Note To Readers

TUNE IN TODAY: What happens now? President Trump says he is stopping federal payments to insurers that fund cost-sharing reductions under the Affordable Care Act. What does this mean to consumers and insurers? KHN will hold a Facebook Live today, Oct. 13, at 3 p.m. ET, to explain. Send in any questions you have here and tune in here.

In This Edition:

From Kaiser Health News:

Kaiser Health News Original Stories

3. Anthem Eases Up On Premium Hikes After State Scrutiny

After regulators questioned Anthem’s forecast for medical costs, the company agreed to reduce rate hikes on its individual and small-business health plans next year, saving customers an estimated $114 million. (Chad Terhune, 10/12)

5. Political Cartoon: 'Shell Out?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Shell Out?'" by Dave Coverly, Speed Bump.

Here's today's health policy haiku:


Why not renew CHIP?
It’s a CHIP off the old block —
Blockheaded Congress

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. Following Through On Months Of Threats, Trump Vows To 'Immediately' End Insurer Subsidies

The move to end the subsidies, which help low-income consumers afford coverage, is likely to cause upheaval in the health law's marketplace. Democrats are blasting the decision as "spiteful" and another way that the president is trying to sabotage the Affordable Care Act.

The New York Times: Trump To Scrap Critical Health Care Subsidies, Hitting Obamacare Again
President Trump will scrap subsidies to health insurance companies that help pay out-of-pocket costs of low-income people, the White House said late Thursday. His plans were disclosed hours after the president ordered potentially sweeping changes in the nation’s insurance system, including sales of cheaper policies with fewer benefits and fewer protections for consumers. The twin hits to the Affordable Care Act could unravel President Barack Obama’s signature domestic achievement, sending insurance premiums soaring and insurance companies fleeing from the health law’s online marketplaces. (Pear, Haberman and Abelson, 10/12)

The Associated Press: Trump To Issue Stop-Payment Order On Health Care Subsidies
The Department of Health and Human Services made the announcement in a statement late Thursday. "We will discontinue these payments immediately," said acting HHS Secretary Eric Hargan and Medicare administrator Seema Verma. In a separate statement, the White House said the government cannot legally continue to pay the so-called cost-sharing subsidies because they lack a formal authorization by Congress. However, the administration had been making the payments from month to month, even as Trump threated to cut them off to force Democrats to negotiate over health care. (10/13)

The Wall Street Journal: Trump To End Subsidies To Health Insurers
“We believe that the last Administration overstepped the legal boundaries drawn by our Constitution,” acting HHS Secretary Eric Hargan and Seema Verma, administrator of the Centers for Medicare & Medicaid Services, said in a joint statement. “Congress has not appropriated money for [the payments], and we will discontinue these payments immediately.” (Armour, 10/13)

Politico: Trump Will Scrap Critical Obamacare Subsidy
The subsidies, which are worth an estimated $7 billion this year and are paid out in monthly installments, may stop almost immediately since Congress hasn’t appropriated funding for the program. (Dawsey and Demko, 10/12)

NPR: Trump Administration To End Obamacare Subsidies For The Poor
The decision ends speculation about whether the Trump administration would continue making the monthly payments to insurers. That money particularly helps people earning between 100 percent and 250 percent of the poverty level pay for the insurance and health care they get through the exchanges set up by the Affordable Care Act, also known as Obamacare. (Kurtzleben and Neuman, 10/12)

Reuters: Trump Nails Obamacare With Decision To Cut Off Billions In Subsidies
The decision is the most dramatic action Trump has taken yet to weaken the Affordable Care Act, President Barack Obama's signature healthcare law, which extended insurance to 20 million Americans. The move drew swift condemnation from Democrats and threats from state attorneys general in New York and California to file lawsuits. (10/13)

The Washington Post: Trump To End Key ACA Subsidies, A Move That Will Threaten The Law’s Marketplaces
Trump has threatened for months to stop the payments, which go to insurers that are required by the law to help eligible consumers afford their deductibles and other out-of-pocket expenses. But he held off while other administration officials warned him such a move would cause an implosion of the ACA marketplaces that could be blamed on Republicans, according to two individuals briefed on the decision. (Goldstein and Eilperin, 10/13)

Modern Healthcare: Executive Order Seeks To Weaken ACA Insurance Rules, Another Would End Cost-Sharing Payments 
But many insurance leaders, state regulators and policy experts fear that Trump's order, depending on how it's implemented by federal agencies, could drive up premiums and make coverage less available in the regulated individual market, which helps people who need comprehensive benefits. That's because healthier customers likely would move into the cheaper, leaner plans, prompting insurers to raise rates for more comprehensive plans or exit the market entirely. (Meyer, 10/12)

The Hill: Dems Rip Trump's 'Spiteful' Decision To End Key ObamaCare Payments  
Democratic leaders blasted the administration on Thursday night over President Trump's decision to end key payments to insurers offering ObamaCare coverage, calling the move "spiteful." “Sadly, instead of working to lower health costs for Americans, it seems President Trump will singlehandedly hike Americans’ health premiums," Senate Minority Leader Charles Schumer (D-N.Y.) and House Minority Leader Nancy Pelosi (D-Calif.) said in a joint statement. (Byrnes, 10/12)

CQ: Trump To Stop Paying Cost-Sharing Subsidies
The move could put more pressure on Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., who are negotiating a package that would provide funding for the payments and additional flexibility for states under the law. The duo still haven't reached an agreement, and many Republicans are opposed to simply funding the subsidies, which they say would be "bailing out" insurance companies. Rep. Mark Walker, chair of the Republican Study Committee, made it clear that House conservatives are not prepared to vote for a deal. "Under no circumstance should Congress attempt to expand Obamacare by cutting a check for President Obama’s bailout of insurance companies," Walker said in a statement. (McIntire, 10/12)

The Hill: New York, California Threaten To Sue Over Health-Care Subsidies 
Attorneys general from California and New York say they are prepared to sue the Trump administration to protect health-care subsides that the White House said would be cut off. New York Attorney General Eric Schneiderman (D) said in a statement that hundreds of thousands of New York families rely on ObamaCare's subsidies for their health care. (Savransky, 10/12)

Meanwhile —

The Hill: Trump Administration Hints At Enforcing ObamaCare Mandate 
The Trump administration is hinting that it will continue to enforce the ObamaCare mandate requiring Americans to have health insurance coverage. An administration document obtained by The Hill that accompanies an executive order signed by President Trump Thursday states that "only Congress can change the law" when it comes to the mandate. (Sullivan, 10/12)

7. Trump Touts Executive Order As First Step Toward ACA Repeal, But Move Was Largely Ceremonial

President Donald Trump on Thursday signed an executive order to allow for "association" plans and to relax other Affordable Care Act regulations. The New York Times and other outlets take a look at what's actually in the order.

Politico: Trump’s Salvo On Obamacare Unlikely To Result In Quick Changes
President Donald Trump may be eager to dismantle the Affordable Care Act after months of failed GOP repeal efforts, but his promise to provide millions of Americans "with Obamacare relief" with the executive order he signed Thursday is sure to collide with the slow grind of the federal bureaucracy. Trump’s order directs a trio of federal agencies to rewrite regulations to encourage the rise of a raft of cheap, loosely regulated health insurance plans that don't have to comply with certain Obamacare consumer protections and benefit rules. They're expected to attract younger and healthier people — leaving older and sicker ones in the Obamacare markets facing higher and higher costs. (Cancryn, 10/12)

CQ: Health Care Rules In Trump's Order Could Take Months
President Donald Trump, frustrated by the lack of action in Congress to roll back the 2010 health care law, used an executive order he signed Thursday to direct three agencies to draft rules that would loosen regulations on insurance. The changes would allow more groups to use association health plans, lengthen the time an individual can be covered by a short-term insurance policy and allow employers to set aside pre-tax dollars for their employees to use for monthly premiums. The administration hopes the new rules would lead to cheaper health care options. (McIntire, 10/12)

The Wall Street Journal: Trump Signs Order Paving Way For Health-Care Changes
Thursday’s executive order paves the way for a proliferation of less-expensive insurance plans with fewer benefits for those who buy their insurance individually, rather than getting it through an employer. A range of next steps are on the table, but White House officials said no final decisions have been made. (Armour, 10/13)

NPR: Trump Order Aims To Promote Insurance Options
"The competition will be staggering," Trump said. "Insurance companies will be fighting to get every single person signed up. And you will be, hopefully, negotiating, negotiating, negotiating. And you will get such low prices for such great care." (Horsley, 10/12)

Los Angeles Times: Trump Issues Order To Deregulate Health Insurance, Promising Relief From Obamacare
The broadly worded order leaves many key elements of the new plans uncertain, however, subject to a lengthy administrative process, which means the order’s impact will remain unclear, and the new plans unavailable to consumers, for this year’s open enrollment season and many months to come. Trump avoided that point as he formally released the order at the White House, declaring that it would “provide millions of Americans with Obamacare relief” and would “increase competition, increase choice and increase access to lower-priced, high-quality healthcare options.” (Levey, 10/12)

Kaiser Health News: Trump’s Order Advances GOP Go-To Ideas To Broaden Insurance Choices, Curb Costs
The executive order directs many agencies, including the Department of Labor, to consider proposing rules or new guidance to loosen current restrictions on what are called “association health plans” and on selling low-cost, short-term insurance. ... Associations are generally membership groups based on a profession or business. Proponents say allowing consumers to buy insurance through these organizations gives them more clout with insurers than they’d have buying their own plan on the individual market — and results in lower premiums. But the real savings in premiums is likely to come because the policies could offer fewer benefits than more regulated ACA plans, and the associations would have more leeway to set premiums based on the health of the group. (Appleby, 10/12)

Bloomberg: Trump Moves To Undo Obamacare After Repeal Drive Fails On Hill 
While the administration characterized the order as a way to drive down rising premiums and expand coverage to more Americans, critics said it would undermine existing markets by encouraging healthier people to buy skimpier plans. That would likely lead premiums for Obamacare plans, which offer more encompassing coverage regardless of a person’s health history, to surge. (Rausch, 10/12)

8. Executive Order Will Likely Further Deplete Healthy Pool Of ACA Customers, Weaken Patient Protections

It's unclear exactly how much the executive order will affect the marketplaces, but analysts see it further destabilizing an already shaky landscape.

The Wall Street Journal: Trump Health Order Could Hurt Many Insurers, Help Others
The executive order on the health-care system signed Thursday by President Donald Trump  will likely have a split effect on the health-insurance industry, creating new challenges for many companies but opportunities for others. The impact of the order will take months to become clear, as federal agencies move the changes through the regulatory process. But actuaries and industry officials said the shift could create problems for insurers that offer plans under the Affordable Care Act, both to individuals and small businesses. (Wilde Mathews, 10/12)

Bloomberg: Trump's Health Care Executive Order: Few Silver Linings
President Donald Trump on Thursday signed an executive order aiming to make it easier for Americans to buy skimpier and cheaper health insurance. The order isn't as aggressive as it might have been in undermining the ACA, but that's scant reassurance for insurers, who face an administration that seems actively hostile to a law it's supposed to enforce. The order aims to let association health plans -- groups of small employers banding together to buy insurance -- offer coverage throughout the U.S. Insurers consistently oppose selling health insurance across state lines because of varying regulations. (Nisen, 10/12)

The Hill: Health Groups Warn Trump's Executive Order Could Hurt Patients
Nearly 20 health organizations warn that an executive order signed by President Trump on Thursday could weaken patient protections and destabilize the individual market. ...Trump’s order seeks to expand the ability of small businesses and other groups to band together to buy health insurance through what are known as association health plans. It also lifts limits on short-term health insurance plans. (Hellmann, 10/12)

The Hill: Hospital Group Warns Trump's Executive Order Could Weaken Insurance Markets 
The largest hospital association warned that an executive order signed by President Trump on Thursday could destabilize insurance markets and make coverage unaffordable for people with pre-existing conditions. "Today’s Executive Order will allow health insurance plans that cover fewer benefits and offer fewer consumer protections," said Tom Nickels, executive vice president of the American Hospital Association, in a statement. (Hellmann, 10/12)

Reuters: Trump Healthcare Order Could Run Afoul Of Retirement Plan Law
President Donald Trump's plan to make it easier for small businesses to band together and buy stripped-down health insurance plans could violate a federal law governing employee benefit plans and will almost certainly be challenged in court, legal experts said. (Pierson and Raymond, 10/12)

Denver Post: Colorado’s Top Insurance Regulator Says Trump’s Health Care Executive Order “Will Cause Problems”
Colorado’s top insurance regulator responded on Thursday to President Donald Trump’s health care executive order with concern, saying the policies endorsed could lead to flimsier coverage in the state and much higher costs for the sick. “The limited benefits, the focus on the healthy at the expense of those with pre-existing conditions, and lack of regulatory oversight will cause problems for the health insurance market as a whole,” said Marguerite Salazar, the state’s insurance commissioner. (Ingold, 10/12)

Concord Monitor: N.H. Officials Split On Trump’s Health Care Executive Order
Some sounded an optimistic note in the Granite State while others warned of dire consequences for consumers after President Donald Trump on Thursday issued a sweeping executive order targeting the Affordable Care Act. The order aims to make it easier for individuals and businesses to buy cheaper health care plans that offer less coverage with fewer government protections. The president and his allies say the move will spur needed competition and give consumers more options. (Duffort and DeWitt, 10/12)

9. Soaring Premiums May Cause Some Sticker Shock, But Effect Might Not Be As Scary As It First Seems

Outlets take a look at premium increases in the states.

Boston Globe: State Health Connector Rates To Rise 8.7 Percent, Less Sharply Than Feared
Still grappling with uncertainty about the future of national health policy, officials at Massachusetts’ health insurance exchange said Thursday they will shield consumers from unusually high rate increases in 2018. Rates will still rise for people who buy insurance through the state’s Health Connector, but less sharply than feared: 8.7 percent, on average. (Dayal McCluskey, 10/12)

State House News Service: Health Connector Opts For Lower Insurance Rate Hike
With uncertainty around federal health care changes looming and the start of an open enrollment period less than three weeks away, the Health Connector and Division of Insurance prepared two sets of rates for 2018 to account for the possibility that the federal government will stop making monthly cost sharing reduction (CSR) payments. (Young, 10/12)

California Healthline: Anthem Eases Up On Premium Hikes After State Scrutiny
Insurance giant Anthem Blue Cross agreed to reduce two planned premium increases for 2018 after California regulators questioned the company’s rationale for raising rates by as much as it had initially proposed. The scaled-back rate hikes, in the individual and small-employer markets, will reduce premiums by $114 million, state officials said. (Terhune, 10/12)

Capitol Hill Watch

10. Ethics Office Finds 'Substantial Reason' To Review Rep. Collins' Dealings With Pharma Company

A new report from the nonpartisan Office of Congressional Ethics finds that there is enough reason to review the actions of Rep. Chris Collins (R-N.Y.) and how he may have used his office to benefit a private biotechnology company.

The New York Times: House Ethics Office Says New York Congressman May Have Violated Rules
Representative Chris Collins of New York may have violated federal law by sharing nonpublic information about a company on whose board he served, according to a report released Thursday by the Office of Congressional Ethics. The report also said Mr. Collins may have broken House ethics rules by meeting with the National Institutes of Health and asking for help with the design of a clinical trial being set up by the company, Innate Immunotherapeutics. Mr. Collins, a Republican whose district encompasses much of western New York, is also the company’s largest shareholder, reporting for the year 2016 that he held between $25 million and $50 million in the company. (Thomas and Kaplan, 10/12)

The Wall Street Journal: Congressional Ethics Office Says New York Republican May Have Violated Law
The Office of Congressional Ethics also said Rep. Chris Collins may have shared nonpublic information about Innate Immunotherapeutics Ltd. with other investors. In a report released Thursday, the ethics office said it found “substantial reason” to believe both allegations and voted unanimously to send the case to the House Ethics Committee for further investigation. The office said the conduct may have violated federal law. (Tau, 10/12)

The Washington Post: Rep. Chris Collins’s Advocacy For Biotech Company Broke Rules, House Ethics Watchdog Finds
Collins’s attorneys have denied the allegations of wrongdoing in the report. “Rep. Collins has done nothing improper, and his cooperation and candor during the OCE review process confirm he has nothing to hide,” they wrote in an Aug. 14 letter released Thursday by the Ethics Committee. “There is nothing in the record to suggest, let alone support, the conclusion that Rep. Collins violated House rules, standards of conduct, or federal law.” (DeBonis, 10/12)

Politico: Ethics Panel Continues Probe Into Rep. Collins’ Stock Trades
Collins — who has repeatedly denied any improper or unethical behavior — is on the board of Innate and is its biggest stockholder, having invested at least $6 million in the firm. His children own a block of Innate shares too. Collins has pushed the company's stock to former HHS Secretary and one-time House colleague Tom Price, other lawmakers and officials in Buffalo, N.Y. Collins was once overheard bragging on the phone in the House Speaker's Lobby about “how many millionaires I’ve made in Buffalo the past few months." Price made more than $225,000 in his Innate stock trades, according to public records. (Bresnahan and Cheney, 10/12)

The Hill: Watchdog Recommends Price Subpoena In Stock Sales Probe
A congressional watchdog is recommending the subpoena of former Health and Human Services Secretary Tom Price after he refused to cooperate in its probe of Rep. Chris Collins (R-N.Y.) related to stock sales of an Australian biotechnology firm. The Office of Congressional Ethics (OCE) on Thursday said Price was one of 10 individuals or entities that refused to cooperate with the investigation into whether Collins improperly shared nonpublic information in the purchase of Innate Immunotherapeutics Limited stocks. (Weixel, 10/12)

11. Conn. Lawmakers Behind Much Of Legislation Pushing For Tighter Gun Control Regulations

The latest proposed bill comes from Rep. Elizabeth Esty (D-Conn.) who wants to prohibit the transfer, import or possession of magazines that can hold more than 10 rounds of ammunition.

The CT Mirror: CT Lawmakers Keep Introducing Gun Control Bills, But Face Uphill Climb
Rep. Elizabeth Esty, who represents Newtown in Congress, on Thursday was the latest lawmaker to introduce a bill aimed at curbing gun deaths. Flanked by several House colleagues from Nevada, Esty on Thursday condemned congressional inaction at a press conference organized to introduce her legislation, called the Keep Americans Safe Act, which would limit high-capacity ammunition magazines. (Radelat, 10/12)

In other news from Capitol Hill —

Modern Healthcare: House Investigates HHS' Hurricane Preparedness And Response 
The House Committee on Oversight and Government Reform is investigating how HHS prepared for and responded to recent hurricanes that ravaged several states and territories in recent weeks. In a letter to HHS dated Wednesday, the committee specifically asked the agency how it provided aid to Puerto Rico and the U.S. Virgin Islands after hurricanes Irma and Maria. Some congressional lawmakers have worried that the territories received different treatment than Texas, Florida and other states in the South in the wake of the storms. The committee requested that HHS send any documents or communications related to threat assessments, mitigation measures, emergency preparedness or other contingency plans in the case of a hurricane striking Puerto Rico or the U.S. Virgin Islands from before Sept. 5. (Dickson, 10/12)

CQ: Community Health Centers Experience Shortfalls
Federal funding for community health centers remains in limbo, and local centers say they are already having trouble retaining staff who are worried about potential cuts. The health centers’ funding expired on Sept. 30, along with funds for the Children’s Health Insurance Program and a host of other health programs. Without a funding renewal, community health centers stand to lose 70 percent of their federal grant money within months. (Raman, 10/13)


12. 'Holy Cow!': FDA Approves Record Number Of Generics This Year

By moving more generic drugs into the marketplace, the Trump administration hopes to create more competition and lower-cost alternatives.

Stat: A 'Holy Cow' Moment: The FDA Approved A Record Number Of Generics
As the Food and Drug Administration attempts to foster more competition in the prescription drug market, the agency appears to be making good on one key effort — approving more generics. In fiscal year 2017, which ended Sept. 30, the agency approved a record number of applications — 763 in all. That beat the previous high of 651 in fiscal year 2016, and worked out to a monthly average of 63 approvals. (Silverman, 10/12)

The Hill: New Campaign Launched For Low Cost Generics
Patients for Affordable Drugs is launching a new campaign to pass a bill aimed at easing hurdles to bringing lower cost generic drugs to the market. The group wants the CREATES Act passed, viewing it as a measure for decreasing the costs of prescription drugs. (Roubein, 10/13)

In other news —

The Washington Post: FDA Advisers Urge Approval For First Gene Therapy For Inherited Disease
A Food and Drug Administration advisory committee unanimously endorsed an experimental gene therapy Thursday for patients with a rare kind of hereditary blindness, setting the stage for a historic approval. If the agency agrees with the recommendation, the one-time treatment would be the first gene therapy cleared in the United States for an inherited disorder. (McGinley, 10/12)

NPR: First Gene Therapy For An Inherited Disorder Gets Expert Endorsement
Gene therapy, which has had a roller-coaster history of high hopes and devastating disappointments, took an important step forward Thursday. A Food and Drug Administration advisory committee endorsed the first gene therapy for an inherited disorder — a rare condition that causes a progressive form of blindness that usually starts in childhood. (Stein, 10/12)


13. Seniors Face Important Insurance Decisions As Medicare Enrollment Begins Sunday

Although many beneficiaries opt to stay in the same plans, experts say it is important to check out the options.

Tampa Bay Times: Navigating Medicare Enrollment: What You Need To Know For 2018
Florida is one of the biggest players in Medicare, with more than 2.4 million people enrolled, according to the Centers for Medicare & Medicaid Services. While most enrollees tend to stick with the plans they know and have used before, there are some subtle changes to Medicare Advantage plans this year that could affect some benefits. For the most part, though, it seems that those changes are slight ones — with some reduced and rising premiums and some expanded coverage. However, any change could mean some doctors may no longer be part of the network, or specific prescription medication may become more expensive or not be covered at all. (Griffin, 10/12)

Dallas Morning News: It Pays To Shop For The Best Medicare Deal
Now's the time for Texans with Medicare to check their health and drug coverage for 2018. Medicare's open enrollment period runs Oct. 15 through Dec. 7. Open enrollment is the best time to make sure your health and drug plans still meet your individual needs, especially if you've had any changes in your health. (Moos, 10/12)


14. Mich., N.H. Governors Dispute Sen. Johnson's View Of 'Soaring' Medicaid Costs

Both Republican governors say the analysis by Sen. Ron Johnson (R-Wis.) of their states' Medicaid spending is faulty. Johnson sent letters to eight states asking for explanations about Medicaid expansion costs that "go far beyond initial projections."

Detroit Free Press: Gov. Snyder: U.S. Senator's Portrayal Of Medicaid Costs Is Wrong
Gov. Rick Snyder finally responded this week to a series of pointed questions from a U.S. senator regarding Medicaid expansion in Michigan, defending the program and saying the senator painted an inaccurate picture of its costs. Snyder wrote a letter to U.S. Sen. Ron Johnson, R-Wis., telling the chairman of the Homeland Security and Governmental Affairs Committee that he “respectfully disagrees that the approach used in your letter to calculate the growth in expenditures is an accurate portrayal of this successful program.” (Spangler, 10/12)

New Hampshire Union Leader: State Disputes Claims Of 'Soaring Costs' In Medicaid Program
Gov. Chris Sununu has responded to U.S. Sen. Ron Johnson, R-Wis., who is investigating overspending on Medicaid, telling Johnson his numbers on New Hampshire are all wrong. Johnson is chairman of the U.S. Senate Committee on Homeland Security and Governmental Affairs, which is investigating what it claims are excessive Medicaid expenditures in eight states. (Solomon, 10/12)

Concord (N.H.) Monitor: Sununu Pushes Back At Wisconsin Senator Over Medicaid
Responding to a September letter from Johnson inquiring into the price tag of New Hampshire’s program, Sununu attached a review by Milliman, an actuarial consulting firm employed by the Department of Health and Human Services. The review, released Thursday, asserted that many of the costs alleged by Johnson were based on figures that had been interpreted and processed out of context. (DeWitt, 10/13)

Veterans' Health Care

15. Chronically Late Payments From VA Jeopardizing Virginia's Veterans, Lawmakers Say

The Virginia delegation is concerned about payments coming from the Veterans Choice program, which allows vets to receive care from private providers if they cannot book an appointment at their local VA facility within 30 days or access a facility within 40 miles of their home.

The Washington Post: Virginia Lawmakers Say Late VA Payments Jeopardize Veterans’ Care
Members of Congress from Virginia say chronic late payments from the Department of Veterans Affairs to doctors are jeopardizing care for the state’s aging veteran population. The state’s two senators and 11 House members urged VA administrators to fix a system that can leave health-care providers waiting more than four months for payments they should have received within 30 days. The delays can damage credit, they said. (Portnoy, 10/12)

In other news —

The Washington Post: ‘This Is Frightening’: Noxious Gas Has Sickened VA Workers For Two Years, With Few Solutions
Staff and patients at a D.C. medical facility for homeless military veterans have endured noxious gas exposure for nearly two years as top hospital administrators, though aware of the problem, have failed to remedy it, according to interviews with staff and documents obtained by The Washington Post. At least eight clinical workers at the Department of Veterans Affairs Community Resource and Referral Center have tested positive for elevated levels of carbon monoxide, a March internal email said, describing a potentially dangerous condition that restricts oxygen circulation. As many as 30 employees, desperate to avoid further exposure, have sought reassignment or permission to work remotely. (Horton, 10/12)

Denver Post: Dozens Of Surgeries At Denver VA Hospital Put Off Because Of Doctor Shortage
A shortage of anesthesiologists at Denver’s veterans hospital – despite salary offers reaching as high as $400,000 a year – has forced a delay in dozens of surgeries just months after the institution was tagged with some of the nation’s worst waiting lists for care. Though the hospital employs eight anesthesiologists and eight nurse anesthetists, they’re short of the complement needed to meet surgery demands that run about 380 operations a month, a spokeswoman said, noting some staff has left for other jobs as well as taken paternity and maternity leaves. (Migoya, 10/12)

Public Health And Education

16. NIH Partners With Pharma As Part Of Next Step In Cancer Moonshot

Each of the industry partners will contribute $1 million a year to the initiative, for a total of $55 million, while the National Institutes of Health will provide $160 million in support over the next five years.

Stat: To Accelerate New Cancer Treatments, NIH Will Team Up With Pharma On Immunotherapy Research
The National Institutes of Health on Thursday announced a $215 million public-private partnership with 11 pharmaceutical companies in what the agency bills as a significant next step in its cancer moonshot. The Partnership for Accelerating Cancer Therapies, or PACT, is a five-year agreement to push ahead with research that seeks to “identify, develop and validate robust biomarkers — standardized biological markers of disease and treatment response — to advance new immunotherapy treatments that harness the immune system to attack cancer,” the agency said. (Facher, 10/12)

The Hill: NIH, Drug Companies Launch Cancer Moonshot Partnership 
A new public-private research collaboration launched Thursday in an effort to increase the number of therapies aimed at attacking cancer. The National Institutes of Health (NIH) is partnering with 11 biopharmaceutical companies to form the Partnership for Accelerating Cancer Therapies (PACT), a five-year, $215 million initiative. It’s part of the Cancer Moonshot, an effort pushed by former Vice President Joe Biden after he lost his son to brain cancer in 2015. (Roubein, 10/12)

Stat: Liquid Biopsy Could Lead To Precision Therapies For Retinoblastoma Tumors
But the children who develop these rare tumors in their retinas have never benefited from that wave of precision diagnostics and therapies. That’s largely because doctors haven’t been able to biopsy the tumors for genetic information that could guide treatment, without removing the very eyes clinicians are trying so hard to save. Now, because a young oncologist at Children’s Hospital Los Angeles followed a hunch, there may be a safe, non-invasive way to biopsy retinoblastoma tumors — using fluid that’s removed from the eye during chemotherapy and typically discarded. A small study published Thursday in JAMA Ophthalmology showed that DNA found in the fluid matched the DNA found in tumors — a discovery that could lead to a new liquid biopsy. (McFarling, 10/12)

In other news, the Los Angeles Times examines some issues around cancer —

Los Angeles Times: When It Comes To Cancer, Here's What You Should Sweat And Here's What You Shouldn't
We all want to avoid cancer. That’s a given. But when cancer risk seems to lurk everywhere, it’s hard to know what you really need to do to protect yourself. The stakes are high. As many as 40% of cancer cases, and about half of all cancer deaths, could be prevented with a healthy lifestyle, according to a study by Harvard researchers published in the journal JAMA Oncology. (Woolston, 10/12)

Los Angeles Times: Life After Cancer: “The Real Battle Happened After Treatment”
Bin McLaurin was lucky. Doctors detected his prostate cancer early, and he successfully completed the surgery, radiation and hormone therapy he needed to keep the disease at bay. But two years out from his 2014 diagnosis, McLaurin didn't feel so great. He had gained 60 pounds during treatment, and the hormones he was taking sapped his energy and drive. (Brown, 10/12)

17. 'There's No Simple Solution' To Ending Opioid Crisis, But Here Are Steps Experts Recommend

Two experts on the opioid epidemic weigh in on moves the government could make to help alleviate the crisis, including a ban on ultra-high dosage painkillers. Meanwhile, lawmakers wonder why there's been a delay in officially declaring the epidemic a national emergency.

The Hill: Warren, Murkowski: Where's The Emergency Declaration On Opioids? 
A Democratic and Republican senator are questioning why President Trump hasn’t officially declared the opioid epidemic a national emergency, despite saying his administration was drafting the paperwork to do so two months ago. “We applaud your stated commitment to addressing opioid addiction and agree with you that the crisis is a ‘serious problem’ deserving of increased federal resources,” Sens. Elizabeth Warren (D-Mass.) and Lisa Murkowski (R-Alaska) wrote in a letter to Trump, referring to comments he made on Aug. 10. (Roubein, 10/12)

And in other news —

Detroit Free Press: Wayne, Oakland Sue Drugmakers Over Opioid Epidemic
Wayne and Oakland county executives announced a joint lawsuit today against several drug manufacturers and distributors, alleging the "deceptive marketing and sale of opioids" including OxyContin and Fentanyl. Wayne County Executive Warren Evans called the opioid-related addictions and deaths—which have claimed 817 lives in his county in 2016, up from 506 in 2015 — a "full-blown health crisis from which the drug companies have made billions," in a joint news release. (Dudar, 10/12)

18. Obesity Rates Continue To Climb: Nearly 40% Of Adult Americans, 20% Of Kids Qualify

The latest data from the Centers for Disease Control and Prevention show that adult obesity rates have spiked from 30.5 percent in 1999-2000 to 39.8 percent in 2015-2016. Also in public health news today: condom sizes and NFL concussion research.

Los Angeles Times: Nearly 4 In 10 U.S. Adults Are Now Obese, CDC Says
Americans’ obesity rates have reached a new high-water mark. Again. In 2015 and 2016, just short of 4 in 10 American adults had a body mass index that put them in obese territory. In addition, just under 2 in 10 American children — those between 2 and 19 years of age — are now considered obese as well. (Healy, 10/12)

The New York Times: A Condom-Maker’s Discovery: Size Matters
Condoms get a bad rap for being a bad wrap. Men often complain of discomfort, diminished sensation and poor fit. A recent federal study found only a third of American men use them. Now, changes by the Food and Drug Administration and industry-standards groups have opened the door to the condom equivalent of bespoke suits. A Boston-based company has begun selling custom-fit condoms in 60 sizes, in combinations of 10 lengths and nine circumferences. (Belluck, 10/12)

The Star Tribune: Minn. Concussion Researcher Looks To Enlist NFL Players In Hunt To Understand Brain Injury
Dr. Uzma Samadani developed an eye-tracking system that detects concussions based on patients’ eye movements as they watch music videos, and has studied how variations in brain scans and blood tests reveal brain injuries as well. Now she wants to apply this diagnostic technology to NFL players and their families: Comparing the brains of athletes who suffered concussions with their genetically similar siblings could yield clues to why some people suffer more symptoms and complications than others. (Olson, 10/12)

State Watch

19. Medicare Cuts Off Payments To Florida Nursing Home Where Residents Died After The Hurricane

Fourteen residents died after the facility lost air conditioning. Florida's two senators have called for a congressional investigation. The nursing home had previously announced it would close permanently.

Miami Herald: Feds To Cut Medicare For Hollywood Hills Nursing Home After Residents Died
Federal regulators on Thursday said they are cutting off Medicare, a crucial financial lifeline, to the Hollywood Hills nursing home where residents died from sweltering heat after Hurricane Irma knocked out power to the facility’s air conditioning and forced an emergency evacuation in September. The Centers for Medicare and Medicaid Services, or CMS, also imposed a penalty of $20,965 a day for the three days that the Rehabilitation Center at Hollywood Hills lost power to its air conditioning unit, from Sept. 10 — when Irma made landfall in Florida — to Sept. 13, when the facility was evacuated as its residents wilted. (Chang, 10/12)

Sun Sentinel: Rubio Joins Nelson In Call For Senate Probe Of Hollywood Nursing Home Deaths
U.S. Sen. Marco Rubio said Thursday the Senate committee with jurisdiction over Medicare and Medicaid should investigate what led to the deaths of 14 residents of a Hollywood nursing home in the aftermath of Hurricane Irma. U.S. Sen. Bill Nelson asked the Senate Finance Committee two weeks ago to investigate what happened at the Rehabilitation Center at Hollywood Hills. (Man, 10/12)

20. 'This Thing Could Get Worse': Calif. Wildfires Force Hospital Evacuations And Hit Medical Personnel

Medical services in California are under pressure from the wildfire crisis as doctors and nurses are impacted personally and professionally at a time when they are needed by residents coping with the air quality. Asthmatics and the elderly are particularly at risk.

Los Angeles Times: Northern California Firestorm Brings Illness, Strains Healthcare System
The deadly Northern California fires — by forcing the evacuation of several hospitals and clinics and destroying the homes of many doctors and nurses — have put a strain on available medical services. The Petaluma Health Center canceled all scheduled appointments this week to make time for people requiring urgent care. They’ve treated asthmatics struggling to breathe amid some of the most unhealthy air in Bay Area history, as well as people who sprained their ankles or forgot to grab their medications as they raced from burning homes in nearby Santa Rosa, clinic chief administrative officer Pedro Toledo said. (Karlamangla, 10/12)

NPR: Wildfire Smoke Has Made Bay Area Air Quality Its Worst On Record
Air pollution in counties of the San Francisco Bay Area this week has been the worst since 1999 when officials began collecting data. "The pollution is so high it's comparable to high pollution days in China," says Lisa Fasano at the Bay Area Air Quality Management District. (McClurg, 10/12)

California Healthline: Fires Prey On Frail Residents Living On Their Own
They were asleep when the fire reached their home. Charles Rippey, 100, and his wife, Sara, 98, had been married 75 years. They died together, after a caregiver struggled to save them but couldn’t get them out in time. A 27-year-old woman had spina bifida and used a wheelchair. In the hours after the fires broke out, her relatives frantically sought information about her whereabouts. When a fire inspector visited her home, he found her body. (Feder Ostrov, 10/13)

21. State Highlights: Child Of Mich. Mother Who Was Jailed For Not Vaccinating Her Son Immunized; Anthem To Develop Health IT Hub In Atlanta

Media outlets report on news from Michigan, Georgia, Florida, Ohio and Texas.

The Washington Post: A Mother Was Jailed For Refusing To Vaccinate Her Son. Now She’s Outraged He’s Been Immunized.
A Michigan mother said she's had a “rough few days” after serving nearly a week in jail for defying a court order to have her 9-year-old son vaccinated and then learning that he received several immunizations after she was locked up behind bars. Rebecca Bredow, from the Detroit area, was sentenced last week for contempt of court nearly a year after an Oakland County judge ordered her to have her son vaccinated. (Bever and Phillips, 10/12)

Georgia Health News: Anthem To Develop Mega-Center Of Health IT In Atlanta
Anthem Inc. announced Thursday that it had signed a lease to develop the 21-story building with Portman Holdings. ...Anthem said the building would be home to about 3,000 IT professionals “dedicated to creating new capabilities that will enhance the consumer health care experience, help improve quality of care, and lower health care costs.” (Miller, 10/12)

The Washington Post: A Doctor Shouted At A Sick Mother To ‘Get The Hell Out.’ Now He’s Under Criminal Investigation.
A doctor in northern Florida is under criminal investigation after he was seen on video shouting at a patient to “get the hell out” of an urgent-care clinic, then apparently grabbing her daughter's cellphone, which was recording the incident. Gallogly, a physician at Gainesville After-Hours Clinic, was captured on video Monday arguing with a patient who was scolding him for a long wait time. (Bever, 10/12)

Health Policy Research

22. Research Roundup: Medicaid Reduces Payday Loans; Diabetes Management; Chronic ER Use

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: Early Medicaid Expansion Associated With Reduced Payday Borrowing In California
We examined the impact of California’s early Medicaid expansion under the Affordable Care Act on the use of payday loans, a form of high-interest borrowing used by low- and middle-income Americans. ...The early Medicaid expansion was associated with an 11 percent reduction in the number of loans taken out each month. It also reduced the number of unique borrowers each month and the amount of payday loan debt. (Allen, Swanson, Wang et. al., 10/1)

JAMA: Insulin Pump Vs Insulin Injection And Type 1 Diabetes Complications
Are the rates of severe hypoglycemia and diabetic ketoacidosis lower with insulin pump therapy than with insulin injection therapy in young patients with type 1 diabetes? ...Insulin pump therapy was associated with reduced risks of short-term diabetes complications and with better glycemic control compared with injection therapy. (Karges, Schwandt, Heidtmann et. al., 10/10)

Health Affairs: Persistent Frequent Emergency Department Use: Core Group Exhibits Extreme Levels Of Use For More Than A Decade
Many frequent emergency department (ED) users do not sustain high use over time, which makes it difficult to create targeted interventions to address their health needs. ...A small but nontrivial population (16.5 percent, 5.7 percent, and 1.9 percent) exhibited persistent frequent use for three, six, and eleven consecutive years, respectively. The strongest predictor of persistent frequent ED use was the intensity of ED use in the baseline study year. (Kanzaria, Niedzwiecki, Montoy et. al., 10/1)

JAMA Internal Medicine: Patients’ Experiences With Institutional Responses To Medical Injury 
Do patients’ and families’ experiences with communication-and-resolution programs suggest aspects of institutional responses to injury that could better promote reconciliation after medical injuries? This interview study of 40 patients, family members, and hospital staff found that patients have a strong need to be heard after medical injury that is often unmet. ...Opportunities are available to provide institutional responses to medical injuries that are more patient centered. (Moore, Bismark, Mello, et. al., 10/9)

Editorials And Opinions

23. Different Takes On Trump's Executive Order On Health Insurance: The Good, The Bad And The Ugly

Opinion writers across the nation express outrage and concern about Thursday's White House directive loosening some of the rules regarding health coverage, but some also defend it and even see it as progress. The opinions also touch on other health policy topics including Medicaid.

The New York Times: Congress Can’t Let Mr. Trump Kill Obamacare On His Own
Fed up with failed attempts in Congress to repeal the Affordable Care Act, President Trump on Thursday took matters into his own hands, signing an executive order that could significantly damage the health insurance market and harm millions of people. Mr. Trump directed his administration to effectively create an alternative health insurance system that does not include the safeguards of the A.C.A. and could sabotage that 2010 law, one of his predecessor’s biggest accomplishments. (10/12)

Bloomberg: Trump's Health-Care Wrecking Ball
His latest executive order, signed Thursday, will cause premiums to fall drastically for “millions of Americans,” Trump said. What he didn’t mention is that these potential savings would accrue only to people healthy enough to gamble on skimpy insurance coverage. Sicker people, left stranded in a deteriorating risk pool, would see their premiums rise. In other words: The changes would shift costs, not save money, for the health-care system. (11/12)

The Washington Post: Trump Ramps Up The Obamacare Sabotage Campaign
President Trump on Thursday signed an executive order directing his administration to ramp up its sabotage campaign against the Affordable Care Act, also known as Obamacare, also known as the health-care law without which millions of needy people would lack coverage. The only good news is that the order merely instructs executive agencies to draw up some new, looser regulations, rather than immediately eroding Obamacare’s protections. The bad news is that those looser regulations may nevertheless come soon, and they could devastate the ACA’s carefully regulated marketplaces. Much depends on how reckless the leaders of agencies such as the Labor Department decide to be. (10/12)

The Wall Street Journal: Salvaging Private Health Insurance
Republicans are still trying to defuse the ticking Obama Care bomb without blowing themselves up, and on Thursday the GOP cut the first wire: President Trump signed an executive order that could begin to revive private insurance markets. More to the point, Americans may start to have more choices at a lower cost. (10/12)

The Washington Post: Trump’s Obamacare Order Could Destroy The Health-Care System
President Trump has made a lot of promises on health care. Somehow, though, I don’t remember him promising stadiums of cheering fans that he’d take away protections for preexisting conditions, increase deductibles, spike premiums, eliminate basic coverage requirements and, more generally, destabilize the individual health-insurance market. But that is what he said he’d do Thursday, when he signed an executive order on health care. (Catherine Rampell, 10/12)

Boston Globe: Donald Trump’s Health Care Order Creates Two Americas
An executive order signed by Trump on Thursday authorizes changes to Affordable Care Act regulations that are designed to create less expensive, less comprehensive health insurance plans. Health care experts predict that changing the ACA formula in that way drives younger people — who are typically healthier — to the cheaper products. (10/13)

The Charlotte Observer: Trump Has A New Plan To Kill Obamacare, And It Could Work
Donald Trump has a new way to get rid of Obamacare. This one comes without the humiliating defeats previous repeal efforts have suffered in Congress. It also might dodge the political outcry that preceded those defeats. It’s a bad idea, however, and not only because Trump’s new idea would do the same thing as Republicans’ old ideas – destabilize insurance markets and cost millions of Americans benefits and coverage. It’s a bad idea because one man shouldn’t solely decide significant domestic policy. (10/11)

Chicago Tribune: While Congress Naps, Trump Acts On Obamacare
President Donald Trump issued a sweeping executive order on Thursday that may help lower costs and create more options for many Americans who struggle to find health insurance. At the same time, the order could be another nail in Obamacare’s coffin. Nobody will know for weeks if not months how the order will pan out: Trump’s edict depends on federal agencies’ regulations to enact it. We hope the rules prompt insurers to offer new policies that attract consumers. (11/12)

The Des Moines Register: Republicans Own Obamacare, And They Should Fix It
Iowans are in big trouble if politicians adopt the philosophy of Jeff Kaufmann, chairman of the Republican Party of Iowa. He issued a statement this month in response to reports about Iowa’s “stopgap” plan — a proposal from the state insurance commissioner to stabilize the private health insurance market for Iowans who buy coverage on their own. The plan needs federal approval to move forward, but President Donald Trump told a top human-services administrator in August to reject it, according to the Washington Post. Iowa officials say they haven't heard that their proposal is dead, and Gov. Kim Reynolds has asked to speak with Trump about it. (10/12)

US News: Medicaid Expansion Comes Home To Roost
In the burst of enthusiasm that followed passage of the Affordable Care Act in 2010, Massachusetts expanded its Medicaid program to cover tens of thousands of able-bodied adults with no children. Cooler heads warned that the bonus federal funding promised by the law would not last forever. Many also warned that supporters were wildly underestimating the increase in state costs .... Along with the Bay State, 30 others and the District of Columbia ignored these warnings. Now the birthplace of Romneycare is trying to move people off Medicaid to stave off fiscal disaster. So, yes, we told you so. (Akash Chougule, 10/11)

24. Viewpoints: The Toll Of Gun Violence On Public Health; Gene Mapping Moves Closer To Reality

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

The New York Times: Gun Carnage Is A Public Health Crisis
“We’ll be talking about gun laws as time goes by,” President Trump promised all too casually after the Las Vegas gunman took 58 lives in a rapid-fire slaughter. Time is indeed going by, and the silence is alarming as the Republican Congress and Mr. Trump, the devoted candidate of the National Rifle Association, duck their responsibility to confront the public health crisis of gun deaths. (10/13)

The Wall Street Journal: Gene Editing Is Here, And Desperate Patients Want It
Should Americans be allowed to edit their DNA to prevent genetic diseases in their children? That question, which once might have sounded like science fiction, is stirring debate as breakthroughs bring the idea closer to reality. Bioethicists and activists, worried about falling down the slippery slope to genetically modified Olympic athletes, are calling for more regulation. (Henry I. Miller, 10/12)

Stat: With Little Help From Doctors, I Mapped My Recovery From Brain Surgery
There was no map for this recovery, no compass to point the way. I had no advocate, no guide to ensure that I received necessary treatments. How was I supposed to find my way? How was I supposed to heal? Would I ever be able to return to my work as a college math professor? Could I be a good mom again? Or would I be lost, a perpetual victim to my symptoms, forever struggling with dizziness, balance, short-term memory, sensory overload, emotional meltdowns — and even with thinking itself? (Deb Brandon, 10/12)

The Columbus Dispatch: Shady Clinics Add To Hell Of Opioids
As Ohio struggles under the crushing burden of an opioid-abuse crisis, flaws in state policy have the potential to make the problem dramatically worse. A mushrooming new business — standalone clinics where addicts can get prescriptions for Suboxone, another highly addictive opioid meant to help them get off of heroin — threatens to spawn a new generation of “pill mills.” (10/13)

Bloomberg: The FDA Needs This Nudge To Speed Along New Drugs
[B]elow those high-volatility positions work layers of appointees who are far enough from the president to be somewhat insulated from the chaos, but sufficiently high up to make a major difference in how the government works. The FDA commissioner is one of those appointees, and Gottlieb represents a much-needed countervailing force against the agency’s tendency to prize caution over speed. He has forcefully and persuasively articulated a vision of an FDA that better weighs the costs of risk aversion against the costs of bad side effects. (Megan McArdle, 10/12)

Chicago Tribune: How Illinois Failed Kenan And Other Babies
Well-run organizations keep track of their work. If a project runs late by weeks or months, managers ask questions, problem-solve and demand results. Suppose that assignment involves a new state law with potentially life-or-death consequences for babies. How long before officials get impatient with delays and sound the alarm? Six days? Six weeks? Six long months? (11/12)