In This Edition:

From Kaiser Health News:

Kaiser Health News Original Stories

1. Podcast: 'What The Health?' Whiplash

In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and Alice Ollstein of Talking Points Memo discuss the bipartisan plan in the Senate to stabilize the individual insurance exchanges, and President Donald Trump’s mixed messages about his support or lack thereof. (10/19)

3. Political Cartoon: 'Sugar The Pill?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Sugar The Pill?'" by Mike Smith, Las Vegas Sun.

Here's today's health policy haiku:


Proposing trade-off
Between CHIP and public health
And they want tax CUTs?

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

4. 'Do The Math, Baby': Senators Seem To Have Secured 60 Votes For Bipartisan Health Bill

Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) have an unusually high number of sponsors on their legislation -- 12 lawmakers from each party -- and Sen. Chuck Schumer (D-N.Y.) promises that every Democrat will vote for it, meaning it seems to have the 60 votes necessary to overcome a fillibuster.

The Hill: 24 Senators Co-Sponsor Bipartisan ObamaCare Deal
The bipartisan deal to stabilize ObamaCare’s markets has 24 co-sponsors, Senate Health Committee Chairman Lamar Alexander (R-Tenn.) announced Thursday. Twelve Republicans and 12 Democrats signed on to the bill, which would continue ObamaCare's insurer subsidies for two years and give states more flexibility to waive ObamaCare rules. (Hellmann, 10/19)

The Hill: Key Senate Republican Warns GOP To Change Course On ObamaCare
Senate Health Committee Chairman Lamar Alexander (R-Tenn.) on Thursday told GOP colleagues bluntly that their efforts to repeal ObamaCare have failed and urged them to change course. Alexander said Republicans need to come up with a new path on health care after holding dozens of votes over the years to repeal ObamaCare and always ending in failure. (Bolton, 10/19)

The New York Times: Will Mitch McConnell Help His Friend Get A Health Care Deal?
Mitch McConnell and Lamar Alexander go way back. The two Southern Republicans met in Washington in 1969 when Mr. Alexander was a promising young aide at the Nixon White House and Mr. McConnell an up-and-coming legislative assistant to Senator Marlow W. Cook of Kentucky. The story goes that Senator Howard H. Baker Jr. suggested to Mr. Alexander, his fellow Tennessean, that he should look up Mr. McConnell, that he was a “smart young man and I think you’d like him.” A nearly 50-year friendship and political alliance was born. (Hulse, 10/19)

Meanwhile, some senators are still seeking tweaks —

The Hill: Graham, Cassidy Trying To Move New ObamaCare Deal To The Right
Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) say they are working to make changes to a bipartisan health-care deal to make it more likely to win favor in the House. Graham and Cassidy, authors of a failed bill to repeal and replace ObamaCare earlier this year, are supporting a bipartisan measure aimed at stabilizing ObamaCare, but they are also looking for changes to move the proposal to the right. (Sullivan, 10/19)

WBUR: Sure, There's A Health Care Deal. That Doesn't Mean It Can Pass
A bipartisan coalition of 24 senators — 12 Republicans and 12 Democrats — has signed on to health care legislation to prop up the individual insurance market and keep premiums down. ...But questions remain over when it might actually get a vote, as well as whether President Trump and House Republicans would bring the bill over the finish line. (Davis, 10/19)

And in more news —

Modern Healthcare: Healthcare Leaders Downbeat On Compromise ACA Fix Bill
Healthcare leaders gathered [in Arizona] for Modern Healthcare's second annual Leadership Symposium have grown pessimistic about the prospect for passing legislation that would stabilize the insurance exchanges for next year's open enrollment season—now just two weeks away. President Donald Trump's sudden reversal on support for the compromise legislation crafted by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) cast a pall over a meeting where the nearly 100 top officials are discussing leadership challenges during a time of "disruption, complexity and uncertainty." (Goozner, 10/19)

Kaiser Health News: Podcast: ‘What The Health?’ Whiplash
The bipartisan leaders of the Senate Health, Education, Labor and Pensions Committee this week agreed on a bill they say could help stabilize the struggling health insurance exchanges. But despite compromises made by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), it’s still unclear whether Congress can pass the measure, particularly in time for the Affordable Care Act’s 2018 open enrollment season, which begins Nov. 1. (10/19)

5. Trump's Support Contingent On Deal Including ACA Rollbacks, White House Says

Many of the changes President Donald Trump wants to see in the legislation are ones that couldn't get through Congress this summer.

Reuters: White House Says Rollback Of Obamacare Must Be Part Of Short-Term Fix
A senior White House aide said on Thursday that U.S. President Donald Trump would demand steps toward repealing Obamacare in any healthcare legislation, comments that cast doubt on the prospects for a short-term bill to shore up insurance markets. Marc Short, the White House's top liaison to Congress, said on CNN that Obamacare's mandates and taxes would have to be rolled back and consumers be allowed to more heavily invest in health-savings accounts for Trump to sign off on any congressional deal. (Cowan and Abutaleb, 10/19)

The Wall Street Journal: Trump’s Support For Bipartisan Health Bill Hinges On Rollbacks Long Sought By Conservatives
“We are certain that it can be improved,” Mr. Alexander said on the Senate floor Thursday. But the White House made clear Thursday that Mr. Trump was seeking more than minor tweaks to the legislation, which would shore up the ACA’s individual insurance markets by extending for two years federal payments known as “cost-sharing reductions” that help insurers offset subsidies they provide to some low-income consumers, while giving states greater say in how the law is implemented. In order for Mr. Trump to support such legislation, it must provide relief from the ACA’s requirement that most people have health coverage or pay a penalty, the spokesman said Thursday. (Armour and son, 10/19)

CQ HealthBeat: Trump Seeks Conservative Additions To Bipartisan Health Deal
A package "must provide immediate benefits to American families," a White House aide said, such as relief from the 2010 health care law's individual and employer mandates, a request pushed by the conservative group Freedom Partners. In addition, the White House is pushing for state regulators to be able to approve more types of coverage options, such as the short-term, limited duration insurance plans encouraged in the executive order signed by President Donald Trump last week. (McIntire, 10/19)

Bloomberg: Trump Encourages Obamacare Effort As Bill Gains Support 
“I respect very much the two senators your talking about, I love that they’re working on it,” Trump said at the White House Thursday when asked about his position on the bill. Shortly after Trump’s comments, Tennessee Republican Lamar Alexander and Washington Democrat Patty Murray introduced their stabilization bill with 22 senators, half of whom are Republicans. That broad backing could give the package momentum in the Senate. (Edney and Sink, 10/19)

Politico: GOP To Trump: Stop Flip-Flopping On Obamacare Deal
Key Senate Republicans are urgently trying to get President Donald Trump to reconsider his apparent opposition to a bipartisan deal shoring up health insurance markets, several senators said Thursday morning. Sens. Lindsey Graham of South Carolina and Lamar Alexander of Tennessee, who negotiated the deal with Democratic Sen. Patty Murray of Washington, both spoke to the president about it on Wednesday evening. (Everett and Haberkorn, 10/19)

6. After Trump's Off-Script Vow To Declare National Emergency For Opioid Crisis, Officials Are Scrambling

“They are not ready for this,” a public health advocate said of an emergency declaration after talking to Health and Human Services officials enlisted in the effort. Meanwhile, states have been quietly taking matters into their own hands.

Politico: Trump Blindsides Advisers With Promised Opioid Plan
President Donald Trump overrode his own advisers when he promised to deliver an emergency declaration next week to combat the nation’s worsening opioid crisis. “That is a very, very big statement,” he said Monday. “It's a very important step. ... We're going to be doing it in the next week.” (Ehley and Dawsey and Karlin-Smith, 10/20)

Stat: While Federal Standards To Battle The Opioid Epidemic Take Shape, States Codify Their Own
There is little that resembles a current and all-encompassing drug policy in the United States. A national drug control plan issued by the Obama administration last year was written immediately prior to a White House transition, and many hoping for a newer framework are waiting for next month’s reveal of a new presidential commission’s final report on the opioid epidemic.  A new analysis by the Kaiser Family Foundation, however, shows that many of the elements that could soon be codified as federal guidance are already creeping toward national standards in a patchwork fashion, apparent in the regulations imposed by a number of states for implementing Medicaid. (Facher, 10/19)


7. Forget Political Upheaval: For Insurers 'Job No. 1' Is Easing Confusion For Consumers

As uncertainty reigns in Washington, D.C., insurers are more focused on the rest of America and making sure people know what to do when enrollment kicks off. In other marketplace news: middle-class Americans are upset about insurer subsidies being cut off; a look at the way this enrollment season will be different; uninsured numbers are expected to rise; and more.

The Washington Post: Health Insurers’ Most Pressing Concern Right Now? Consumer Confusion.
Health insurers heading into the 2018 Affordable Care Act enrollment season say they’re staying laser focused on maximizing sign-ups, even as Republicans remain in disarray and even denial over the seven-year-old health-care law. A big funding infusion that could help lower Obamacare premiums is in flux just 12 days before enrollment starts. President Trump sent mixed signals this week about whether he’d support legislation funding subsidies for lower-income Americans to get coverage. (Winfield Cunningham, 10/19)

Reuters: Some Middle-Class Americans Worry Trump Health Subsidies Cut Will Hurt
Tom Westerman voted for Donald Trump in last year's election but says he might not do so again after the president cut off billions of dollars in Obamacare subsidies to health insurance companies. "It really upset me," said Westerman, 63, a self-described "middle-class guy" with an annual household income of about $60,000 in the western Pennsylvania city of Arnold. (Reid and Abutaleb, 10/19)

The Wall Street Journal: 5 Ways This ACA Open Enrollment Period Will Be Different
In less than two weeks, the first Trump-era open enrollment season for health insurance will commence. Whether consumers look to renew insurance plans or join the individual market for the first time, here are some ways the experience may be different this year compared to years prior, according to a presentation to reporters Wednesday by the nonpartisan Kaiser Family Foundation. (Jamerson, 10/19)

Los Angeles Times: With Obamacare, Fewer Americans Were Uninsured When They Were Told They Had Cancer
As President Trump and his allies in Congress keep pushing to get rid of Obamacare, new research shows that the contentious law has succeeded in expanding health insurance coverage for Americans with cancer. But not everywhere. This upside of Obamacare — known formally as the Patient Protection and Affordable Care Act, or ACA — was seen primarily in states that participated in the Medicaid expansion that the law made possible. (Kaplan, 10/19)

California Healthline: Calif. Locks In Plans For Open Enrollment As Congressional Bipartisanship Fades
A sudden burst of bipartisanship this week on health care just as quickly appeared to lose steam in Washington. Two key senators, Republican Lamar Alexander and Democrat Patty Murray, announced a bill Tuesday aimed at stabilizing the health insurance marketplaces under the Affordable Care Act. It would guarantee payment of “cost-sharing reduction” subsidies that help lower-income consumers with their deductibles and copays for 2018 and 2019. President Donald Trump had halted those payments last week. (Other federal subsidies that help people pay for their premiums weren’t affected and remain intact.) (10/19)

State House News Service: In Switch, State Health Exchange Will Post Steep Rate Increases
The Massachusetts Health Connector announced last week it would use the lower of two rate sets for some of its plans, but President Trump's decision hours later to end certain federal insurance subsidies means the Connector will use the higher rates after all. ...With uncertainty still prevalent about the federal health care landscape, the Health Connector and Division of Insurance had prepared two sets of rates for its 2018 plans, including one featuring bigger rate increases that accounted for the possibility the federal government would stop making monthly payments to insurers known as cost-sharing reduction (CSR) payments. (Lannan, 10/19)

Capitol Hill Watch

8. In Mostly Symbolic Gesture, Democrats Introduce Bill To Stop Rollback Of Contraception Mandate

“President Trump wants to make birth control about ideology, but let’s be clear: for women and their families in the 21st century, birth control is about being healthy and financially secure,” said Sen. Patty Murray (D-Wash.).

The Hill: Dems Introduce Bill To Overrule Trump On Birth Control Mandate 
Nineteen Senate Democrats have signed on to a bill that would reverse the Trump administration's new exemption for ObamaCare's birth control mandate. The administration recently announced it will allow most employers to stop providing birth control coverage in their insurance plans if they have moral or religious objections. (Hellmann, 10/19)

Seattle Times: Sen. Patty Murray Legislation Targets Trump’s Rollback Of Birth-Control Coverage 
Democratic Sens. Patty Murray of Washington and Bob Casey of Pennsylvania introduced a bill Thursday to overturn the rule issued by the U.S. Health and Human Services Department last week allowing more employers to opt out of providing no-cost contraceptives by claiming religious or moral objections. The bill, which is co-sponsored by Sen. Maria Cantwell, D-Wash., and others, says the rule would not take effect and would be treated as if it never happened. (Blethen, 10/19)

CQ: Arguments Over Impact Of Contraceptive Rules Continue
Lawmakers and advocates continue to argue about the scope of two rules creating moral and religious exemptions for employers who do not want to cover birth control, two weeks after the Trump administration revealed the policies. The rules significantly expanded the types of organizations that can apply for exemptions to a mandate established under the 2010 health care law (PL 111-148, PL 111-152), which requires most private plans to cover birth control without a copay. Under the rules, any employer is able to qualify for an exemption, provided they have a religious or moral objection to contraception. (Raman, 10/19)

In other news from Capitol Hill —

Stat: These Health Programs Work. But Congress Has Left Their Future Uncertain
Another program that lost funding helps seniors navigate the complexities of Medicare, still another gives payments aimed at keeping smaller, often rural hospitals financially afloat. Others offer grants to providers and other businesses working to address childhood obesity or improving abstinence education efforts. In the past, Congress has reauthorized this slate of extenders with bipartisan support. Already this year, two House committees have approved tweaks or reauthorizations of many of the programs, teeing them up for further consideration from the full legislative body. The Senate also approved several of the programs, including a broad expansion of the Independence at Home program, as part of a bill aimed at improving care for individuals with chronic conditions. (Mershon, 10/19)

Administration News

9. Court Of Appeals Stays Ruling To Allow Undocumented Girl's Abortion; Hearing Set For Friday

The court did, however, allow for the girl to see a counselor -- which Texas law requires before obtaining an abortion. If the stay is lifted, she could decide to seek the procedure later today or tomorrow.

The Associated Press: Court To Review Ruling Allowing Abortion For Immigrant Teen
An appeals court on Thursday temporarily stayed a judge's ruling that would have allowed a pregnant 17-year-old being held in a Texas facility for unaccompanied immigrant children to obtain an abortion. The U.S. Court of Appeals for the District of Columbia issued a short ruling that still allowed the teenager to be taken to a counseling meeting with the doctor who would perform the abortion. Texas state law requires women to receive counseling 24 hours before an abortion. (Merchant, 10/19)

The Wall Street Journal: Appeals Court To Review Case Of Undocumented Teenager Seeking Abortion
In a rare move Thursday, a federal appeals court hastily scheduled an oral argument for Friday morning after U.S. District Judge Tanya Chutkan in Washington, D.C., sharply criticized the administration’s position and ordered it to release the teen to travel to the nearest abortion clinic this week. The government appealed the decision immediately. The appeals court put the court order on hold temporarily so it could consider the case, which raises questions about whether undocumented immigrants in custody have the same constitutional right to an abortion that is accorded to U.S. citizens. (Kendall and Meckler, 10/19)

The Washington Post: Appeals Court To Review Judge's Order Allowing Abortion For Undocumented Immigrant
Federal officials say the 17-year-old, who entered this country in September, could solve the problem herself by voluntarily leaving or finding a sponsor in the United States to take custody of her. “The Administration stands ready to expedite her return to her home country,” the White House said in a statement. But the American Civil Liberties Union, which is representing the teenager, says she is entitled to have an abortion, which she would pay for, under the 1973 Supreme Court ruling in Roe v. Wade. (Sacchetti and Marimow, 10/19)

Reveal: Immigrant Girl In Federal Custody Must Wait For Abortion Until Appeals Court Can Rule
The ACLU, which is representing the girl, has produced internal emails from the Department of Health and Human Services Office of Refugee Resettlement suggesting the agency has quietly implemented a new policy banning abortion for immigrant minors in its care. The office’s new director under President Trump, Scott Lloyd, has told his staff to refer pregnant girls to pro-life religious pregnancy counseling instead of abortion clinics. In at least one case, he has personally met with a girl considering abortion. (Michels, 10/19)

In other news on abortion —

The Washington Post: U.S. Abortion Rate Fell 25 Percent From 2008 To 2014; One In Four Women Have An Abortion
The U.S. abortion rate has fallen dramatically, by 25 percent, in recent years. The procedure continues to be common: One in  four women will have an abortion by 45, according to a report published in the American Journal of Public Health on Thursday. Researchers used data from three surveys, two conducted by the federal government and the third by the Guttmacher Institute, to estimate abortion rates. They found that in 2008, there were 19.4 abortions per 1,000 women ages 15 to 44. By 2014, the number had dropped to 14.6 per 1,000. (Cha, 10/19)

10. Medicare Agency May Have 'Overcorrected' When Canceling Cardiac Pay Models

Also in the news from the Centers for Medicare & Medicaid Services, the agency will begin evaluating some of the changes put in place by MACRA to reduce Medicare spending.

Modern Healthcare: CMS May Have Overcorrected In Cancellation Of Cardiac Models
The CMS may have overcorrected when it honored some hospitals' request to cancel mandatory cardiac pay models. The move means hospitals that were ready to embrace the models could be out millions of dollars. Those hospitals are also missing out on millions in bonus payments they would have received had they improved care. The CMS wants to cancel models for acute myocardial infarction, coronary artery bypass and as well as the Cardiac Rehabilitation Incentive Payment Model, all of which were scheduled to begin on Jan. 1, 2018. Comments on the termination were due Oct. 16. (Dickson, 10/19)

Modern Healthcare: CMS Makes First Move To Hold Docs Accountable For Medicare Spending 
The CMS is taking its first steps to evaluate whether MACRA will lead to reduced Medicare spending with a new pilot test. The test will evaluate eight new measures to determine if physicians in the Merit-based Incentive Payment System, known as MIPS, are actually reducing the cost of care. The CMS unveiled the initiative just two weeks after the Medicare Payment Advisory Commission suggested repealing MIPS over concerns it wouldn't lead to better quality of care for patients or lower costs. (Dickson, 10/19)


11. As Medicaid Enrollment Stabilizes, States Seeing Modest Rise In Spending

The Kaiser Family Foundation's annual survey of 50 states looks at changes expected in Medicaid programs. In other Medicaid news, Pennsylvania's governor vetoes a bill that would impose work requirements for enrollees, Louisiana lawmakers weigh new contracts for managed care companies and New Hampshire approves coverage of gender reassignment surgeries.

The Associated Press: Report: Medicaid Enrollments, Costs Begin To Stabilize
States are seeing more stability in their Medicaid programs after experiencing a surge in enrollment and costs associated with the Affordable Care Act, suggesting that one of the major pillars of former President Barack Obama's health overhaul may be nearing its peak. At the same time, they are experiencing a high level of uncertainty as Republicans in Congress continue to advocate for a major overhaul of a program that provides health insurance to tens of millions of lower-income and disabled Americans. Thursday's report by the Kaiser Family Foundation found Medicaid enrollments in the states slowed considerably to an increase of just 2.7 percent in fiscal year 2017. (Cassidy, 10/19)

CQ: Medicaid Spending Likely To Rise While Enrollment Growth Slows
Medicaid spending is expected to grow modestly in the coming year, fueled in part by rising prescription drug costs, provider rate increases and growth in the cost of long-term care services, a new report released Thursday says. That’s despite the fact that enrollment in the health program for the poor is projected to grow less rapidly during the same time period, according to the nonpartisan Kaiser Family Foundation’s annual survey of state Medicaid programs. (Williams, 10/19)

The Associated Press: Louisiana Medicaid Contracts Proposed For 2-Year Extension
Louisiana's health department wants to keep the five managed-care companies that coordinate health services for most state Medicaid patients in place, extending the lucrative government contracts for another two years. Lawmakers on the joint House and Senate budget committee on Friday will consider whether to approve the extensions, expected to cost $15 billion with federal and state dollars. (Deslatte, 10/19)

Concord Monitor: Vote Allows Medicaid Funds To Be Used For Gender Reassignment Surgeries
New Hampshire Medicaid money may now be used for gender reassignment surgeries, after legislators on the state’s administrative rules committee narrowly approved a change Thursday. Submitted by the Department of Health and Human Services, the change eliminates a provision of the rules that stipulates “sex change operations shall be non covered.” (DeWitt, 10/19)


12. Prices For Cancer Drugs Creeping Up Much Higher Than Inflation Warrants

“Some [increases] exceeded inflation drastically and some increased at a slower rate,” said Dr. Daniel Goldstein, the author of the study. “But overall, we’re seeing a gradual creep each year.”

Stat: Cancer Drug Prices Have Been Rising Much, Much Faster Than Inflation
The prices for injectable cancer drugs — including older medicines that face competition — rose over a recent eight-year period at rates that far exceeded inflation, according to a new study. Specifically, the mean price increase for 24 branded cancer medicines that were approved in the U.S. between 1996 and 2012 was a whopping 25 percent. After adjusting for inflation, the increase was 18 percent. Moreover, gradual price increases over the years can result in substantial cumulative increases. In this instance, the mean cumulative price increase for all two dozen drugs was 36.5 percent. (Silverman, 10/19)

In other pharmaceutical news —

Stat: Allergan Faces A Cheaper, Compounded Version Of Its Restasis Eye Drops
Hoping to capitalize on consumer outrage, Imprimis Pharmaceuticals (IMMY) plans to sell a cheaper, compounded version of the Restasis dry-eye treatment that is sold by Allergan (AGN) and has been at the center of a widening controversy in recent weeks. The company plans to sell its version for a fraction of the roughly $500 monthly cost for Restasis, which generated nearly $1.5 billion in sales last year, although may now face generic competition next year after a federal court judge last week invalidated several patents for the medicine. (Silverman, 10/19)

Stat: Celgene Just Lost A Crucial Drug For Its Revenue Stream After A Clinical Trial Blowup
Celgene just lost one of the most important drugs in its research pipeline to a late-stage clinical trial blowup. The drug is mongersen, a key component in Celgene’s burgeoning immunology and inflammation franchise. On Thursday, a phase 3 study of mongersen in Crohn’s disease was halted prematurely following a finding of clinical futility by independent monitors, the company said. (Feuerstein, 10/19)

CNN: City Of Los Angeles Opens Investigation Into Drugmaker Following CNN Report
Los Angeles City Attorney Mike Feuer has launched an investigation into California-based drugmaker Avanir Pharmaceuticals, the subject of a CNN report into its aggressive targeting of nursing home residents with a drug called Nuedexta that may be unnecessary or unsafe for this population. Feuer confirmed the investigation to CNN, saying that his office is seeking information and tips from the public to help determine whether state or federal laws have been broken in the sale, marketing or prescribing of Nuedexta. (Ellis and Hicken, 10/19)

Public Health And Education

13. Pollution Kills More People Than AIDS, Tuberculosis And Malaria Combined

A recent study has found just how dangerous pollution is to the world's health. In other public health news: high blood pressure, obesity and cholesterol, tobacco, adult-onset ADHD, broken hearts and concussions.

The Associated Press: Study Finds Pollution Is Deadlier Than War, Disaster, Hunger
Environmental pollution — from filthy air to contaminated water — is killing more people every year than all war and violence in the world. More than smoking, hunger or natural disasters. More than AIDS, tuberculosis and malaria combined. One out of every six premature deaths in the world in 2015 — about 9 million — could be attributed to disease from toxic exposure, according to a major study released Thursday in the Lancet medical journal. The financial cost from pollution-related death, sickness and welfare is equally massive, the report says, costing some $4.6 trillion in annual losses — or about 6.2 percent of the global economy. (Daigle, 10/20)

The New York Times: Women Are More Likely To Address High Blood Pressure
Hypertension is dangerous. High blood pressure damages the inner lining of the arteries, limits the ability of the heart to pump blood and strains the organ in a way that can lead to heart failure. The condition increases the risk for stroke and vascular dementia, and hypertension is one of the most common causes of kidney failure. It impairs vision by damaging the blood vessels in the eyes. (Bakalar, 10/19)

Los Angeles Times: Scientists Engineer Proteins That Caused Obese Animals To Lose Weight And Lower Cholesterol
As the U.S. obesity rate has galloped toward 40%, doctors, drug designers and dispirited dieters have all wondered the same thing: What if a pill could deliver the benefits of weight-loss surgery, but without the knife? New research brings that hope a notch closer. Scientists from the biotechnology company Amgen Inc. report they have identified and improved upon a naturally occurring protein that brought about significant changes in obese mice and monkeys, including weight loss and rapid improvements on measures of metabolic and heart health. (Healy, 10/19)

Bloomberg: 8 Million Tobacco Deaths Could Be Avoided By Slashing Nicotine
Reducing nicotine levels in cigarettes to nonaddictive levels could prevent as many as 8 million tobacco-related deaths and keep 30 million people from becoming regular smokers this century, according to new estimates from the Food and Drug Administration. FDA Commissioner Scott Gottlieb revealed the initial estimates on Thursday during a tobacco discussion at the Johns Hopkins Bloomberg School of Public Health. (Edney and Kaplan, 10/19)

The New York Times: New Study Casts Doubt On Diagnosis Of Adult-Onset A.D.H.D.
In just the past few years, researchers have identified what they believe is an adult version of attention deficit disorder: a restless inability to concentrate that develops spontaneously after high school, years after the syndrome typically shows itself, and without any early signs. The proposed diagnosis — called adult-onset A.D.H.D. and potentially applicable to millions of people in their late teens or older — is distinct from the usual adult variety, in which symptoms linger from childhood. (Carey, 10/20)

The Washington Post: A Woman's Dog Died, And Doctors Say Her Heart Literally Broke
Joanie Simpson woke early one morning with a terrible backache. Her chest started hurting when she turned over. Within 20 minutes, she was at a local emergency room. Soon she was being airlifted to a hospital in Houston, where physicians were preparing to receive a patient exhibiting the classic signs of a heart attack. But tests at Memorial Hermann Heart & Vascular Institute -Texas Medical Center revealed something very different. Doctors instead diagnosed Simpson with Takotsubo cardiomyopathy, a condition with symptoms that mimic heart attacks. It usually occurs following an emotional event such as the loss of a spouse or child. That link has given the illness its more colloquial name: broken-heart syndrome. (Brulliard, 10/19)

The Washington Post: State Laws Have Reduced Concussion Risks In High School Kids, Study Finds
A lot has changed in the past 10 years when it comes to sports concussions. As evidence has grown of the devastating effects of traumatic brain injuries, athletes and parents have become increasingly alarmed and demanded preventive steps. Some of the most tangible results of that concern are new laws passed in all 50 states and the District of Columbia that try in some form to address head injuries among young athletes. (Wan, 10/19)

Columbus Dispatch: New Laws Appear To Be Helping To Reduce Concussion Rates In High School Athletes
A study of more than 8,000 concussions sustained by U.S. high-school athletes indicates that traumatic brain injury laws aimed at protecting children in the aftermath of such injuries are having their intended effect. In the 11-year study of nine sports, researchers found that the rate of repeat concussions significantly declined beginning a little more than 2 1/2 years after the laws went into effect, said senior author Ginger Yang, a principal investigator in the Center for Injury Research and Policy at Nationwide Children’s Hospital. (Viviano, 10/19)

State Watch

14. State Highlights: Minn. Gov. Blasts Medica For $120M Funds Transfer; In Mass., Closing Arguments In Murder Trial Related To Compounding Pharmacy Meningitis Outbreak

Media outlets report on news from Minnesota, Massachusetts, Texas, New Hampshire, Kansas, Arizona, Pennsylvania, Ohio, Georgia and Ohio.

The Associated Press: Closing Arguments Set In Deadly Meningitis Outbreak Trial
Attorneys are preparing to make their closing arguments in the case of a Massachusetts pharmacist charged with second-degree murder in a deadly meningitis outbreak. Closing arguments in Glenn Chin’s trial are expected Friday in Boston’s federal courthouse. Chin faces second-degree murder, mail fraud and other charges under federal racketeering law. (Richer, 10/20)

Dallas Morning News: Two Texas ERs Got Bad Reviews Online. Now They Want Google To Help Them Find Out Who Did It 
Two North Texas free-standing emergency room operators want tech giant Google to give up the identities of nearly two dozen reviewers who rated them poorly online. Highland Park Emergency Center on Lemmon Avenue and Preston Hollow Emergency Room on Walnut Hill Lane filed a joint petition Tuesday in Dallas County District Court. The 30-page pre-suit deposition lists the screen names used by 22 individuals, who the facilities claim never were treated in their emergency centers. (Rice, 10/19)

Kansas City Star: Fungus Destroyed Inmate’s Brain While Kansas Prison Contractor Did Nothing, Suit Says
Marques Davis was in the infirmary at Hutchinson Correctional Facility on Dec. 27, 2016, back with the same symptoms he’d been complaining of for months, including numbness and weakness in his legs. But on that day there was something new. “It feels like something is eating my brain,” Davis told Corizon Health employees who staff the prison infirmary. According to a lawsuit filed in federal court Monday, something was infecting his brain: a fungus that slowly killed the 27-year-old over the next four months, as he pleaded for help. (Marso, 10/17)

Arizona Republic: Arizona Heat Takes An Extra Toll On People With Mental Illness
Out of all the people who died of heat-associated causes in Maricopa County in 2016, around 15 percent had a history of mental illness, according to an Arizona Republic analysis of autopsy reports. ...Some medications, including certain types of antidepressants and antipsychotics, block the body’s ability to regulate its temperature, said Dr. David Eisenman, a professor of medicine at the University of California, Los Angeles. (Altavena, 10/19)

The Philadelphia Inquirer/ Major Sanctions At Darby Nursing Home After Neglect Found
The Pennsylvania Department of Health revoked the regular license of St. Francis Center for Rehabilitation & Healthcare last month and installed a temporary manager at the Darby nursing home after an August inspection found that a patient had developed “wounds that went down to the bone with exposed tendon.” The 273-bed facility, one of five sold in 2014 by the Archdiocese of Philadelphia to Center Management Group of New York, appealed the decision and remains open under a temporary manager installed by the health department. The revocation was the first in Pennsylvania since at least the beginning of 2014. (Brubaker, 10/20)

Des Moines Register: Quadriplegic Spent Hours In Dirty Diaper After Services Cut
Throughout last summer, 25-year-old quadriplegic Louis Facenda Jr. spent as much as half of each day in a dirty diaper after his caregiver services provided through Iowa's Medicaid program were dramatically cut. ...The cuts ended payments for at least 16 visits each week for an in-home care program that helped the family dress, feed and change the diapers of Facenda Jr. two to three times each day. (Clayworth, 10/19)

Health Policy Research

15. Research Roundup: Hospital Readmissions; HPV Vaccine; Housing And Asthma

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

The New England Journal of Medicine: Effect Of A Hospital-Wide Measure On The Readmissions Reduction Program
The Hospital Readmissions Reduction Program penalizes hospitals that have high 30-day readmission rates across specific conditions. There is support for changing to a hospital-wide readmission measure to broaden hospital eligibility and provide incentives for improvement across more conditions. ... We used Medicare claims from 2011 through 2013 to evaluate the number of hospitals that were eligible for penalties, in that they met a volume threshold of 25 admissions over a 3-year period for a specific condition or 25 admissions over a 1-year period for the cohorts included in the hospital-wide measure. ... Changing to the hospital-wide measure would result in 76 more hospitals being eligible to receive penalties. (Zuckerman et al., 10/19)

Annals Of Internal Medicine: Sex Differences In Prevalence And Concordance Of Oral Vs. Genital HPV
The burden of human papillomavirus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC) is disproportionately high among men, yet empirical evidence regarding the difference in prevalence of oral HPV infection between men and women is limited. ... The overall prevalence of oral HPV infection was 11.5% ... in men and 3.2% ... in women (equating to 11 million men and 3.2 million women nationwide). (Sonawane et. al, 10/17)

The Kaiser Family Foundation: The HPV Vaccine: Access And Use In The U.S.
The human papilloma virus (HPV) vaccine is the first and only vaccination that helps protect women and men from getting many different types of cancer that are associated with different HPV strains. The vaccine protects young people against infection from certain strains of the HPV, the most common sexually transmitted infection (STI) in the United States.1 Since HPV vaccines were first introduced in the U.S. in 2006 there have been changes in the range of protection they offer and the dosing regimen. Furthermore, the vaccines were originally recommended only for girls and young women and were subsequently broadened to include boys and young men. This factsheet discusses HPV and related cancers, use of the HPV vaccines for both females and males, and insurance coverage and access to the vaccines. (10/19)

Urban Institute: The Relationship Between Housing And Asthma Among School-Age Children
Interest in the intersection between health and housing is rising within both sectors as they work together to prevent asthma attacks and reduce related emergency room (ER) and hospital use. Initiatives to reduce asthma triggers in the home—including mold, pests, and tobacco smoke—are under way across the country, from home remediation to new regulations (e.g., a public housing smoking ban). Understanding the relationship between asthma, ER and urgent care visits, and housing-related triggers is difficult, but the 2015 American Housing Survey includes a special module with questions on asthma and triggers in the home. (Ganesh, Scally, Skopec and Zhu, 10/16)

Commonwealth Fund: Preventable Spending High-Cost Medicare Patients
A large share of Medicare spending is generated by a relatively small group of patients with expensive medical needs. These patients, many of whom are frail and elderly, account for the vast majority of potentially preventable Medicare spending. Interventions targeting the health conditions of these patients could significantly reduce avoidable expenditures in Medicare. (Jha et. al, 10/17)

JAMA Internal Medicine: Gestational Diabetes And Long-Term Cardiovascular Disease Risk
In this cohort study, with follow-up of nearly 90 000 US women older than 26 years, women with a history of gestational diabetes had 43% greater risk of CVD (myocardial infarction or stroke) compared with women without prior gestational diabetes , although absolute rates in this cohort were low. Adhering to healthy lifestyle factors over follow-up mitigated this modestly elevated risk. (Tobias et al., 10/16)

Editorials And Opinions

16. Policy Perspectives: When It Comes to Health Care, Why Is Compromise So Difficult?; Ideas On How To Move Forward

Opinion writers offer their thoughts on the outlook for the Obamacare fix advanced by Sen. Lamar Alexander (R-Tenn.) and Sen. Patty Murray (D-Wash.) as well as on President Donald Trump's recent executive order loosening some restrictions on health insurance and how Medicare prices can help advance efforts at reform.

Bloomberg: Why There's No Compromise On Obamacare
Senators Alexander and Murray may well have tried and tried to devise a deal that gave both sides a real win. In health care, though, it is extremely hard to find one, because there is little overlap between liberal and conservative policy objectives. If you allow catastrophic plans, a lot of young and healthy people will choose them, and the comprehensive plans liberals prefer will have high premiums. So liberals see almost any step conservatives want to take as a way of undermining or unraveling Obamacare. (Ramesh Ponnuru, 10/19)

The Washington Post: How Republicans Can Get Everyone To Stop Blaming Them
Republicans may have unified control of government, but they seem curiously incapable of getting major agenda items through. Maybe it’s because Republicans have insisted on cutting out Democrats and doing things unilaterally. Or at least they had been until Thursday, when a bipartisan coalition of 24 senators signed onto a bill to patch up Obamacare. While President Trump and congressional Republican leadership remain skeptical about working with the enemy, this could be the start of a turnaround for the GOP. To be clear, “bipartisan” ideas are not necessarily “good” ideas. Sometimes a policy that both parties support turns out to be a huge mistake. As a political matter, though, it can be extremely useful for the majority party to get buy-in from the other side, for three reasons. (Catherine Rampell, 10/19)

The New England Journal Of Medicine: Lessons From The Latest ACA Battle
At the end of the 2017 Obamacare repeal-and-replace legislative battle (and before the next one begins), it is worth taking stock of why — defying the odds — the Affordable Care Act (ACA) still stands. From my perspective as an Obama administration veteran of every near-death experience of the law to date, this one is notable for its unlikely heroes. (Jeanne M. Lambrew, 10/18)

The Columbus Dispatch: Breaking The Gridlock On Obamacare
For seven years, congressional Republicans and Democrats battling over Obamacare have agreed on only one thing: They couldn’t agree on anything. As more Americans dropped or skipped coverage because of soaring premiums, lawmakers of the two parties couldn’t — wouldn’t — agree on how to fix the 2010 law. (10/20)

The Wall Street Journal: The Limits Of Trump’s Health-Care Order
Give President Trump an A for effort with his latest executive order, which tries to expand health-insurance options for individuals battered by exploding premiums and fleeing insurers. At least somebody is trying to do something after congressional Republicans failed to repeal and replace ObamaCare. While the executive order represents progress, Congress still needs to act. (Merrill Matthews, 10/19)

The New England Journal Of Medicine: Strengthening The ACA For The Long Term
Most complaints about the Affordable Care Act (ACA) (e.g., high and rising insurance premiums, large deductibles, and insurer exits) relate to nongroup insurance markets. These markets, the ones that were the most dysfunctional before the ACA, provide coverage to just 7% of the nonelderly population (under 65 years of age) and 6% of the full U.S. population. The ACA’s changes to employer-sponsored insurance plans, Medicare, and Medicaid were more limited, and enrollees are generally satisfied with those coverage options. The problems with the nongroup market, though significant, are fixable, and correcting them does not necessitate disruption of coverage for the remaining 94% of the population. (Linda J. Blumberg and John Holahan, 10/18)

The New England Journal Of Medicine: Using Medicare Prices — Toward Equity And Affordability In The ACA Marketplace
As the U.S. Congress debates the future of the Affordable Care Act (ACA), the public has increasingly called for bipartisan solutions on health care reform. An immediate challenge is stabilizing the ACA marketplace, where 10.3 million people enroll in coverage. Given that certain areas of the country have few insurers participating in the marketplace — because of high enrollee costs, uncertainty over cost-sharing–reduction payments from the federal government, and the expiration of protections for insurers such as reinsurance and risk corridors (which limit how much they can gain or lose through risk sharing) — policies that encourage insurers to enter and stay in the marketplace are needed. (Zirui Song, 10/18)

17. Viewpoints: Doctors Facing Racism In The Exam Room; Medication's Role In Curbing Addiction

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

The Washington Post: Racist Patients Often Leave Doctors At A Loss
Patients refuse care based on health-care providers’ ethnicity and religion so often that this phenomenon has been dubbed “medicine’s open secret.” A new poll shows that a majority of health-care professionals say they have faced prejudice from patients. In 2013, a nurse in Flint, Mich., sued a pediatric intensive care unit after it granted a request from a father to enter “no African American nurses” on his infant’s care plan. Damon Tweedy, an African American psychiatrist, describes similar experiences in bruising detail throughout his memoir, “Black Man in a White Coat.” And when Esther Choo, an Asian American emergency department physician, tweeted last month that white nationalists refused her care, she set off a Twitter storm of health-care providers responding with similar stories. (Dorothy R. Novick, 10/19)

The Des Moines Register: To Prevent Full-Blown Opioid Crisis, Iowa Needs Overdose Of Vigilance
Drug overdoses are now the leading cause of death for Americans under age 50, killing roughly 64,000 people in the United States last year. An increase in fatalities is largely fueled by opioids, including fentanyl, a powerful synthetic substance considered up to 50 times more potent than heroin. Although Iowa has not been hit as hard as some other states by the opioid epidemic, we have not been spared. (10/19)

Stat: Long-Acting Medications For Addiction Help Patients Maintain Recovery
Many addicted people try to bind their future selves to a commitment to stop using drugs. Some move across the country to a place where they don’t know any dealers or fellow users. Others throw away all their drugs and injection equipment. ... Such tactics are often thwarted by the future self of the addicted person who adopted them. Like other drugs to which people become addicted, opioids cause enduring adaptations in the brain that weaken self-control and increase the urge to use these drugs. In addition, many people with drug addictions inhabit social networks that provide repeated stimuli and opportunities to use drugs. (Keith Humphreys, 10/19)

The New York Times: The Trump Administration’s Power Over A Pregnant Girl
In early September, a 17-year-old girl from Central America was apprehended trying cross the border between the United States and Mexico. After being taken to a shelter for unaccompanied minors in South Texas to await immigration proceedings, she learned she was pregnant. The girl, referred to as Jane Doe in court filings, was adamant that she wanted an abortion. ... For almost a month, some of these Trump appointees have been waging a crusade to force the young woman, whose future in this country is extremely uncertain, to carry her pregnancy to term. Their standoff shows us the real-world consequences of this administration’s radical disregard for women’s autonomy. (Michelle Goldberg, 10/20)

Los Angeles Times: The U.S. Government Can't Hold Undocumented Pregnant Teens Hostage When They Want An Abortion
It is unconscionable that the federal government would so flagrantly undermine the rights of a person in its custody. The girl, known in court papers simply as Jane Doe, may not be here legally, but, while she is here, she has a constitutional right — like every other pregnant girl or woman in the United States — to a legal abortion. Even U.S. District Judge Tanya Chutkan, who ruled Wednesday that Doe could get the abortion, shook her head in disbelief when a U.S. Department of Justice lawyer at the hearing would not concede that Doe has constitutional rights. (10/20)

Los Angeles Times: A Judge Calls Foul On Allergan's Attempt To Hide Its Drug Patents Behind An Indian Tribe's Sovereignty
In the annals of cynical corporate subterfuges, it would be hard to top the effort by the drugmaker Allergan to fend off a patent challenge by selling its drug rights to a rural New York Indian tribe. ... [Judge William] Bryson didn’t invalidate the tribal deal because that wasn’t at issue in the case before him, but he expressed “serious reservations” about whether the deal should be treated as valid. That could function as a guidepost for the U.S. Patent Office, which will have to rule on the transaction’s validity. Legal authorities say Bryson’s opinion should be taken as a red light by other companies thinking about using the same maneuver. (Michael Hiltzik, 10/19)