KHN Morning Briefing

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When care moves back home
After a hospital stay
Pressure comes with it.

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Summaries Of The News:

Health Law

Once A Long Shot, Now Last-Ditch Repeal Effort Is Gaining Traction On Hill

The measure from Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) includes deeper spending cuts and covers fewer people than the bill in July.

The Associated Press: Senate GOP Musters Final Push To Erase Obama Health Care Law
Senate Republicans expressed growing hope Monday for a final push to scuttle President Barack Obama's health care law, an effort that still faces an uphill climb and just a two-week window to pass. Adding more risk, senators would be in the dark about the bill's impact on Americans, since the Congressional Budget Office says crucial estimates won't be ready in time for a vote. (Fram, 9/18)

The Washington Post: The New GOP Health-Care Measure Goes Further Than The Failed One
The latest Obamacare overhaul bill gaining steam on Capitol Hill slashes health-care spending more deeply and would likely cover fewer people than a July bill that failed precisely because of such concerns. What’s different now is the sense of urgency senators are bringing to their effort to roll back the Affordable Care Act, with only a dozen days remaining before the legislative vehicle they’re using expires. (Winfield Cunningham, 9/18)

The Washington Post: New Push To Replace Obamacare Reflects High Stakes For Republicans
The latest proposal would give states control over billions in federal health-care spending, repeal the law’s key mandates and enact deep cuts to Medicaid, the federally funded insurance program for the poor, elderly and disabled. It would slash health-care spending more deeply and would probably cover fewer people than the July bill — which failed because of concerns over those details. The appearance of a new measure reflected just how damaging Republicans consider their inability to make good on a key campaign promise of the past seven years: to repeal and replace President Barack Obama’s signature domestic policy achievement. (Sullivan and Snell, 9/18)

Bloomberg: McCain Holds Out As GOP Wages Last-Gasp Push To Repeal Obamacare 
Because the measure strives to equalize Medicaid funding between states, some Republicans from Medicaid expansion states in the House could find it hard to support. That includes states like New York and California, which stand to lose federal funds under Graham-Cassidy. Those states have only Democratic senators, but have some GOP House members. (Litvan and Wasson, 9/18)

Bloomberg: Senate GOP Has 12 Days To Repeal Obamacare And No Room For Error 
They need to act by Sept. 30 to use a fast-track procedure that prevents Democrats from blocking it, but the deadline doesn’t leave enough time to get a full analysis of the bill’s effects from the Congressional Budget Office. The measure would face parliamentary challenges that could force leaders to strip out provisions favored by conservatives. Several Republicans are still withholding their support or rejecting it outright. (Litvan, Kapur and Wasson, 9/19)

The Hill: Finance To Hold Hearing On ObamaCare Repeal Bill
The Senate Finance Committee will hold a hearing Monday on the latest effort to repeal ObamaCare as Republicans eye a potential vote next week. “A hearing will allow members on both sides of the aisle to delve deeper into its policy and gain a better understanding of what the authors hope to achieve,” Finance Chairman Orrin Hatch (R-Utah) said in a statement. (Carney, 9/18)

Nashville Tennessean: Latest ACA Repeal Bill Could Hit Those With Pre-Existing Conditions
The latest Obamacare repeal-and-replace bill in the U.S. Senate raises the possibility that Tennesseans with pre-existing diseases could see increased costs or change in coverage. The legislation would hand states broad authority to determine coverage parameters, including the decision to waive community ratings and the essential health benefits. Known as the "Graham-Cassidy" bill, the measure was crafted by Sens. Bill Cassidy, R-La., and Lindsey Graham, R-S.C. (Fletcher, 9/18)

Meanwhile, some are already speaking out against it —

The Hill: Top Louisiana Health Official Rips Cassidy Over ObamaCare Repeal Bill 
Louisiana’s top health official sent a scathing letter to Sen. Bill Cassidy (R-La.) blasting his new bill to repeal and replace ObamaCare, saying “the harm to Louisiana from this legislation far outweighs any benefit.” “The legislation you’ve introduced this past week gravely threatens health care access and coverage for our state and its people,” Secretary of the Louisiana Department of Health Rebekah Gee wrote. (Carter, 9/18)

A Look At Where Lawmakers Stand: It Will Take Three Senators To Put Final Nail In Repeal Coffin

Despite growing support for the Cassidy-Graham Bill, there are two senators likely to oppose the measure. One more would halt the latest proposal to repeal and replace the Affordable Care Act.

Politico: Momentum Builds For Obamacare Repeal
Three “no” votes would kill the bill, but in an encouraging sign for repeal proponents, no one is stepping forward yet to deliver that final nail. Instead, wavering senators remain on the sidelines. Conservative Sen. Mike Lee of Utah is warming to the legislation, which would turn federal health care funding into block grants for states and eliminate Obamacare’s coverage mandate, while Alaska Sen. Lisa Murkowski is undecided. (Everett and Haberkorn, 9/18)

The Wall Street Journal: Republicans Press Graham-Cassidy Repeal Effort
Mr. Graham said Thursday that Vice President Mike Pence had called him to say the administration is “100%” on board with the bill. A White House statement earlier last week said only that the president “sincerely hoped” Messrs. Graham and Cassidy had found a solution on health care. House Speaker Paul Ryan (R., Wis.) also appeared to support the proposal Friday. “I appreciate Senators Graham and Cassidy continuing to work on a plan to pass the Senate. I’ll take federalism over Obamacare any day,” he said in a tweet. (Armour and Hackman, 9/18)

The Hill: Graham: Trump Trying To Sell Governors On Latest ObamaCare Repeal Plan 
President Trump is calling governors to try to get their support for a last-ditch ObamaCare repeal effort taking place in the Senate, says Sen. Lindsey Graham (R-S.C.). "He’s on the phone as I speak getting governors who are a little nervous about this, saying we’re not going to let you fail, we’re going to give you the flexibility over time and we’re going to empower you unlike anything you’ve ever seen," Graham told Breitbart News over the weekend. (Hellmann, 9/18)

Los Angeles Times: With A Deadline Approaching, Republicans' Last Push To Roll Back Obamacare Gains Strength
Prospects for the new repeal legislation — sponsored by Sens. Bill Cassidy (R-La.) and Lindsey Graham (R-S.C.) — remain uncertain, but the proposal won an important endorsement Monday from a key Republican governor, Arizona’s Doug Ducey. That raised the possibility that the state’s senior senator, John McCain, who cast the crucial vote in July to kill the last repeal push, could back the new bill. McCain has said he would be influenced by Ducey’s position, but has also called for a less partisan, less rushed approach to healthcare legislation. (Levey, 9/18)

The Hill: Arizona Governor Backs New ObamaCare Repeal Bill 
Arizona Gov. Doug Ducey has endorsed a new Senate Republican bill that would repeal and replace ObamaCare. Ducey, a Republican, called the legislation offered by GOP Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.) "the best path forward" to gut the health-care law. (Roubein, 9/18)

Politico: McCain: I’m Not There Yet On Latest Obamacare Repeal Bill
Sen. John McCain said on Monday that he's not yet on board with his party's latest Obamacare repeal bill, airing some of the same objections that he cited when killing the last GOP push to axe the health law. "I am not supportive of the bill yet," McCain told reporters, adding that he and fellow Republicans would "talk more about it" as the clock ticks closer to the Sept. 30 deadline for the GOP to repeal Obamacare with a simple majority vote in the Senate. (Schor, 9/18)

The Hill: Paul 'Worried' New ObamaCare Repeal Bill Might Pass 
Sen. Rand Paul (R-Ky.) said he’s worried the latest attempt to repeal ObamaCare might pass, and the unintended consequences could be severe. “There's a big groundswell of people pushing for this,” Paul told Reporters on Monday. “Two weeks ago, I’d have said zero [chance it’ll pass], but now I’m worried.” Paul has called the bill from Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) “Obamacare lite” and said he will not support it. (Weixel, 9/18)

The Hill: Collins Skeptical Of New ObamaCare Repeal Effort 
Sen. Susan Collins (R-Maine) is voicing concern about the latest GOP ObamaCare repeal effort, which could potentially be moving forward without a full Congressional Budget Office (CBO) analysis. "That's problematic. ... That's part of the problem with short circuiting the process," Collins, one of three Republicans who voted against the Senate’s last repeal push, told reporters Monday when asked about CBO's estimate that it wouldn't know the impact on insurance coverage of a bill from GOP Sens. Lindsey Graham (S.C.) and Bill Cassidy (La.) for weeks. (Carney, 9/18)

The Hill: Murkowski Still Studying New ObamaCare Repeal Bill 
Sen. Lisa Murkowski (R-Alaska), who could be the deciding vote on a new ObamaCare repeal bill, says she is still studying the measure and its effects on Alaska. "I need to figure out how all the numbers work with regards to Alaska," she told a small group of reporters Monday. (Sullivan, 9/18)

Concord (N.H.) Monitor: Sununu Praises, Then Disavows Graham-Cassidy Bill To Replace Obamacare
Gov. Chris Sununu disavowed a last-ditch federal bill to repeal the Affordable Care Act Monday, praising provisions that would introduce block-grant funds to states but distancing himself from vast Medicaid cuts included in the legislation. The bill, proposed by Republican Sens. Lindsay Graham and Bill Cassidy, would dramatically overhaul the U.S. health care system, replacing Affordable Care Act tax subsidies with a state-by-state grant system and making deep reductions to Medicaid and Medicare. (Dewitt, 9/18)

CQ: GOP Still Short Of Votes For Health Care Repeal
Some Senate Republicans are prodding their colleagues to roll back the 2010 health care law this month after abandoning the effort earlier this summer, but the caucus is still short of the votes needed to advance a bill. The latest replacement plan — rolled out last week by GOP Sens. Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson —faces major challenges. The nonpartisan Congressional Budget Office on Monday said it would aim to offer a preliminary analysis of the draft Graham-Cassidy health care proposal by early next week. (McIntire, 9/18)

The Hill: New Ad Targets Heller On Support Of ObamaCare Repeal Bill 
A new ad is targeting Sen. Dean Heller (R-Nev.) for his support of a last-ditch ObamaCare repeal bill in the Senate. The digital ad from pro-ObamaCare group Save My Care shows the "consequences of passing ... health care repeal for people with pre-existing conditions." (Hellmann, 9/18)

Senators' Interpersonal Dynamics On Display As Lawmakers Try To Court Hold-Out Votes

Passing the latest repeal-and-replace bill may all come down to old friendships. Meanwhile a look at how this all came about, and how Senate Majority Leader Mitch McConnell (R-Ky.) has been put into a strange position of supporting work created outside his leadership team.

The Hill: How Senate Relationships Could Decide ObamaCare Repeal 
In the clubby world of the Senate, relationships could determine the fate of ObamaCare repeal. The bill’s main sponsors — Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) — are laboring to sell their Republican colleagues on the legislation, which would turn much of ObamaCare’s funding into block grants to the states. With Sen. Rand Paul (R-Ky.) pledging to vote against the bill, Graham and Cassidy need to win over at least two of the three Republicans who voted in July against the last repeal bill: Sens. John McCain (Ariz.), Lisa Murkowski (Alaska) and Susan Collins (Maine).  (Hellmann, 9/18)

The New York Times: Health Bill Tests A Signature Senate Bond: John McCain And Lindsey Graham
“I always do whatever Lindsey Graham tells me to do,” Senator John McCain, the unpredictable Arizona Republican, said last week, while entertaining questions from a scrum of reporters in a Capitol hallway. He was referring to his best Senate friend and frequent travel partner, Senator Lindsey Graham, the South Carolina Republican who is so closely identified with Mr. McCain that when he arrived in the Senate after serving in the House, he was called “McCain’s mini-me.”But now the McCain-Graham bond is being tested. (Stolberg, 9/19)

Roll Call: McConnell In Difficult Spot With Latest Health Care Push
Now that he has endorsed it, the Kentucky Republican is invested in a proposal that, if successful, would exist primarily because of work outside his leadership team. “We kept working on it, so now we have this possibility,” [Sen. Ron] Johnson said Monday. (Williams, 9/18)

CNN: How Obamacare Repeal Came Back With A Fury
Sen. Pat Roberts, a Republican from Kansas, said everyone is aware this is the last shot. "We'd like to do something and something's better than nothing," Roberts said. By Monday, the momentum was growing. Behind the scenes, Cassidy and Graham were engaged in a full-court press, reaching out to colleagues and leadership and trying to get them to back their plan publicly. By Monday, House Speaker Paul Ryan was calling the plan the "best, last chance" the GOP has to overhaul Obamacare -- and the Senate's finance committee had announced a hearing on the proposal. (Fox and Mattingly, (9/19)

CBO Warns It Won't Have Time To Give Full Analysis On Graham-Cassidy Bill

That could make it difficult for some Republicans to throw support behind the bill, but it will also allow lawmakers to avoid any damaging headlines until after the vote. The Congressional Budget Office's "preliminary assessment" is expected next week.

The Hill: CBO To Release Limited Analysis Of ObamaCare Repeal Bill Next Week 
The Congressional Budget Office (CBO) said Monday it's aiming to provide a "preliminary assessment" of a repeal bill sponsored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) by early next week. The score will include information on whether the legislation would reduce deficits by at least as much as was estimated for the House repeal bill passed earlier this year. It will also assess if the bill would save at least $1 billion and whether it would increase on-budget deficits in the long term. (Hellmann, 9/18)

The Hill: Democratic Leaders Want Full CBO Analysis Of ObamaCare Repeal Bill 
Democrats on Monday asked the Congressional Budget Office to conduct a full analysis on coverage losses that would result from the latest Senate GOP effort to repeal and replace ObamaCare. In a letter sent to the nonpartisan budget office, Senate Minority Leader Chuck Schumer (D-N.Y.) and House Minority Leader Nancy Pelosi (D-Calif. ) said the public needs a “full understanding of the impact this legislation would have” on Americans. (Weixel, 9/18)

'This Is A Red Siren Moment': Democrats Launch Flurry Of Attacks Against Repeal Bill

The lawmakers are putting pressure on their moderate Republican colleagues to take a stand against the Graham-Cassidy bill. They also held the Senate floor for a four-hour talk-a-thon on Monday night.

Politico: Dems Rush Back To Obamacare Battle
Democrats hustled Monday to beat back the GOP’s latest Obama-care repeal push, leaning on moderate Republicans and mobilizing advocacy groups off the Hill to sound the alarm. The flurry of pressure tactics from Democrats comes as a new repeal bill remains very much alive among Senate Republicans, who have until Sept. 30 to ax former President Barack Obama’s signature health care law with a simple majority vote. (Schor, 9/18)

The Hill: Senate Dems Hold Floor Talk-A-Thon Against Latest ObamaCare Repeal Bill 
Senate Democrats held a nearly four-hour talk-a-thon on Monday night to protest the latest GOP bill to repeal and replace ObamaCare ahead of a potential vote next week. A bill, spearheaded by GOP Sens. Bill Cassidy (La.) and Lindsey Graham (S.C.), to repeal much of ObamaCare is gaining momentum as Republicans face an end-of-the-month deadline to try to nix the Affordable Care Act with a simple majority. (Carney, 9/18)

Ryan Says House Would Vote On Senate's Bill: 'I'll Take Federalism Over Obamacare Any Day'

House leaders and key conservative members have signaled a willingness to take up the measure if it passes the Senate, but its path through the lower chamber might not be completely smooth.

Roll Call: Ryan Says House Would Vote on Graham-Cassidy If Senate Passes It
Speaker Paul D. Ryan said Monday that the House would bring up a health care measure sponsored by Sens. Lindsey Graham and Bill Cassidy for a vote if it were to pass the Senate. “It would be our intention to bring the matter through,” Ryan said at a news conference from a Harley Davidson facility in Wisconsin, where he was promoting GOP plans to overhaul the tax code. ... House Freedom Caucus Chairman Mark Meadows agreed that the Graham-Cassidy measure is the GOP’s last shot. (McPherson, 9/18)

The Hill: Ryan: Graham-Cassidy 'Best, Last Chance' To Repeal ObamaCare
“We hope the Senate does pass Graham-Cassidy. We’re encouraged by the development of Graham-Cassidy,” Ryan said at a town hall-style event at the Harley-Davidson facility in Menomonee Falls, Wis. “And I am encouraging every senator to vote for Graham-Cassidy, because it is our best, last chance to get repeal and replace done. “And I do believe it is a far greater improvement over the status quo,” the Speaker continued. “I’ll take [the] federalism of Graham-Cassidy over a collapsing ObamaCare system any day.” (Wong, 9/18)

Politico: Freedom Caucus Chief: House Would Pass Obamacare Repeal Plan
House Freedom Caucus Chairman Mark Meadows predicted Monday that the House would pass a last-ditch effort to repeal Obamacare if it clears the Senate, with conservatives getting on board. The North Carolina Republican said in an interview that while it’s too early for his group to take a position on the 11th-hour Obamacare replacement bill authored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), he is “very optimistic” about its prospects in the House. (Bade, 9/18)

The Washington Post: Would The House Pass Graham-Cassidy? It’s Not A Slam Dunk.
As Senate Republicans work feverishly to try to revive plans to replace parts of the Affordable Care Act ahead of a Sept. 30 deadline, it’s easy to forget: There’s another chamber in Congress, and it is not a potted plant. One might assume that the House, which already passed a GOP health-care bill in May, would simply rubber-stamp any Senate bill, high-five, and call it a day, but things are not quite so simple. The American Health Care Act (AHCA) passed the House 217-to-213, meaning two flipped decisions would have stopped the bill cold. (DeBonis, 9/18)

There Are Now Three Senate Health Care Plans Pitted Against Each Other

News outlets take a deeper look at the Graham-Cassidy bill, the market stabilization efforts and the Democrats' single-payer proposal.

The Wall Street Journal: Senate’s Three Health-Care Proposals: A Guide
Since the Republican effort to repeal and replace most of the Affordable Care Act faltered in July, three major efforts have emerged in the Senate as lawmakers seek a path forward. They include a final effort to repeal the ACA; an attempt to find a compromise that would shore up the insurance markets; and a push for a new government-run system. All of them face big political hurdles. Here are some key details of the three proposals. (Hackman, 9/19)

Modern Healthcare: The Race Is On As Senate Factions Vie To Either Fix Or Replace The ACA
Three separate legislative trains, one from the right, one from the center and one from the left, are running down Congress' heavily mined healthcare reform tracks, and it's not clear which one will reach the station. Time is running out fast, at least for the conservative and centrist trains. That spells trouble for insurers, providers and patients heading into 2018. Healthcare industry groups hope the winner is the bipartisan initiative being crafted in the Senate Health, Education, Labor and Pensions Committee to stabilize the individual market and reduce premiums for next year. (Meyer, 9/18)


After Government Guts Health Law Outreach Budget, Insurers Kick Off Own Ad Campaigns

"Particularly in this year of uncertainty, it's really important for us to be in market early and and reassure the 22 million folks that are insured that it is really important to get covered," says Sara Rowghani, insurance startup Oscar's vice president. Meanwhile, Affordable Care Act navigators say their job is a lot more complex than the government seems to think.

NPR: Private Insurer Steps Up To Advertise Open Enrollment For Obamacare
Open enrollment for Affordable Care Act insurance doesn't start for another six weeks. But the quirky insurance startup Oscar Health is launching an ad campaign Monday aimed at getting young people to enroll. The company is boosting its ad spending after the Trump administration announced it would slash its ACA advertising budget by 90 percent. (Kodjak, 9/18)

Kaiser Health News: Bemoaning Budget Cuts, Navigators Say Feds Don’t Appreciate Scope Of The Job
The Trump administration says many of the organizations that help people enroll in health plans on the federal insurance marketplaces don’t provide enough bang for the buck, sometimes costing thousands of dollars to sign up each customer. So, it is cutting their funding, some by as much as 90 percent, the government told the groups last week. But the navigators, as they’re called, say the government doesn’t understand the time involved in the effort or the complexity of the enrollment challenge. Nor do federal officials appreciate the variety of tasks that navigators are asked to handle, they say. (Andrews, 9/19)


Senators Release Details Of Children's Health Insurance Bill As Funding Deadline Approaches

The funding authority for the popular Children's Health Insurance Program (CHIP) expires on Sept. 30, but senators have a bipartisan proposal to extend it. Some states are getting nervous. In Medicaid news, a Republican candidate for governor in Ohio breaks with the state's current Gov. John Kasich on Medicaid expansion.

CQ HealthBeat: Senate Finance Leaders Release Children's Health Bill
Leaders from the Senate Finance Committee introduced their bill to renew funds for the Children’s Health Insurance Program for five years on Monday, less than two weeks before funding expires. The legislation (S 1827) by Finance Chairman Orrin G. Hatch of Utah and ranking member Ron Wyden of Oregon would extend funding for the program through fiscal year 2022 and maintain for two years a 23 percentage point enhanced federal match given to states in previous laws. After that, the matching rate would decline and states would receive an 11.5 percent bump for fiscal 2020. In fiscal 2021, the rate would return to traditional levels. (Raman, 9/18)

CQ: Minnesota Children's Health Program In Jeopardy
Minnesota’s health insurance program for children could exhaust its funds sooner than expected — a development that may put pressure on Congress to meet a Sept. 30 federal funding deadline. The nonpartisan Medicaid and CHIP Payment and Access Commission previously projected that three states, including Minnesota, as well as the District of Columbia, would begin running out of funding for their CHIP programs by December. MinnesotaCare, Minnesota’s CHIP program, may actually exhaust their annual allotment of $115 million by the end of this month, according to the state. (Raman, 9/18)

Georgia Health News: Key Federal Health Funds May Not Get OK In Time
Tens of millions of dollars in government funding for Georgia health care faces a dangerous deadline in less than two weeks. ... The money at risk includes funding for a popular children’s health insurance; Medicaid funds for hospitals that deliver a high level of indigent care; and financial support for community health centers. And there’s about $10 million at risk for rural hospitals in Georgia that have a low number of Medicare patients. (Miller, 9/18) Mary Taylor Breaks With John Kasich, Proposes Ending Medicaid Expansion
Republican Lt. Gov. Mary Taylor said Monday she would end the Medicaid expansion in Ohio if she is elected governor -- a clean break from the man she has served alongside for the last seven years, Gov. John Kasich. As part of her run to succeed Kasich, Taylor unveiled her plan to alter the health care system in Ohio on Monday in Cleveland. (Richardson, 9/18)

Public Health And Education

Trump Administration Embraces Partnership With Pharma To Fight Opioid Crisis

The partnership will "fast track" the development of non-opioid pain medication, as well as new medication-assisted treatment options. However, the administration still hasn't moved forward with its opioid commission's main recommendation, which was to declare a national emergency.

Politico: White House Backs Pharma Partnership After Delaying Other Opioid Panel Proposals
The White House has delayed implementing two of the top recommendations of the presidential opioid commission chaired by New Jersey Gov. Chris Christie, but the Trump administration sent several officials to Trenton on Monday to advance a third program — a public-private partnership with the pharmaceutical industry. Standing next to Christie, counselor to the president Kellyanne Conway said President Donald Trump has made the opioid epidemic a priority, which is why he established the Commission on Combating Drug Addiction and the Opioid Crisis in the first place. (Jennings, 9/18)

The Associated Press: Christie: Drugmakers To Work On Nonaddictive Pain Medication
New Jersey Gov. Chris Christie said Monday that pharmaceutical companies agreed to work on nonaddictive pain medications and additional treatments to deal with opioid addiction. The Republican governor made the announcement in Trenton, shortly after he convened a meeting of the White House opioid commission that he chairs. That roundtable discussion was closed to the press. (Catalini, 9/18)

And in news from the states —

The Associated Press: City Asks Judge To Let Case Against OxyContin Maker Proceed
A Washington city that says the pain medication OxyContin has devastated the community asked a federal judge Monday to let it move forward with its lawsuit seeking to hold the pill's manufacturer accountable for damages. Everett, a working-class city of about 108,000 north of Seattle, sued Connecticut-based Purdue Pharma in January, alleging the company knowingly allowed pills to be funneled into the black market and into the city and did nothing to stop it. (Le, 9/18)

Modern Healthcare: Safe Injection Site Bill Fails To Pass In California
The failure of a California bill to make it the first state in the country to legalize safe injection sites for drug users has not deterred proponents, which include many providers and public health experts. California bill AB 186 would have allowed Alameda, Humboldt, Los Angeles, San Francisco and San Joaquin counties to approve facilities specifically designed to allow for the consumption of drugs. The bill fell two votes shy of the 21 needed to approve the measure before the end of the state's legislative session on Friday. A number of lawmakers were absent for the vote last week, giving Dr. Paula Lum, professor of medicine at the University of California San Francisco hope that the issue will be revisited in the next session in January. (Johnson, 9/18)

New Orleans Times-Picayune: Louisiana Infants Born Exposed To Drugs, Alcohol Triples In 8 Years 
The number of newborns in Louisiana exposed to alcohol and drugs before their births almost tripled over an eight year period ending in 2016, according to information provided by the Department of Children and Family Services Monday (Sept. 18). In 2008, hospitals reported 569 newborns with drugs or alcohol in their systems at birth to the agency. In 2016, they reported 1,659 of the same cases. Opioid addiction is part of what is driving the increase, said Marketa Walters, secretary of the Department of Children and Family Services. "We know that's a huge factor," she said. (O'Donoghue, 9/18)

Boston Globe: Addiction Event On Cape Cod Mingled Courses, Controversy
Sovereign’s prominent and untimely sponsorship of the Cape Cod Symposium on Addictive Disorders, one of the largest and most influential addiction treatment events of the year, created an awkward juxtaposition for an industry eager to improve its reputation. Many in the sprawling, $35 billion addiction treatment business are dismayed by revelations of unethical marketing, patient brokering, and shoddy care — all coming as the demand for quality treatment has never been higher amid a national opioid epidemic. (Allen and Armstrong, 9/19)

Aside From Florida Nursing Home Tragedy, Most Health Facilities Performed Well During Irma

Just 10 of Florida's more than 300 hospitals were closed by the storm. While 150 of the 700 nursing homes lacked full power three days after Hurricane Irma struck, most had backup generators, according to the Florida Health Care Association. In Texas, a key federal official is looking at what lessons should be learned from Hurricane Harvey.

NPR: When Irma Arrived, Most Florida Health Care Facilities Were Ready
Another hurricane, another health care horror story. At least that's how it looked when eight patients died at a nursing home in Hollywood, Florida. The facility lost its air conditioning several days after Hurricane Irma struck. That event conjured memories of the scores of elderly who died in Louisiana hospitals and nursing homes following Hurricane Katrina in 2005. But it would be misleading to attribute the Florida deaths primarily to Irma. (Hamilton, 9/19)

Health News Florida: Hollywood Nursing Home Where Eight Died Wasn't On Priority List For Power Restoration
The nursing home where residents died following a hurricane-induced air conditioning outage was not on the priority list for power restoration, according to the facility's utility provider and Broward County officials. Emergency responders confirmed eight deaths last Wednesday at the Rehabilitation Center at Hollywood Hills, three days after Hurricane Irma knocked out power to the facility's air conditioning system. (Stein, 9/18)

Houston Chronicle: Mobile Dialysis Centers Urged For Next Catastrophe 
Seema Verma, administrator of the federal Centers for Medicare and Medicaid Services, arrived in Houston on Monday not only to gather tales of Hurricane Harvey but also, and perhaps more importantly, to contemplate any hard lessons learned before the next disaster strikes. "I wanted to come and say thank you," she told a packed meeting room of employees and officials at a dialysis center near Brays Bayou. She then added she was sent by the Trump administration to ask, "How can we do better?" (Deam, 9/18)

Global Health Progress Has Been Made, But U.S. Aid Cuts Could Be Lethal To Millions

Bill and Melinda Gates release a report card assessing global health, and warn only the United States is rich enough and generous enough to lead the charge on foreign aid. In other public health news: MRIs, tattoos and infections.

The New York Times: Bill And Melinda Gates Grade The World’s Health
Bill and Melinda Gates handed the world a report card last week, assessing its progress on 18 global health indicators: infant mortality, AIDS, vaccine use, smoking rates and so on. Called “Goalkeepers,” the report was a huge statistical effort, three years in the making, aimed squarely at the world leaders gathering at the United Nations General Assembly this month. To draw extra attention to it, the Gateses will hold an awards dinner and a public release this week featuring former President Obama. (McNeil, 9/18)

The Wall Street Journal: A Question For Anyone Getting An MRI
Most patients getting an MRI don’t know to ask a critical question: Will the MRI use gadolinium or not? Magnetic resonance imaging with a gadolinium-based contrast agent, called a GBCA, leaves metal deposits in the body’s organs and tissues including the brain, research shows. Scientists are exploring whether the deposits harm patients. (Reddy, 9/18)

Los Angeles Times: Pediatricians May View Tattoos, Piercings As Red Flags. They Should Discuss It Instead, Report Says
Tattoos or pierced body parts have long been considered a red flag for pediatricians who found them on their patients. Physicians who came across an inked symbol or a navel ring while examining an adolescent or young adult were taught to probe for other dangerous behaviors, including drug use, weapons carrying, risky sexual activity, and self-injury. In a flood of ink both literal and figurative, that medical advice has been washed away. (Healy, 9/18)


In Blow To GSK, Judge Upholds Verdict In Case Over Paxil's Link To Suicide

The federal court jury decided GlaxoSmithKline failed to properly warn about the risk of its medicine.

Stat: Glaxo Loses Bid For A New Trial In An Unusual Paxil Suicide Case
In a setback for GlaxoSmithKline (GSK), a federal judge upheld a $3 million verdict in a closely watched trial that involved a highly contentious issue — whether consumers can successfully sue a brand-name drug maker if they suffered harm after taking a pill made by a generic rival. The verdict was issued last spring in a lawsuit that was brought by Wendy Dolin, the widow of an attorney who committed suicide after taking a generic version of Glaxo’s Paxil antidepressant. The federal court jury decided the drug maker failed to properly warn about the risk of its medicine. On Monday, a Glaxo spokeswoman wrote us that the company plans to appeal the decision. (Silverman, 9/18)

In other pharmaceutical news —

Stat: Nabriva Novel Antibiotic Meets Goals In Late-Stage Bacterial Pneumonia Study
Nabriva Therapeutics (NBRV) took a big risk pushing its novel antibiotic, lefamulin, into a late-stage clinical trial in patients with hospital-acquired pneumonia without any prior clinical data. On Monday, the bet paid off. The Ireland-based company said lefamulin achieved the primary and secondary endpoints in a phase 3 study of 551 patients with community-acquired bacterial pneumonia. This is the first of two phase 3 clinical trials needed to seek regulatory approval for lefamulin. The second study will read out results in the fourth quarter. (Feuerstein, 9/18)

Veterans' Health Care

Western States Have Disproportionately High Suicide Rates For Veterans

Epidemiologist Rajeev Ramchand, who has a background in studying suicide, said there could be several factors that led to the results, including gun ownership, difficulty accessing proper health care and isolation from communities. Meanwhile, after a series of disappointments from its supercomputer Watson, IBM is counting on Watson's efforts with the VA health system.

The Hill: High Suicide Rate Among Military Vets In Western US, Rural Areas 
The western U.S. and rural areas of the country have seen the highest rates of suicide among veterans, according to a new study.  Veterans in the western states of Montana, Utah, Nevada and New Mexico have the highest suicide rates in the country at 60 per 100,000 individuals, according to new data from a study by the Department of Veterans Affairs (VA), ABC News reported. This is compared to the national average of 38.4 per 100,000 individuals. (Delk, 9/16)

Politico Pro: IBM Pins Its Hopes For Watson On VA Health System
IBM unveiled its Watson Health system in a blitz of hype in 2013, promoting it with an army of sales reps and even Super Bowl ads. But Watson’s artificial intelligence has failed to blow away doctors, a humbling experience for the company that hoped to “disrupt” health care the way competitors transformed other industries. (Pittman, 9/19)

State Watch

State Highlights: Calif. University Receives Record $200M Donation For Health Sciences College; Childhood Hunger Skyrockets In Pa.

Media outlets report on news from California, Indiana, Pennsylvania, Colorado, Minnesota, Oregon, Maryland, Iowa and New Hampshire.

Los Angeles Times: Corona Del Mar’s Samuelis Donate Record $200 Million To UCI To Establish Health Sciences College
UC Irvine officials Monday announced the university’s largest gift ever — a $200-million donation from Corona del Mar philanthropists Susan and Henry Samueli that will establish a health sciences college in their name.The grant is the seventh-largest gift to a single public university. The Susan and Henry Samueli College of Health Sciences will focus on integrated health, defined by university officials as a healthcare approach that incorporates conventional medicine, complementary and alternative medicines and “self-care,” which emphasizes evidence-based behavioral and nutritional approaches that promote wellness. (Zint, 9/18)

Los Angeles Times: UC Irvine Aims To Transform Public Health With Record-Breaking $200-Million Donation
Susan Samueli caught a cold while visiting France more than three decades ago. Instead of the usual medicines, a friend suggested aconite, a homeopathic remedy derived from a plant in the buttercup family. She was cured — and became a lifelong advocate of homeopathy and other alternative healing methods to complement conventional medicine. Her husband, Henry — the billionaire co-founder of Broadcom, the Irvine semiconductor maker — says he was initially skeptical but found the integrative health approach helped him easily shake off colds and flus and kept their children healthy without antibiotics. (Watanabe, 9/18)

The Philadelphia Inquirer/ Childhood Hunger In North Philadelphia More Than Triples
Between 2006 and 2016, childhood hunger in North Philadelphia has more than tripled among families where parents work 20 or more hours a week, according to Chilton’s research at St. Christopher’s Hospital for Children, part of Children’s HealthWatch, a national research network that investigates the impact of public assistance programs on children’s health. Chilton said her findings in North Philadelphia likely resemble rates of childhood hunger throughout the city. (Lubrano, 9/18)

The Associated Press: Indiana Nursing Home Company Sues Former Executives
A nursing home management firm in Indiana has sued several former executives who are already criminally charged with embezzling more than $16 million from the company. American Senior Communities filed the lawsuit Friday against several individuals, including former CEO James Burkhart, and 16 shell companies, The Indianapolis Star reported. (9/18)

Los Angeles Times: In San Diego, Hundreds Line Up For Hepatitis A Vaccinations After Deadly Outbreak May Have Hit Restaurants
After news that San Diego’s deadly hepatitis A outbreak may have infiltrated the food service industry, more than 200 people this weekend lined up for vaccinations as restaurants reinforced their health safety measures. “All eyes are on San Diego,” Steve Zolezzi, president of the Food & Beverage Assn. of San Diego, said of the outbreak, one of the nation’s largest in decades, which prompted county officials to declare a local public health emergency earlier this month. (Nikolewski, 9/18)

California Healthline: State Lawmakers Tackle Public Smoking And Lead Poisoning, But Punt On Single-Payer
California lawmakers approved several key health care proposals — and stalled on others — in their mad dash toward last Friday’s do-or-die legislative deadline. They adopted a bill that would require drugmakers to give 60 days’ notice on big price hikes, but pushed off a decision on single-payer health care. They banned smoking at state parks and beaches, but delayed a proposal that would have established staffing requirements for dialysis clinics. (Ibarra and Bartolone, 9/18)

The Oregonian: Former Oregon Health Officials Skip Hearing Into Smear Plan 
Lawmakers in Salem held a hearing on Monday into the Oregon Health Authority's internal public relations plan to smear a Portland health provider. But despite Republicans' requests for the former officials involved to testify, none of them showed up. Instead, lawmakers heard from the agency's new acting director, Patrick Allen. Former director Lynne Saxton resigned in early August at the request of Gov. Kate Brown, soon after the plan became public. She had apologized and said the agency never implemented the plan. (Borrud, 9/18)

The Baltimore Sun: 'DNA Day' Planned For Ravens' Game Undergoes Federal And State Scrutiny 
A Massachusetts biotech firm still intends to give away DNA test kits to fans at a Ravens game this season, according to the team, but the promotion first must undergo scrutiny from a federal agency and the state. The “DNA Day” event, scheduled for last Sunday’s Ravens-Cleveland Browns game at M&T Bank Stadium, was postponed after the federal Centers for Medicare & Medicaid Services raised questions with the state about approvals, state and federal officials said. (Barker, 9/18)

Iowa Public Radio: One Of America's Biggest Food Banks Just Cut Junk Food By 84 Percent In A Year
A year ago, Washington D.C.'s Capital Area Food Bank — one of the largest in the country — decided to turn away junk food, joining a growing trend of food banks that are trying to offer healthier options to low-income Americans. ... While some critics have argued that the poor are too often told what to eat, as if they can't make responsible decisions for themselves, Salmon says the goal of the program isn't to be the food police. (Johnson, 9/18)

Editorials And Opinions

Different Takes: A Repeal-Replace Redux?; Time To Take Graham-Cassidy's 'Zombie' Bill Seriously

Editorial pages across the country are analyzing recent developments in the congressional GOP's ongoing repeal-and-replace effort and taking notice of the latest -- what some say is the last-ditch -- measure to undo the Affordable Care Act.

Bloomberg: Last-Ditch Obamacare Repeal Is Worth Taking Seriously 
Think of Graham-Cassidy as allowing each state to try its hand at health-care policy, backed by a federal lump sum payment. Not surprisingly, opponents fear the states could waive essential components of Obamacare, such as the individual mandate, required coverage for pre-existing conditions or the regulations for “essential” health benefits. Alternatively, states could use the money to help develop their own single payer systems or pursue other innovations. The bill would also replace the federal-state partnership on Medicaid with capped per capita aid to each state, a formula that would induce many states to spend less on the health program for the poor. (Tyler Cowen, 9/18)

The New York Times: The Republican Health Care Zombie Is Back
Republican lawmakers have wasted much of the year trying to repeal the Affordable Care Act, a move that would deprive millions of people of health insurance. They’re back at it. Like a bad sequel to a terrible movie, a proposal whose main architects are Bill Cassidy of Louisiana and Lindsey Graham of South Carolina would in many ways be worse than bills that came before. It would punish states like California and New York that have done the most to increase access to health care and set in motion cuts to Medicaid, the federal-state program that provides insurance to nearly 70 million people, many of whom are disabled and elderly. (9/19)

Los Angeles Times: The GOP's Last-Ditch Obamacare Repeal Bill May Be The Worst One Yet
The Republican effort to repeal the Affordable Care Act is back, a zombie again on the march weeks after it was declared dead. The newest incarnation is Cassidy-Graham, named after chief sponsors Bill Cassidy of Louisiana and Lindsey Graham of South Carolina. Compared with its predecessors, the bill would increase the ranks of America’s medically uninsured more — by millions of people — cost state governments billions more and pave the way for the elimination of all protection for those with preexisting medical conditions. (Michael Hiltzik, 9/18)

San Francisco Chronicle: Obamacare Alternatives Fall Short
The enduring frustration with the ACA — much of it properly directed at the costly, creaky and often cruel system it incrementally improved — is understandable. But the critics’ efforts to undo it keep unintentionally underscoring its centrist pragmatism compared with the alternatives. (9/18)

The Washington Post: On Health Care, Cassidy Flunks His Own ‘Jimmy Kimmel Test’
Sen. Bill Cassidy (R-La.) told late-night host Jimmy Kimmel, who had delivered an impassioned speech on health care after his own son was born with a heart defect, he would only support a bill that would make sure that a child like Kimmel’s would not lack health coverage. Cassidy later articulated his “Jimmy Kimmel test“: “Would the child born with a congenital heart disease be able to get everything she or he would need in that first year of life … even if they go over a certain amount?” (Jennifer Rubin, 9/18)

The Wall Street Journal: How To End ObamaCare In Two Pages
The GOP’s push to repeal the Affordable Care Act is running out of steam—and time. Unless Republicans can agree by Sept. 30, they won’t be able to pass a bill without 60 Senate votes. So here’s a wild idea: Instead of repealing ObamaCare, make it unconstitutional. Recall how the Supreme Court split when it upheld ObamaCare in 2012. Four justices thought the law’s individual mandate—the requirement that Americans buy health insurance or pay a penalty—was unconstitutional. Another four thought it was hunky dory. What broke the tie was a novel opinion by Chief Justice John Roberts, who upheld the penalty by declaring it a tax. (James F. Blumstein, 9/18)

Los Angeles Times: Are Democratic And Republican Healthcare Proposals Really Equally 'Extreme'?
Will the real moderate party please stand up? On the same day that socialist Sen. Bernie Sanders (I-Vt.) introduced his “Medicare for All” healthcare plan, Sens. Lindsay Graham (R-S.C.) and Bill Cassidy (R-La.) introduced a last ditch effort to sorta-kinda repeal and replace Obamacare. Despite having zero chance of being passed any time soon, Sanders’ bill grabbed the limelight for two reasons. (Jonah Goldberg, 9/19)

Single-Payer Perspectives: 'A Growing Moment' Or 'No Miracle Cure'

Opinion writers offer a variety of thoughts on single-payer health care systems in general and the current proposal put forth by Sen. Bernie Sanders (I-Vt.) in specific.

The New York Times: The Sanders Single-Payer Plan Is No Miracle Cure
Last week, Senator Bernie Sanders introduced “Medicare for all” legislation, which would enroll all Americans into the nation’s Medicare program within four years. Senator Sanders, the Vermont independent, argues that his proposal would create a system that “works not just for millionaires and billionaires, but for all of us.” (Lanhee J. Chen and Micah Weinberg, 9/19)

San Francisco Chronicle: A Growing Movement For Single-Payer Health Care
From a candidate who famously declared that single payer will “never ever come to pass” and branded it as offering everyone “a pony” to legislation — Sen. Bernie Sanders’ Senate Bill 1804, co-sponsored by a third of Senate Democrats, and Rep. John Conyers’ House Resolution 676 by half of House Democrats. What happened? A huge shift toward participatory democracy, with millions of people participating in rewriting what is possible and necessary for their lives. (RoseAnn DeMoro, 9/18)

San Jose Mercury News: Sanders’ Medicare For All Bill Comes Up Short; Show Us The Money
Bernie Sanders talks big, but the record shows that in his 25 years in Congress he has failed to deliver on any of his ideological proposals. Expect the same from the independent Vermont senator’s ambitious Medicare for all plan. It’s impossible to take his single-payer plan seriously because it fails to address the single biggest issue: how to pay for it. (9/18)

USA Today: Canadian Doctor To U.S.: Try Single-Payer Health Care Instead Of Trashing It
There’s a joke we sometimes tell in Canada: What’s a Canadian? An apologetic American with health care. It’s funny because we half-believe it’s true. The United States and Canada are about as similar as two countries get. But Canada has had a publicly funded, single-payer health care system in each of our provinces and territories since the 1960s. It works. Maybe it can work for you too. (Danielle Martin, 9/18)

Medicaid Meanderings: Thoughts On Privatization, Expansion And Attending To The Program

Kansas' Medicaid program offers a lens through which one can view various aspects of the ongoing debate over revamping this state-federal program.

Des Moines Register: Medicaid Misgivings: DHS Director Foxhoven May Be Only Hope For Sick Iowans
There is hope for Iowa’s Medicaid program. Finally, an administrative branch official has publicly acknowledged privatized Medicaid is not working for at least some Iowans. The state may resume directly overseeing health services for seriously disabled people, Department of Human Services director Jerry Foxhoven said. Doing that could rescue them from the cuts in service realized under private managed care companies. Foxhoven should follow through with this idea. It opens the door for the state doing what it really needs to do: reclaim the task of directly making care decisions for all Iowa Medicaid beneficiaries. (9/18)

The Wichita Eagle: Huge Cost Would Come With Kansas Medicaid Expansion
Conspicuously absence from most commentary arguing that Kansas should expand Medicaid under the Affordable Care Act is any discussion about the program actually improving the health of recipients. Instead, we are left with terribly materialistic arguments about forgone federal money. Why is it that on the biggest policy questions facing Kansas, such as Medicaid or education, we hear lots about money spent and little about health outcomes or student achievement? (James Franko, 9/19)

The Hill: Lawmakers, Pick Up The Ball On Health Care And Reform Medicaid
Congressional leaders may want to leave the wreckage of this year’s health care reform debacle behind them as they move on to other issues, but the latest Census Bureau report on poverty and health insurance is a good reminder of why Medicaid reform should still be a priority. Legislators may well want to look at individual states again for possible solutions. (Ryan Streeter, 9/18)

Viewpoints: Treat Heroin Like The Public Health Crisis It Is; Examining Tax-Exempt Hospitals Commitment To Charity Care

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

Stat: Some Tax-Exempt Hospitals Are Lax At Providing Charity Care, Accountability
I’ve been evaluating and investigating tax-exempt hospitals for more than a decade. Most of them work hard to meet their obligations and care for low-income patients to the best of their abilities. But when the wheels fall off at certain hospitals, they fall off badly. Such hospitals seem to forget that tax exemption is a privilege, not a right. In addition to withholding financial assistance to low-income patients, they give top executives salaries on par with their for-profit counterparts. Early on in my oversight of tax-exempt hospitals, the congressional Government Accountability Office concluded that nonprofit hospitals and for-profit hospitals were virtually indistinguishable in their levels of uncompensated care. (Sen. Chuck Grassley, 9/18)

Stat: Is There A Future For A Zika Vaccine?
When Zika does start to spread again, which seems likely, the loss of this one vaccine is unfortunate, particularly because it is from a major manufacturer. But there are numerous other Zika vaccine candidates currently in the works. While it’s not entirely clear what lies behind Sanofi Pasteur’s decision, it is worrisome, suggesting that a deeper problem is at play and highlighting one of the biggest challenges in vaccine development. (Seth Berkley, 9/18)

The Columbus Dispatch: New Bill Is Bad Medicine
Ohio House Speaker Cliff Rosenberger showed common sense by putting the brakes on a bill to bar Ohio employers from requiring employees to be vaccinated against the flu. The bill was opposed by every major health-care association in Ohio, along with the Ohio Chamber of Commerce. (9/19)

Seattle Times: Gates Foundation’s $120 Million Fuels PATH’S Lifesaving Work
AS Seattle recovers from the one-two punch of Amazon’s wanderlust and Mayor Ed Murray’s ignominious resignation, residents should find inspiration in the city’s thriving global-health ventures.Bill and Melinda Gates continue to raise the bar for generosity with investments in health programs saving millions of lives. (9/18)