painkiller crisis killing thousands of Americans, President-elect Donald Trump has promised to build a wall on the Mexican border and provide more treatment to those who need it. After Trump’s shocking electoral upset, people who work in addiction recovery say they want to believe the new president will take the crisis seriously and hope Republicans in Congress who understand the problem will help guide the new administration. (Scott, 11/14)

The Wall Street Journal: One Employer Fights Against Prescription-Drug Abuse
A handful of companies are trying strong medicine to limit employees’ use of prescription painkillers like OxyContin. Engine-maker Cummins Inc. is one of the few large employers aggressively responding to opioid misuse in their ranks. After managers found evidence of drug activity in one of its plants in 2013, the Columbus, Ind., company now requires personnel to take drug tests for prescription painkillers and encourages employees to seek alternatives to their use. (Silverman, 11/15)

And in other news on the epidemic —

The Wall Street Journal: Clinical Trial For Long-Lasting Injectable Opioid Dependence Treatment Succeeds
A late-stage trial for an injectable treatment for addiction to heroin and other opioids was successful, potentially adding to the stable of treatments for the growing epidemic of opioid abuse, Braeburn Pharmaceuticals and Camurus AB said Monday. The trial follows a May U.S. Food and Drug Administration approval of another treatment option from Braeburn: a long-lasting arm implant that provides six months’ worth of the drug—buprenorphine. (Hufford, 11/14)

The Philadelphia Inquirer: Feds Allege Two South Jersey Pharmacists Were Pushing Pills Illegally
Two Medford-area pharmacists were charged Monday for selling large quantities of oxycodone and other drugs at two local drugstores, according to federal authorities. Pharmacy owner Michael Ludwikowski, 44, of Medford, and his employee, David Goldfield, 58, of Medford Lakes, were charged in a 16-count indictment with conspiracy to distribute and dispense controlled substances, according to court records released Monday. The men worked at the Olde Medford Pharmacy on Stokes Road and the Medford Family Pharmacy on Old Marlton Pike, and illegally dispensed drugs between March 2008 and August 2013, according to court documents. Among their clients, officials said, were known drug addicts using phony prescriptions. (Boyer, 11/15)

Desperate Cancer Patients Smuggle Unapproved Vaccine From Cuba Into U.S.

Cuba is home to an innovative vaccine called Cimavax, but American trials on the drug could take years. Many, however, can't wait that long. In other public health news, Donald Trump's stance on healthy eating may upend first lady Michelle Obama's efforts to improve school lunches; timeouts are taking the place of spankings for disciplining children; proteins that signal Alzheimer's don't always lead to diagnosis; and more.

The New York Times: Trying To Bring Home Hope From Cuba In The Form Of A Cancer Vaccine
Zuby Malik is an unlikely candidate to violate international law. A 78-year-old mother of four with a crown of silver hair, she is a retired obstetrician-gynecologist with a penchant for order. But Ms. Malik is fighting for her life. After receiving a Stage 4 non-small-cell lung cancer diagnosis a year ago, she exhausted many of the treatments available to her and grappled with torturous side effects that left her itching and gasping for breath. During the summer, she decided to go to Cuba and bring back a cancer vaccine that is not approved in the United States. (Jacobs, 11/14)

The Associated Press: Fast-Food Fan Trump Could Remake Healthy School Lunches
Will President-elect Donald Trump remake school lunches into his fast-food favorites of burgers and fried chicken? Children grumbling about healthier school meal rules championed by first lady Michelle Obama may have reason to cheer Trump's election as the billionaire businessman is a proud patron of Kentucky Fried Chicken and McDonald's while promising to curb federal regulations. (11/15)

NPR: Spanking And Other Physical Discipline Declines As Timeouts Rise
The share of U.S. mothers who spank their young children or endorse physical discipline has declined significantly over the past two and a half decades, according to an analysis of four national surveys. The findings, out Monday in the journal Pediatrics, came from an analysis of data from 1988 to 2011. Researcher found that 21 percent of median-income mothers of kindergarten-aged children endorsed physical discipline at the end of that period — down from 46 percent at the start. (Stein, 11/14)

Stat: Their Brains Had Signs Of Alzheimer's, But Their Minds Were Still Nimble
The defective proteins that are widely thought to kill brain neurons and cause, or at least indicate, Alzheimer’s disease do not always have that calamitous result, scientists reported on Monday, raising more doubts about conventional approaches to diagnosing and finding treatments for Alzheimer’s.The researchers analyzed the brains of eight people who died in their 90s and who had excellent recall until then. (Begley, 11/14)

Richmond Times Dispatch: Dancing With Parkinson's Disease 
Veronica Nugent — who owns Simply Ballroom with her husband, Lee — began the Parkinson’s Dance Class in 2011, creating the nonprofit organization Richmond Parkinson’s Dance Project to run the program. A dance instructor for 25 years, Nugent was trained to teach those with Parkinson’s at the Mark Morris Dance Center in Brooklyn, N.Y., which developed a dance program specifically for those living with the disease. (Demeria, 11/14)

Efforts To Keep Zika Out Of United States' Blood Supply Seem To Pay Off

Screenings reveal that Zika infections in the blood supply are exceedingly rare.

The New York Times: Zika Infection In U.S. Is Still Rare So Far, Blood Donations Indicate
By the end of this week, all blood banks in the continental United States must begin testing donated blood for contamination with the Zika virus. Many banks are doing so already, and the early results indicate that the country has dodged a bullet — for now. Screenings in a dozen states suggest that Zika infection remains exceedingly rare. Among the approximately 800,000 blood donations tested in the past six months or so, about 40 were initially positive for the virus. (Saint Louis, 11/14)

Sacramento Bee: California Department Of Public Health Warns Holiday Travelers Headed For Mexico To Avoid Zika Virus Infections
Holiday travelers headed to Mexico this winter were warned Monday to protect themselves against Zika-carrying mosquitoes. Any travel to Mexico is now considered to be risky for Zika virus infections, especially for pregnant women, according to the California Department of Public Health, which specifically cited popular tourist destinations such as Cancun, Acapulco, Cabo San Lucas, Puerto Vallarta, Ixtapa and Mazatlan. (Buck, 11/14)

Researchers Suggest Link Between Rise In Gender Equality, Decrease In Infectious Diseases

They say the correlation is as strong as smoking and lung cancer. In other news, cholesterol drugs are underused in women and the election sparks a dramatic reaction from many worried about contraception under the new administration.

The Washington Post: Women Have More Rights In Places With Fewer Pathogens
There is a curious connection between sickness and social change. Studies suggest that communities suffering from more infectious diseases are more likely to be collectivist — ethnocentric, conformist, highly protective of their own group's members and antagonistic toward anyone from outside. (Kaplan, 11/14)

WBUR: Mass. Planned Parenthood Sees 16-Fold Spike In IUD Demand In Days After Election 
On a typical couple of October days, Planned Parenthood clinics in Massachusetts got six online requests for appointments from women who wanted an IUD. On Wednesday and Thursday after last week's presidential election, they got 97... The spike in IUD demand came as many a young woman's social media feed lit up with advice to get an IUD now, while Obamacare — which mandates that birth control be covered with no out-of-pocket costs — is still in force. (Goldberg, 11/15)

Marketplace: Birth Control Access Is A Priority For Some Women Post-Election
If Trump and the Republicans pursue their plan to repeal Obamacare, what will happen to birth control? Currently, many types of contraception are available at no out-of-pocket cost. While health care lawyers are debating how quickly the law could be changed, many women are booking visits to their OB-GYNs to get care now — in case services are cut back. (Gorenstein, 11/14)

As Marijuana Legalization Sweeps Country, Worrisome Trends Emerge

Marijuana use has become so prevalent and so accepted that many don’t think of it as a drug.

The Bend Bulletin: Mainstreaming Marijuana: Pot Legalization Is Revealing Unintended Consequences
When Oregon voters debated legalizing recreational use of marijuana, proponents argued that marijuana was relatively harmless, that it differed little from other legal drugs like alcohol and tobacco. While the vast majority of individuals who use marijuana will suffer no ill effects, data from Oregon and other states that have fully legalized marijuana sales show there are real risks with marijuana use that may have not been fully appreciated. When Colorado was the first state to legalize recreational use of marijuana, Gov. John Hickenlooper called it “one of the great social experiments of the century.” But the early returns in Colorado and Oregon suggest that states could soon regret their decisions. (Hawryluk, 11/14)

Boston Globe: Towns May Try To Block Marijuana Shops 
A number of cities and towns are exploring ways to limit or even snuff out marijuana shops in their communities, less than a week after voters legalized the drug for recreational use in Massachusetts. Some local officials worry that a profusion of marijuana stores will turn quaint New England downtowns into drug havens. (Levenson, 11/15)

State Watch

State Highlights: Allina Spent Millions To Keep Minn. Hospitals Open During Nurses' Strike; Virginia Groups Partner To Fight Antibiotic Resistance

Outlets report on health news from Minnesota, Virginia, Michigan, Ohio, Iowa, Pennsylvania, Washington, Florida, Texas, California, Massachusetts and Georgia.

The Star Tribune: Allina Spent $104M To Keep Hospitals Open During Strikes
Allina Health spent more than $104 million to keep its Twin Cities hospitals open during two nursing strikes this year, according to a financial report released Monday. The total matched the amounts that had been rumored on the picket lines, where striking nurses grumbled that all the stopgap spending could have been spent to preserve their benefits. (Olson, 11/15)

Cleveland Plain-Dealer: Nurse Home Visiting Program Gets $560,000 In State Funds To Enroll 140 First-Time Low-Income Moms
A nurse home visiting program with a proven track record for reducing infant mortality among first-time low-income mothers has received a $560,000 state grant to help MetroHealth enroll up to 140 families in its first year. Nurse-Family Partnership (NFP), which was brought to the Cleveland area last year with a $2 million grant from several local foundations, is designed to monitor and address health issues, improve parenting skills, share child development information and encourage positive health behaviors. (Zeltner, 11/14)

Des Moines Register: Grinnell Hospital May Join UnityPoint, UI Health Care
A financially struggling central Iowa hospital hopes to join forces with two of the state’s biggest health-care systems. Grinnell Regional Medical Center announced Monday that it is negotiating an agreement with the UnityPoint Health System and University of Iowa Health Care. Chief Executive Officer Todd Linden said the negotiations could lead to a sale of the Grinnell hospital or an agreement under which it would be managed by UnityPoint, which is based in Des Moines. The talks also could lead to a less extensive partnership, he said in an interview Monday morning. The Grinnell hospital lost more than $2.1 million last year, and it has lost a total of more than $4 million over the past three years, according to an annual report posted by the Iowa Hospital Association. (Leys, 11/14)

The Philadelphia Inquirer: Council Committee To Consider Bills To Combat Lead Poisoning
A committee of City Council will consider on Wednesday a package of bills aimed at protecting against lead poisoning, including one that would mandate testing at day-care facilities in homes built before 1978....Last year, the city's Department of Public Health checked the houses of about 500 children who showed elevated lead levels, according to the Toxic City report, though nearly 2,700 children displayed levels at or above what the federal government says should prompt officials to intervene. (Nadolny, 11/15)

Seattle Times: 3 More Children Hospitalized With Rare, Polio-Like Illness
Three more children in Washington have been hospitalized with symptoms of a rare, polio-like illness, state health officials said Monday. If the new cases of suspected acute flaccid myelitis (AFM) are confirmed, they will bring the total in the state this fall to 11. The children are between the ages of 3 and 14 and all showed signs of weakness or paralysis in one or more limbs and distinctive spinal-cord changes that are required for a diagnosis of AFM, said Julie Graham, a spokeswoman for the Washington state Department of Health. (Aleccia, 11/14)

Miami Herald: CareCloud Raises $31.5 Million To Compete In Changing Healthcare Market 
In CareCloud’s world, when you walk into your physician’s office, you aren’t handed that ubiquitous clipboard but rather a tablet and you enter your information — just once. And after the appointment, your doctor can serve up a bill for the growing portion not covered by your insurance with a transparent, consumer-friendly way to pay. To that end, CareCloud, a Miami-based management platform for high-growth medical groups, announced Tuesday it has raised $31.5 million to finance its continued growth. (Dahlberg, 11/15)

San Jose Mercury News: Santa Cruz Mental Health Services Under Microscope After Fatal Officer-Involved Shooting
Members of the greater Santa Cruz community sat inside the United Church of Christ Nov. 1 and took the first steps of a raw, difficult journey; a process that has become all too familiar in communities across the U.S. They asked why. Why, in the midst of a rainstorm at 3 a.m. Oct. 16, did a Santa Cruz police officer shoot Sean Arlt, 32, a mentally ill man — once in the head and once in the chest? (Masters, 11/14)

The Philadelphia Inquirer: Patient Says Pro-Trump Doctor Kicked Her Out For Disagreeing
All Heidi Kravitz Dunn wanted when she went to the doctor at 8:50 Friday morning was to get a physical. Instead, the Havertown woman said, she got a "rant" from her doctor of eight years about the "riots" on college campuses that followed Donald Trump's election as president. Within minutes,  she said, she had been kicked out of his practice for disagreeing with his political views. "The best person is now elected," she said family physician Joseph LaBricciosa told her. "He will be good for us." Dunn, who was feeling shaky because she has hypoglycemia and had fasted all night for blood work, didn't want a political discussion, but said she disagreed and said the students had a right to protest peacefully. "I just wanted to get my blood taken so I could eat a banana," she said. Uncomfortable with his angry reaction, she said, she got up to leave. (Burling and Wood, 11/14)

Georgia Health News: Smoke From Wildfires Casts Pall Over Georgians’ Health 
State health officials said Monday that significant increases in the number of emergency room visits for asthma occurred in the Dalton, Gainesville, Jasper and metro Atlanta areas last week, at a time when smoke from wildfires drifted over those areas. The state Department of Public Health told GHN that it’s not possible to determine with certainty that these visits were attributable to smoke from the ongoing wildfires in North Georgia, Tennessee and North Carolina. (Miller, 11/14)

Editorials And Opinions

A Post-Election Health Law Inventory: It's Like Cleaning Out The Closet -- Some Things Have To Go, But Some May Have A Few More Seasons

Opinion and editorial writers around the country analyze how certain parts of the Affordable Care Act, as well as other health policies, may fare in the Trump era.

The Washington Post: Are Trump And The Republicans Really Going To Repeal Obamacare?
Since they took control of the House in 2010, Republicans have held more than 60 votes to repeal the Affordable Care Act, in what surely must be a record in American legislative history. So of course they’re going to get right on it as soon as President Trump is inaugurated and can sign the repeal. In fact, Kellyanne Conway said yesterday that Trump is considering “convening a special session” of Congress to repeal the law. “It would be a pretty remarkable move,” she said, which indeed it would be, because Congress will already be in session, but apparently the people in Donald Trump’s inner circle are under the impression that Congress is like the Texas legislature that meets once every two years and has to be called back into special session to pass laws. (Paul Waldman, 11/14)

Sacramento Bee: Repealing Obamacare Won't Be Simple For Trump
When it comes to their oft-repeated vow to repeal the Affordable Care Act, President-elect Donald Trump and his Republican allies in Congress are like the dog that chased the car. Now that they’ve caught it, what are they going to do? (Daniel Weintraub, 11/14)

The New York Times: Why Keeping Only The Popular Parts Of Obamacare Won’t Work
The pre-existing conditions policies are very popular. Nearly everyone has relatives or friends with illnesses in their past — cancer, arthritis, depression, even allergies — that could have shut them out of the individual insurance markets before Obamacare, so it’s an issue that hits close to home for many Americans. But keeping those provisions while jettisoning others is most likely no fix at all. Those policies that make the insurance market feel fairer for sick Americans who need it can really throw off the prices for everyone else. That’s why Obamacare also includes less popular policies designed to balance the market with enough young, healthy people. (Margot Sanger-Katz, 11/14)

The Wall Street Journal: The Trump ObamaCare Panic
Democrats are already panicked that Donald Trump will repeal ObamaCare and throw millions of people off the subsidy rolls, while some conservatives seem panicked that the President-elect will renege on his campaign promises and millions of people won’t be thrown off the entitlement. Like most inflamed political questions after Mr. Trump’s victory, the health-care debate would benefit from some perspective. (11/14)

The New York Times: What Could Be Worse Than Repealing All Of Obamacare?
Donald J. Trump made headlines on Friday by saying he would like to keep two components of the Affordable Care Act: allowing young people to stay on their parents’ insurance until age 26, and continuing the ban on the exclusion of pre-existing conditions by insurers. These have long been staples of proposed Republican replacements for the act, but their reaffirmation by the president-elect heightens the importance of understanding what these provisions do, and what they don’t. (Jonathan Gruber, 11/14)

The New York Times: Politics Aside, We Know How To Fix Obamacare
President Obama’s Affordable Care Act marketplaces were supposed to give consumers choices of health plans from insurers that compete to keep premiums down. But fewer insurers are participating, and premiums are increasing sharply. Fixing this problem will obviously be politically difficult with a Republican-controlled Congress that has vowed to “repeal and replace.” ... From a policy standpoint, however, some solutions to problems facing the marketplaces are ones that Republicans have endorsed before: for Medicare. (Austin Frakt, 11/14)

Los Angeles Times: Selling Health Insurance Across State Lines Is A Favorite GOP 'Reform.' Here's Why It Makes No Sense.
Of all the healthcare reform nostrums in all the world, the most popular among Republicans in the U.S. is allowing the sale of insurance policies across state lines. The idea has been part of every GOP proposal to “repeal and replace” Obamacare. It was written into GOP presidential candidate John McCain’s platform in 2008 and Mitt Romney’s in 2012, and shows up right there in paragraph two of President-elect Trump’s healthcare policy statement. To healthcare economists and other experts in the field, however, the idea is nonsense. (Michael Hiltzik, 11/14)

The Columbus Dispatch: Health-Care Reform Needed, Possible
The Affordable Care Act was a good idea poorly executed at a politically divisive time. Come Jan. 20, the Republican Party will control the federal government, and scrapping the act — which is so tied to President Barack Obama that even he calls it Obamacare — will be a top priority of President Donald Trump and probably House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell as well. Many have long urged Congress and the White House to try to fix the ACA, believing that it would never be replaced so long as Democrats held the White House or controlled part or all of Congress. When the GOP runs Washington, a better idea is to dismantle the ACA while keeping what’s best about the 2010 law. (11/15)

The Health Care Blog: The Age Of Trumpian Uncertainty
The new Chief Executive Officer of the United States of America Inc. will take office January 20th and likely make good on his promise to repeal the Patient Protection and Affordable Care Act. It only requires a majority in both houses of Congress to pass and that’s assured based on the election results last week. (Paul Keckley, 11/14)

Bloomberg: Trump Puts Hospitals In The ICU 
Hospital companies are just as miserable about the election of Donald Trump as pharma companies are ecstatic.  Obamacare repeal is one Trump's few proposals amounting to more than a detail-free promise of something Yuge. It's also one of the few areas of wholehearted agreement between him and GOP congressional leadership. If and when it will actually happen, to what degree, and the structure of any replacement are all unknown. But just about any move in this direction will hurt health-care providers that have benefited from the law's efforts to make health care more accessible. (Max Nisen, 11/11)

Stat: Donald Trump Should Be Good Medicine For The Drug Industry
Many Republicans would like to speed the Food and Drug Administration process for getting new medicines to patients. That’s going to remain a high priority. All one has to do is look at the health care page on Trump’s transition website, which late last week made clear that change is in the offing with this one sentence: “Reform the Food and Drug Administration, to put greater focus on the need of patients for new and innovative medical products.” (Ed Silverman, 11/15)

Fortune: Why The Trump Drug Rally Won't Last
The stock market has been a lousy prognosticator of late. Prior to the election, Mr. Market seemed utterly convinced of a Clinton win. (It didn’t happen.) Then, as the outcome looked clear, it predicted panic—then galloped giddily into euphoria. (Hapless traders trying to chase these ups and downs no doubt mistimed them—because, well, it’s a sucker’s game to try to time the market. But then you knew that…) That said, the market has seemed to send a more consistent message regarding the pharma and biotech industries. (Clifton Leaf, 11/14)

Bloomberg: Trump's Threat To Abortion Rights Isn't Immediate 
Donald Trump’s comments on “60 Minutes” suggest that the president-elect has assimilated a version of the traditional moderate Republican position on abortion rights: call for the repeal of Roe v. Wade, while hoping that in practice, abortions will still be available somehow. The logic of this position is purely political. At least some of the Republican base wants abortion outlawed, but lots of people who voted for Trump would be extremely upset if they or a woman they cared about couldn’t actually get an abortion. (Noah Feldman, 11/14)

Viewpoints: Facing Off Over Medicare's Future; Value-Based Purchasing Is 'Shining Example' Of Bipartisan Health Reform

A selection of opinions and editorials from around the country.

San Francisco Chronicle: Ryan Now Has The Muscle To Phase Out Medicare — Within Months
House Speaker Paul Ryan's plan to phase out Medicare is nothing new. But now, under a Trump presidency and with both houses of Congress in Republican hands, it looks like he could finally make it happen, possibly within months. Back in 2011, as a U.S. representative for Wisconsin's 1st Congressional District, Ryan floated a plan to turn Medicare into a "premium support" program. The "premium support" would be a payment that would let you buy insurance from private insurers. But you won't get full coverage. (Mike Moffitt, 11/14)

Los Angeles Times: Paul Ryan Is Determined To Gut Medicare. This Time He Might Succeed
Bursting with the policymaking power that control of both houses of Congress and the White House gives Republicans, House Speaker Paul D. Ryan (R-Wis.) has lost no time in teeing up a favorite goal: gutting Medicare. In an interview with Fox News Channel last Thursday, Ryan said: “Obamacare rewrote Medicare … so if you’re going to repeal and replace Obamacare, you have to address those issues as well. … What people don’t realize is that Medicare is going broke, that Medicare is going to have price controls. … So you have to deal with those issues if you’re going to repeal and replace Obamacare. Medicare has got some serious problems because of Obamacare. Those things are part of our plan to replace Obamacare.” (Michael Hiltzik, 11/14)

The New Republic: Democrats Need To Pick A Big Fight Over Medicare
Interviewed over the weekend on Fox News’s Special Report, House Speaker Paul Ryan hinted that the Republican Party’s longstanding promise to “repeal and replace” Obamacare will be fused with his own enduring goal of privatizing Medicare and replacing it with a cash subsidy that almost certainly won’t be adequate to cover senior health care costs. Ryan’s appearance was a preview of the horrors we can expect from the newly emboldened GOP-controlled Congress, which is going to put pressure on Donald Trump to sign a raft of conservative legislative priorities. (Jeet Heer, 11/14)

RealClear Health: One Health Care Fix We All Can Agree on
But one shining example of bipartisan agreement is the desire to move away from fee-for-service medicine to a value-based system. Rather than focus on the number of tests, scans, and medical procedures that can be ordered, the aim is to pay for better care instead of simply paying for more. (Ceci Connolly, 11/14)

Pioneer Press: 3 Reasons Why MNsure Is Such A Mess
The roughly 100,000 Minnesotans buying unsubsidized health insurance from MNsure don’t need any stats or charts to tell them Minnesota’s individual market is in a crisis. Their premiums are going up by an average of 59 percent, their plan options have narrowed and many of them have been kicked off their old plan when Blue Cross Blue Shield left the market. But the stats tell a stark tale nonetheless — and Minnesota policymakers are paying very close attention as they try to find a way to end the crisis and help Minnesotans get good, affordable health insurance. (David Montgomery, 11/14)

The Wichita Eagle: State Snipping Holes In Safety Net For Disabled
Tim Keck, acting secretary of the Kansas Department for Aging and Disability Services, recently wrote a commentary stating that the safety net for the disabled in Kansas is strong (Oct. 24 Opinion). As the parent and guardian of an adult son whose disability is on the autism spectrum, I disagree. Keck said more people have received dental care under KanCare. My son’s care coordinator gave me a list of about 30 dentists. I started calling and found no dentist who would take an additional adult KanCare patient. I was told it was too hard to get reimbursement and the amount of reimbursement just wasn’t worth it. (Kay Soltz, 11/14)

Sacramento Bee: California Must Add Cancer Warning On Processed Meats
When you stroll up to virtually any meat counter in any grocery, the “freshly slaughtered” color of red stares back at you. But for many of those products, that deep color is a troubling ruse – a fiction maintained only by the addition of nitrates and nitrites. (Nathan Donley, 11/14)

Boston Globe: Looking For A Few Good Docs 
Many female physicians who choose to have children are fighting an uphill battle. The current model of medical education and training, after all, was designed exclusively for men more than a century ago. It consists of a rigid curriculum with a tight timeline for rotations, boards, and fellowships, to say nothing of the 80-hour duty weeks and, at times, punishing schedules. But is that the best way to fill the ranks of tomorrow’s clinicians? (Chloe K. Fox, 11/13)

Stat: Climate Change Agreements Will Save Millions Of Lives
If an infectious disease was killing 7 million people a year, it would be ludicrous to work to allay its impact decades from now rather than taking immediate action against it. Yet that is exactly how we are approaching the causes of climate change, which are both immediate and long-term killers. This week’s “airpocalypse” in New Delhi shows just how urgently action is needed to prevent the air pollution that is not only damaging our planet and human health in the long term but killing millions of people around the world in the present. (David J. Hunter and Francesca Dominici, 11/14)