In This Edition:

From Kaiser Health News:

Kaiser Health News Original Stories

4. Training New Doctors Right Where They’re Needed

Eight teaching centers in California aim to train and retain doctors in medically underserved areas such as California’s Central Valley. They are among 57 such institutions across the country that may soon receive a boost in funding from Congress. (Ana B. Ibarra, 10/9)

5. Political Cartoon: 'Luck Of The Draw?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Luck Of The Draw?'" by RJ Matson, Roll Call.

Here's today's health policy haiku:

How Long Before You Learn?

Health plans: Risk shifting is not
True cost reduction.

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

Summaries Of The News:

Health Law

6. High-Performing ACA Navigators Mystified By Deep Cuts Less Than Year After Being Touted As 'Superstars'

“We have yet to receive any explanation of the cut. We have met or exceeded every one of our performance metrics. There was never any feedback that gave us any indication that we were not going to receive the same amount,” says Lisa Hamler-Fugitt, the executive director of the Ohio Association of Foodbanks. The Trump administration slashed funding for theses navigators by more than 40 percent nationally, with some places seeing cuts of nearly 90 percent.

The New York Times: Trump’s Cuts To Health Law Enrollment Efforts Are Hitting Hard
Michigan Consumers for Health Care, a nonprofit group, has enrolled thousands of people in health insurance under the Affordable Care Act and was honored last year as one of the nation’s top performers — a “super navigator” that would serve as a mentor to enrollment counselors in other states. So the group was stunned to learn from the Trump administration that its funds for assisting consumers ahead of the open enrollment period that begins Nov. 1 would be cut by 89 percent, to $129,900, from $1.2 million. (Pear, 10/9)

Meanwhile, in other health law news —

The Hill: Trump Could Make Waves With Health Care Order 
President Trump's planned executive order on ObamaCare is worrying supporters of the law and insurers, who fear it could undermine the stability of ObamaCare. Trump’s order, expected as soon as this week, would allow small businesses or other groups of people to band together to buy health insurance. Some fear that these Association Health Plans (AHPs) would not be subject to the same rules as ObamaCare plans, including those that protect people with pre-existing conditions. (Sullivan, 10/10)

Politico: Republicans Privately Admit Defeat On Obamacare Repeal
For the first time, rank-and-file Republicans are acknowledging Obamacare may never be repealed. After multiple failures to repeal the law, the White House and many GOP lawmakers are publicly promising to try again in early 2018. But privately, both House and Senate Republicans acknowledge they may never be able to deliver on their seven-year vow to scrap the law. (Haberkorn, 10/9)

Administration News

7. Washington Is Latest State To Sue Trump Administration Over Contraception Mandate Rollback

Washington state Attorney General Bob Ferguson says that the new rules violate the First Amendment by “requiring individuals to bear the burdens of religions to which they do not belong,” as well as the equal protection clause of the Fifth Amendment.

The Associated Press: Washington State Sues Over New Trump Birth-Control Rules
Washington state sued President Donald Trump on Monday over his decision to let more employers claiming religious or moral objections opt out of providing no-cost birth control to women. State Attorney General Bob Ferguson, who successfully sued to block Trump's initial travel ban early this year, announced his latest lawsuit on Monday, three days after the new rules were issued. (Johnson, 10/9)

The Hill: Washington AG Files Lawsuit Against Trump For Rollback Of Birth Control Mandate
“President Trump’s contraception rules are unfair, unlawful, and unconstitutional,” Attorney General Bob Ferguson (D) said in a statement. “I refuse to let President Trump disregard our laws and our constitution in an effort to deny women access to contraception.” Ferguson alleges that the new rules, announced last week by Trump administration officials, violate the First Amendment by “requiring individuals to bear the burdens of religions to which they do not belong,” as well as the equal protection clause of the Fifth Amendment. (Carter, 10/9)

Meanwhile, nearly 60 percent of women use birth control at least in part for purposes other than pregnancy prevention —

The Washington Post: Birth Control Manages Cramps, Acne, Endometriosis, Depression And Other Conditions
On Friday, the Trump administration issued new rules that allow a wide range of employers and insurers to be exempt from the Affordable Care Act's provision that grants women contraceptives without additional payments. The move may appeal to social conservatives who object to contraception, but is it a good idea from a medical perspective? Birth control pills, shots and other devices — especially the still-ubiquitous little pink or blue pills — are about much more than preventing pregnancy. Many women suffer from major hormonal fluctuations in their monthly cycle. (Cha, 10/9)


8. California Governor Signs One Of Strictest Drug Transparency Bills In Nation

The pharmaceutical industry has fought hard to kill the legislation, and it will likely be a legal target now that the bill is law.

The Associated Press: California To Require Advanced Notice On Hikes In Drug Costs
Drug companies doing business in California will soon have to notify the public two months in advance of dramatic price spikes under legislation signed Monday by Gov. Jerry Brown. California's legislation marks one of the strictest drug-price transparency laws in the country, as states move to shine a spotlight on rapidly rising costs in the hopes of enticing drugmakers to keep them down. (Ronayne, 10/9)

The Wall Street Journal: California Governor Signs Bill Requiring Greater Drug Price Transparency
The law, which drew bipartisan legislative support and Democrat Gov. Jerry Brown signed Monday, requires that, starting Jan. 1, 2019, companies give a 60-day notice if list prices of drugs are raised more than 16% in a two-year period. The law applies to drugs with a wholesale price of more than $40 for a 30-day supply. Health plans and insurers would also have to file annual reports outlining how drug costs affect health-care premiums in the state. (Armental, 10/9)

Los Angeles Times: Californians Will Get More Information On What’s Driving Prescription Drug Prices Under Law Signed By Governor
Supporters call the law the nation’s most sweeping effort to make prescription drug pricing more transparent. The measure would require drugmakers to provide notice to health plans and other purchasers 60 days in advance of a planned price hike if the increase exceeds certain thresholds. The measure, SB 17 by state Sen. Ed Hernandez (D-Azusa), will also require health plans to submit an annual report to the state that details the most frequently prescribed drugs, those that are most expensive and those that have been subject to the greatest year-to-year price increase. (Mason, 10/9)

Bloomberg: Legal Fight Looms Over California's New Drug Pricing Law 
The law -- like measures in other states -- is expected to be a legal target by the industry. Last month in Nevada, the industry’s two major lobbying groups -- Pharmaceutical Research and Manufacturers of America, of PhRMA, and the Biotechnology Innovation Association, or BIO -- sued the state over a law requiring drug plan administrators to reveal rebates they get on diabetes drugs. In Maryland, the Association for Accessible Medicines, the trade association for generic drugmakers, challenged a state “price gouging” law, although a judge allowed it to take effect on Oct. 1. (Hopkins, 10/9)

Sacramento Bee: Drug Price Measure Signed By Jerry Brown
California Gov. Jerry Brown moved to shed light on escalating prescription drug prices on Monday, signing heavily lobbied legislation requiring insurers to break down and provide drug costs to the state. Senate Bill 17, which drew millions in opposition spending from the powerful pharmaceutical industry, is designed to arm the state with data on the percentage of health insurance premiums and premium increases that can be attributed to prescription drug costs. (Cadelago, 10/9)

Politico Pro: California's New Drug Law Could Serve As Template For Other States
Gov. Jerry Brown, in a rare bill-signing ceremony on Monday, approved drug legislation that doesn't directly affect prices but is designed to keep costs in check by requiring drug manufacturers to give purchasers advance notice when they significantly raise prices and making them justify the hike. Advocates see Senate Bill 17 not just as a rare blow to the pharmaceutical industry, but also as a pushback by the country's most populous state against inaction in Washington D.C. and against inequities fueled by special-interest groups and powerful lobbying entities. (Colliver, 10/9)

Public Health And Education

9. 10 Years Ago This Lawyer Went Up Against Pharma Over Opioids And Won. Now He's Ready For Round Two.

Back in 2007, Purdue settled with individual patients who alleged that it had underplayed the addiction risk of its medications. It was a huge case for lawyer Paul Hanly and a rare win against makers of painkillers. Now, in an entirely different landscape -- one where these companies are becoming the targets of states who want to try to curb the national crisis -- Hanly is gearing up to go again. Meanwhile, PBS looks at how the brain gets addicted to opioids in the first place.

Stat: A Veteran NY Litigator Is Taking On Opioid Makers. They Have A History
It is one of the few instances — maybe the only one, experts say — in which a drug maker agreed to pay individual patients who alleged that it had underplayed the addiction risk of its medications. A decade later, the smooth, stylish [Paul] Hanly has again set his sights on opioid manufacturers, this time on behalf of cities and counties in five states. The drug companies, those plaintiffs allege, sought to create a false perception around opioids, seeding a public health and safety crisis that has cost Hanly’s clients hundreds of millions of dollars. (Joseph, 10/10)

PBS NewsHour: How A Brain Gets Hooked On Opioids
Pain and pleasure rank among nature’s strongest motivators, but when mixed, the two can become irresistible. This is how opioids brew a potent and deadly addiction in the brain. (Akpan and Griffin, 10/9)

PBS NewsHour: How One Group Of Doctors Drastically Decreased Opioid Prescriptions
With addictions and overdoses surging over the past two decades, recent CDC guidelines urge doctors to avoid or dramatically limit the use of legal painkillers. In Southern California, a group of Kaiser Permanente doctors has been helping chronic pain patients "step down" from high-dose opioids with the help of alternative therapies that work well for many. (Wise, 10/9)

And in other news on the epidemic —

Los Angeles Times: Gov. Jerry Brown Vetoes Measure To Create New State Task Force On Opioid Prescriptions
Gov. Jerry Brown vetoed a measure on Monday that sought to curb escalating opioid addiction rates by creating a new state working group tasked with determining best practices in prescribing addictive drugs. The measure, Assembly Bill 715 by Assemblyman Jim Wood (D-Healdsburg), would have directed the state Department of Public Health to convene doctors, opioid addiction specialists and other experts to examine how painkillers are being prescribed to treat acute, short-term pain. (Mason, 10/9)

10. Saline Shortage Looms After Hurricane Disrupts Production In Puerto Rico

Hospitals and others in the health industry are watching the aftermath of the hurricane with worried eyes because Puerto Rico is a hub of manufacturing for pharmaceuticals.

The Washington Post: Hospitals Scramble To Avert Saline Shortage In Wake Of Puerto Rico Disaster
The hurricane that wreaked havoc on Puerto Rico last month has disrupted production of widely used intravenous solutions. Several prominent hospitals across the country are scrambling to find alternative supplies, change the way they administer drugs and devise backup plans to make the fluids themselves. The products affected are smaller-volume bags of sodium chloride, known as saline, and dextrose. These normally ubiquitous solutions are used to rehydrate patients and to dilute medications from antibiotics to painkillers to cancer drugs. Their manufacturer, Baxter International, has said that “multiple production days” were lost in the wake of Hurricane Maria, and it has set up an allocation system for hospitals based on past purchases. (McGinley, 10/9)

In other news —

Miami Herald: Florida Doctors Watch Hurricane Evacuee Health Risks
Anticipating a wave of hurricane migrants from Puerto Rico and the U.S. Virgin Islands, Florida health officials are advising doctors and others caring for evacuees to look out for health risks associated with the aftermath of storms, including bacterial infections, puncture wounds and diseases spread by mosquitoes and animal bites. (Chang, 10/9)

Dallas Morning News: Dallas Nursing Home Chain Comes Under Fire For Not Evacuating Before Hurricane
When the police arrived at the nursing home during Hurricane Harvey, more than a foot of water filled the one-story building — along with the stench of urine and feces. Volunteers with boats stood ready to remove the 70 frail residents, many of them in wheelchairs. But the man in charge of Lake Arthur Place nursing home in Port Arthur refused to allow the evacuation, according to a police affidavit detailing the incident. He had to be handcuffed before police and volunteers could begin taking the elderly to shelters and hospitals. (Langford and Hacker, 10/9)

11. Lack Of Mental Health Services Blamed For Disparity In Suicide Rates Between Rural, Urban Areas

Although the rates have been increasing all across the country, researchers found that rural areas are hit particularly hard. In other public health news: blood pressure, surgery scars, autism and smoke exposure.

Georgia Health News: Rise In Suicide Rates Haunts Rural Areas
Overall, suicide death rates for rural counties nationally (17.32 per 100,000 people) were higher than medium/small metropolitan counties (14.86) and large metropolitan counties (11.92), the CDC reported late last week. Dr. W. Vaughn McCall of the Medical College of Georgia (MCG) at Augusta University said Monday that there’s a growing disparity in the economic status of rural vs. urban residents. (Miller, 10/9)

The New York Times: New Blood Pressure Guidelines For Children
Had Matthew Goodwin’s blood pressure been checked at age 3, when it should have been, he most likely would have been spared a medical emergency a year later. He spent two weeks in the pediatric intensive care unit while doctors tried to determine why his blood pressure had spiked off the charts following minor surgery. (Brody, 10/9)

The Baltimore Sun: Hidden Scar Surgery Hides Marks, Reminders Of Breast Cancer 
While surgeons can remove tumors without removing a whole breast, spare nipples and skin, and begin reconstruction immediately after surgery using an implant or fat from a women’s own belly, the scars remain. They are often big, jagged lines women can see every time they look in the mirror. ...Most of the more than 230,000 women diagnosed with the cancer each year require surgery. It’s unclear how many surgeons are working to hide scars, which remains a relatively new approach, [Dr. Dona] Hobart said. (Cohn, 10/10)

Spectrum: Despite Dearth Of Data, Firms Sell Brain Training As Autism Antidote
On the website of the company Neurocore, an illustration of an anthropomorphized human brain, complete with hopeful eyes and a wide smile, is pumping iron. “A stronger brain makes anything possible,” says the tagline next to the cheery brain. This concept — body-building for the brain — is the premise behind the Michigan-based company’s popular therapy. Known as neurofeedback, the therapy is based on the idea that by monitoring and adjusting electromagnetic signals, or waves, emanating from the brain, people can improve their mood, for example, or alleviate a headache. (Furfaro, 10/9)


12. Democratic Candidates Looking To Unseat Wis. Governor Vow To Expand Medicaid If They Win

Meanwhile, Gov. Scott Walker says doing so would send the state back into a recession.

The Associated Press: Wisconsin Democratic Candidates For Governor Unified On Medicaid Expansion
Wisconsin Democrats running for governor promised to take federal Medicaid expansion money if they defeat Gov. Scott Walker next year, presenting a unified front Monday as the crowded field of candidates gathered at their first forum. The candidates’ remarks were well-received by the audience: the Wisconsin Alliance for Retired Americans. Walker has repeatedly rejected Medicaid expansion dollars. (Moreno, 10/9)

Milwaukee Journal Sentinel: Democrats Running For Governor Want Expanded Health Coverage
"We need to take that Medicaid money and take it now," state Schools Superintendent Tony Evers told the luncheon audience at the Italian Community Center. Political activist Mike McCabe and former state Democratic chairman Matt Flynn went further and called for allowing state residents to buy into BadgerCare as a so-called "public option," which would be a coverage alternative offered by the government. "We have an economy that works exceptionally well for a privileged few but leaves a lot of people behind," said McCabe, who also called Monday for allowing Wisconsin residents to buy into the state pension system. (Stein, 10/9)

And in Florida —

News Service of Florida: Scott Administration Eyes Hospitals In Proposed Medicaid Spending Cuts
Florida Gov. Rick Scott’s administration continues to target hospitals for potential Medicaid spending reductions in the coming year. The Agency for Health Care Administration’s top four proposed budget cuts for the Legislature to consider during the 2018 session would reduce Medicaid payments to hospitals by nearly $1 billion. Those reductions would be on top of nearly $500 million in recurring cuts made to hospitals during the 2017 session. (Sexton, 10/9)


13. Thousands Of Conn. Seniors, Disabled May Lose Help Paying For Medicare Under Budget Proposal

“For my folks, if they wind up losing this … it could make the difference between getting a prescription or having food on the table,” says lawyer Kevin Brophy.

Hartford (Conn.) Courant: Republicans, Democrats Propose Cuts To Medicare Assistance For Seniors, Disabled
As budget negotiations continue at the state Capitol, advocates are calling on legislators not to include a proposal that would cause tens of thousands of low-income elderly and disabled people in Connecticut to lose financial assistance to pay for Medicare. Both the Republican and Democratic budget alternatives reduced the income eligibility levels for the federal Medicare Savings Program, resulting in a two-year savings of between $81.9 million and $107.7 million, according to nonpartisan fiscal analysts. (Blair, 10/10)

Great Falls (Mont.) Tribune: Blue Cross Cuts Back On Medicare Advantage For 7,500 Rural Montanans
Blue Cross Blue Shield of Montana sent notices to nearly 7,500 residents in 30 counties statewide saying it will no longer offer Medicare Advantage in 2018, with officials citing lack of service and costs. ... Medicare Advantage will still be offered in nine of the state’s more urban counties, officials said, adding that residents throughout the state can still get the Medicare Supplement Plan, which can be catered to their needs. (Drake, 10/9)

State Watch

14. State Highlights: Calif. Downgrades Exposing Others To HIV From Felony To Misdemeanor; 'Microhospitals' Are New Kid On Block In Ohio

Media outlets report on news from California, Ohio, Colorado, Virginia, Oregon, Minnesota, New Jersey, Texas and North Carolina.

The Washington Post: Knowingly Infecting Others With HIV Is No Longer A Felony In California. Advocates Say The Law Targeted Sex Workers.
California lawmakers have passed legislation to reduce the penalty for those who knowingly or intentionally expose others to HIV without their knowledge, rolling back a law that mostly affected sex workers. The bill, SB 239, which was approved by the Democrat-controlled state legislature in September and signed into law by Governor Jerry Brown (D) on Friday, will lower the charges for these acts from a felony to a misdemeanor when the law goes into effect in 2018. The act of knowingly donating HIV-infected blood, also a felony now, will be decriminalized. (Rosenberg, 10/9)

Denver Post: Inmate Suicides: Jails And Prisons Work To Stem Upward Trend
In Arapahoe County, there is plexiglass paneling on bunk beds. Jefferson County’s strategy involves flexible pens. And in Denver, it is tear-resistant sheets and blankets. Across the state, jails and prisons are employing an array of strategies to push back against rising inmate deaths and suicide attempts, a problem complicated by the state’s burgeoning mental health and opioid abuse crises. (Aguilar, 10/9)

Richmond Times-Dispatch: 'Arbitrary And Unwise': Medical Professionals Respond To Anthem's Plan To Change Imaging Reimbursement Guidelines
The health insurance giant Anthem Blue Cross and Blue Shield is planning to change its guidelines for reimbursing imaging services like MRIs and CT scans, favoring freestanding outpatient clinics or imaging centers over hospitals. In a statement, the company said a subsidiary, AIM Specialty Health, will help “identify when hospital outpatient services for certain imaging tests, such as MRIs and CT scans, are medically unnecessary,” in which cases members can receive those services — frequently used to help in the diagnosis process — at free-standing centers instead. (O'Connor, 10/9)

The Oregonian: Bend Woman Who Claimed Doctors Ignored Cardiac-Arrest Symptoms Drops Lawsuit 
A 46-year-old Bend woman who filed an $8.75 million lawsuit against her doctors -- claiming that for months they misread telltale signs that she was about to suffer cardiac arrest -- has dropped her 2016 lawsuit. Attorney Gordon Welborn said cardiac arrest victim Shelley Harding decided to withdraw her lawsuit against doctors Dana Rhode and Jeffrey Scott after it became clear she didn't have the evidence to prove her case. Welborn, who represented the doctors, said they both testified in pretrial depositions that they never heard Harding tell them, "I feel like I'm having a heart attack." (Green, 10/9)

Kaiser Health News: In Oregon, End-Of-Life Wishes Are Just A Click Away
Just four hours earlier, Sallie Cutler had been sharing Mother’s Day lunch with her mom, Alyce Cheatham. Then, that same evening, Cheatham, 96, landed in a Portland, Ore., emergency room, lethargic, unable to speak and paralyzed on her right side by a massive stroke. Cutler now admits her first impulse was to demand action. (Aleccia, 10/10)

Pioneer Press: Regions Hospital Is Sued, Years After Stillborn Baby Discarded With Dirty Laundry 
The family of a stillborn baby discarded in Regions Hospital’s dirty laundry after staff promised to cremate the remains is suing the medical institution. The mother of the child, Esmeralda Hernandez, filed a lawsuit against the St. Paul hospital in Ramsey County District Court earlier this month along with several of her family members. The civil suit accuses Regions of reckless interference with a dead body. The family is seeking damages “far in excess of $50,000” for their ongoing pain related to the incident, according to legal documents. (Horner, 10/9)

The Philadelphia Inquirer/ Why N.J. Patients With Chronic Pain Still Can't Get Medical Marijuana
Five months ago, a New Jersey health panel voted in favor of dramatically expanding the list of conditions that may be treated with cannabis. Chronic pain, Alzheimer’s, autism, anxiety, migraines, and other maladies should be added to the list of 13 ailments, said the panel of doctors and other health professionals. Before the panel reached this decision, it reviewed petitions submitted by 68 patients a year ago, and then held three hearings. At these hearings, patients pleaded for the right to use cannabis to alleviate various ailments. Many confided that they had tried cannabis and wanted to be able to use it legally because it had helped. (Hefler, 10/10)

North Carolina Health News: It Takes A Village To Improve A Community's Health
In 2015 and the years preceding, Halifax County came in almost dead last North Carolina’s county health rankings at 99 out of 100. The local medical community was alarmed by this rating, and by the number of people suffering complications from hypertension, cancer and heart disease. ...In response, Hardy said, the medical community formed the Roanoke Valley Community Health Initiative. The group talked about changing the healthcare landscape from caring for people who are already sick to preventing disease. An additional motivation was cost: Practicing “sick care” and treating chronic diseases is costly and patients didn’t always have the best insurance. (Knopf, 10/9)

The Star Tribune: Synthetic Cannabis Sent 60 To Hospital In Mpls. In Last Week
Overdoses on synthetic cannabis sent people to the hospital in Minneapolis at least 60 times last week, causing hallucinations and violent behavior in some users, while leaving others nearly “comatose,” health officials said. The number of emergency calls involving suspected overdoses in the city was double that number, from midnight Sept. 29 through Sunday afternoon, officials said. (Jany, 10/9)

Editorials And Opinions

15. Viewpoints: Trump's Executive Order Could 'Gut' Consumer Protections; Faulty Logic On Bundled Payments

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

Los Angeles Times: Trump Plots Another Backdoor Effort To Gut Obamacare's Consumer Protections
Still smarting from congressional Republicans’ abject failure to repeal the Affordable Care Act by legislative means, President Trump now reportedly is plotting a backdoor attack aimed at gutting the act’s most important consumer protections. An executive order expected to be issued sometime this week would expand the ability of small businesses to band together and create “association health plans.” On the surface, the idea looks like a means of offering employees of those businesses more options for health coverage; in reality, according to health reform experts, it would strip the ACA’s consumer safeguards from those plans. (Michael Hiltzik, 10/9)

Huffington Post: Trump Has A New Plan To Undermine Obamacare And It Doesn’t Need Congress
President Donald Trump has already done a lot to sabotage the Affordable Care Act, whether it’s slashing the program’s advertising budget or threatening to cut off some payments that insurers need to cover their costs. Now Trump is thinking about using his executive authority to do something that could be even more damaging to the law ― and, arguably, more threatening to people who depend on it for coverage. Sometime in the next few days, according to a report in The Wall Street Journal, Trump is likely to instruct three key agencies to rewrite a series of regulations that affect health insurance. (Jonathan Cohn, 10/9)

Forbes: There Actually Is A Middle Ground On The Affordable Care Act
President Trump has strongly hinted that new rules may be forthcoming imminently that would let many more people purchase "Short Term Health Insurance" and "Association Health Plans" instead of being largely confined to higher-priced plans that conform to all the requirements of the Affordable Care Act. Critics of this proposal argue that it would result in healthy people exiting the Exchanges established by the ACA, resulting in major insurer losses for 2018 and higher premiums or, frankly, collapse of many markets by 2019. Supporters of the proposal note that Obamacare has left individual health insurance unaffordable for large segments of the American public and that some alternative needs to be provided. ... There actually is a middle ground, though. ... Make the insurance alternatives (short term plans, association plans) more widely available, but do so only to persons for whom the Obamacare market has indeed become unaffordable. (Seth Chandler, 10/9)

Bloomberg: Trump's Gamble On Health-Care Costs
Promising efforts to get a grip on medical costs have lately run into resistance from the Trump administration. The federal agency in charge of Medicare is moving to curtail new requirements that hospitals "bundle" medical charges for hip and knee replacements, rather than assess separate fees for each appointment. Efforts to arrange similar lump-sum payments for other procedures are to be stopped altogether. These changes are misguided on two counts. (10/9)

The New York Times: Doubtful Science Behind Arguments To Restrict Birth Control Access
In a new rule about coverage of contraception, the Trump administration argues against the positives of birth control and highlights potential harms. But those claims don’t stand up to scrutiny. The new rule weakens the mandate for health coverage of contraception under the Affordable Care Act, giving more leeway to employers with religious or moral objections. (Aaron E. Carroll, 10/10)

Los Angeles Times: The GOP Is Craven And The Democrats Are Extremist On An Abortion Restriction Most Americans Favor
Large majorities of Americans believe first-trimester abortions should be legal. But once pregnancy moves into the second trimester — that is, at 12 to 24 weeks — only 27% of Americans have a pro-choice position. These Gallup poll results mirror policy in most European nations, where abortion is legally restricted early in the second trimester. For years now, anti-abortion activists in the United States have been trying to establish similar restrictions at 20 weeks’ gestation. (Charles C. Camosy, 10/9)

Boston Globe: The Democrats’ Single-Payer Trap
Primary fights to the death over single payer will accomplish nothing good — including for those who want to pass single-payer. Parties do not expand through purges. (Richard North Patterson, 10/10)

The New York Times: Shouldn’t Doctors Control Hospital Care?
Who ultimately should be in charge of care at our nation’s hospitals — physicians or businesspeople? In January 2016, the board of directors at Tulare Regional Medical Center, a small community hospital in central California, voted to terminate the elected leaders of its medical staff office. Medical staff offices help ensure that patient needs are kept separate from business imperatives, such as increasing hospital profits. They have historically operated independently of hospital administrators. (Sandeep Jauhar, 10/10)

Boston Globe: Guns Are America’s Blind Spot; In Britain, It’s Health Care
Generally speaking, according to World Health Organization statistics for 2015, the American rate of mortality from interpersonal violence is four times higher than the British. Americans are also 10 times more likely to die from cocaine use, and between two and three times more likely to die from drug abuse, poisonings, and intentional injuries. ... In any case, the Brits have their own idiosyncrasies when it comes to death. In 2015 they were five times more likely than Americans to die of the lung cancer known as mesothelioma, nearly three times more likely to die of oesophageal cancer, twice as likely to die of stomach cancer, and nearly twice as likely to die of prostate and bladder cancer. These figures are in line with a variety of studies showing that Britain is not the best place in the developed world to be diagnosed with cancer. (Niall Ferguson, 10/10)

The Washington Post: America Is Running Out Of Doctors. Trump Ending DACA Will Only Make The Crisis Worse.
Unfortunately, the doctor shortage will get worse quickly if the Deferred Action for Childhood Arrivals (DACA) program is ended .... the move could also be debilitating for our health-care system. DACA recipients are nurses, physician assistants, medical technicians, respiratory therapists and yes, doctors. In fact, more than 25 percent of America’s doctors are immigrants, and if DACA continues, the program will add roughly 5,400 physicians who would otherwise be ineligible to work in the United States over the next few decades. (Anirudh Rao, 10/10)

Los Angeles Times: Bad Medicine: California Lags Other States In Empowering Nurse Practitioners
California doesn’t have enough doctors. By 2025, the state will be short about 4,700 primary-care physicians, according to a recent report from the UC San Francisco Healthforce Center. This will result in more people turning to costly emergency-room visits for routine care, it predicts. One solution is to expand the role of well-trained nurse practitioners, who can meet the basic healthcare needs of our growing population at a fraction of the cost of doctor visits. That’s what many other states are doing. (David Lazarus, 10/10)

Stat: Adolescent Victims Of Physical Assaults Need Help For Emotional Trauma, Too
While our medical system can usually fix the physical trauma, it is largely unprepared to address the emotional trauma that follows being a victim of an assault. Young patients are often discharged back into the same environment in which the injury occurred, with an ongoing risk for retaliation, re-injury, and sometimes even death. Boys and young men of color experience a disproportionate burden of assaults. (Rachel Myers, 10/9)

Stat: The Other Overdose Crisis: Over-The-Counter Pain Medications
Another overdose issue is playing outside their shadow: the misuse of over-the-counter pain medicines like acetaminophen, aspirin, ibuprofen, naproxen, and others. These widely used “safe” medications can cause serious gastrointestinal bleeding; create stomach ulcers; damage the esophagus, intestine, and liver; and even kill. In the United States, misuse of these medications sends nearly 200,000 people to the hospital each year. (Charles Melbern Wilcox, 10/9)