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Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Bark At The Moon?'" by John Deering.

Here's today's health policy haiku:

HOSPICE PATIENTS ABANDONED

"It was a nightmare."
Hospice care disappears for
Those who need it most.

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Summaries Of The News:

Health Law

4. Judge Rules Against States In Insurer Subsidies Case, Saying They've Found Good Workarounds

"The emergency relief sought by the states would be counterproductive," U.S. District Judge Vince Chhabria said in the ruling. "State regulators have been working for months to prepare for the termination of these payments."

The Associated Press: States Lose Push To Force Trump To Restart Health Subsidies
State attorneys general, all Democrats and led by Xavier Becerra of California, argued that the monthly payments are required under former President Barack Obama's health care law and cutting them off will harm consumers. The payments reimburse insurers for providing lower-income people with discounts on out-of-pocket costs. U.S. District Judge Vince Chhabria, an Obama appointee, said the states had devised workarounds to the lost subsidies that would give millions of lower-income people even better health care options. (Thanawala, 10/25)

CQ: Judge Dismisses States' Request To Pay Health Subsidies
The states, led by California Attorney General Xavier Becerra, essentially torpedoed their own case through their innovative response to the president’s decision. Trump’s move to sever the funds prompted insurance companies across the country to re-file premiums with double-digit surcharges on top of the often hefty hikes consumers have borne under the 2010 health care law. California and others loaded those increases onto a certain category of plans — silver plans on the exchanges, the only plans that offer the subsidies. Because tax credits for premiums are based on the cost of silver plans — which the majority of consumers purchase — the higher premiums will also result in higher tax credits for consumers of bronze, gold and platinum plans. This means that consumers who don’t qualify for tax credits can purchase plans outside of the exchange for the standard rate, while others benefit from the increased premium assistance. Chhabria noted the quirk during a hearing Tuesday, pressing California attorney Gregory Brown to prove how the action hurts rather than helps consumers in the end. (Clason, 10/25)

Politico: Judge Denies Request To Force Trump To Pay Obamacare Insurance Subsidies
“The fight for affordable healthcare moves forward,” California Attorney General Xavier Becerra said in a statement. “The actions by the Trump Administration undermine critical payments that keep costs of healthcare affordable for working families. The judge made clear in his ruling that the ACA is the law of the land. Without an emergency order halting the Trump action, swift action in this litigation becomes even more compelling.” (Colliver and Bettelheim, 10/25)

San Jose Mercury News: Judge: Trump Doesn't Have To Resume ACA Subsidies
Gregory Brown, who represented California at the hearing, said the loss of the subsidies was creating “uncertainty and chaos” that could lead insurance companies to opt out of the health law. The administration had been making the monthly payments even as Trump threatened to cut them off to force Democrats to negotiate over health care. A bipartisan effort in Congress to restore the payments has run into opposition. (Thanawala, 10/25)

The Wall Street Journal: Trump Administration Won’t Be Forced To Provide Health-Insurance Subsidies
The government payments reimbursed insurers for providing subsidies to some low-income consumers for out-of-pocket costs, including deductibles and copays. Insurers are required by the ACA to provide these cost-sharing subsidies and about seven million people who buy health plans on the ACA’s insurance exchanges get them. President Donald Trump announced earlier this month that he would end the subsidies as of Oct. 18 because Congress never appropriated money for the program. The payments are estimated at $7 billion in 2017. (Kendall and Armour, 10/25)

Modern Healthcare: Federal Judge Rules Trump Can End Cost-Sharing Subsidies
The suit claimed the administration violated federal law when it ordered the end of the CSR payments. It argued the ACA appropriated funding for the subsidy payments and that Congress doesn't need to renew that appropriation periodically. But the federal government argued that Congress never appropriated funds for the CSRs. If Congress doesn't appropriate money for a program, the Constitution prohibits the executive branch from spending money on it. (Livingston. 10/25)

California Healthline: Federal Judge Denies Bid To Force Feds To Resume ACA Subsidies
Some experts and states are concerned jumpy insurers will bolt from the market and leave some regions with minimal or no choices for coverage. However, a bipartisan bill in Congress would restore the cost-sharing subsidies and aims to stabilize the insurance markets. But it’s not clear the bill will muster the support it needs to pass both the Senate and House or whether Trump would sign it. (Nguyen, 10/25)

The Hill: Judge Won't Force Trump To Keep Making ObamaCare Payments 
Congress could still decide to appropriate the payments, and there is some bipartisan agreement that they should be made. Bipartisan legislation funding the payments for two years has been introduced in the Senate by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.). (Weixel, 10/25)

5. Premiums On Popular Silver Plans To Go Up Average Of 34 Percent Following Trump Actions, Uncertainty Over ACA

The window shopping period for open enrollment kicked off Wednesday on healthcare.gov. While many consumers will find high premium increases for 2018, there are cheaper coverage options too. Meanwhile, the Trump administration says it will not release a projection for how many people it expects to sign up for coverage. Enrollment begins Nov. 1.

The Associated Press: Premiums Rising 34 Percent For Most Popular Health Plan
Premiums for the most popular "Obamacare" plans are going up an average of 34 percent, according to a study Wednesday that confirms dire predictions about the impact of political turmoil on consumers. Window-shopping on HealthCare.gov went live Wednesday, so across the country consumers going online can see the consequences themselves ahead of the Nov. 1 start of sign-up season for 2018. (Alonso-Zaldivar, 10/25)

The Wall Street Journal: Some Affordable Care Act Premiums Set To Jump For 2018
Some consumers who get health insurance through the Affordable Care Act exchanges next year will face sharp premium increases and have fewer insurer options, though federal premium subsidies mean that others will be able to get cheaper coverage. The federal HealthCare.gov website posted new details Wednesday about what plans will be available for 2018 under the health law. Open enrollment starts on Nov. 1. (Wilde Mathews, 10/25)

The Hill: Analysis: Premiums For Most Popular ObamaCare Plans To Rise 34 Percent
"Plans are raising premiums in 2018 to account for market uncertainty and the federal government's failure to pay for cost-sharing reductions," Caroline Pearson, senior vice president at Avalere, said in a statement. "These premium increases may allow insurers to remain in the market and enrollees in all regions to have access to coverage." (Weixel, 10/25)

Houston Chronicle: Obamacare Choices Up For 2018, But So Are Prices
Dire political predictions that insurers would flee the individual market and consumers would have fewer choices in 2018 - in essence killing off the Affordable Care Act - do not appear to have come true. But the coming year could be nightmarish for middle-class and higher earners who could face rate hikes as high as 45 percent in the Houston area. (Deam, 10/25)

The Washington Post: Maryland Will Allow Insurers To Hike Premiums After Trump Ends Subsidies
Maryland regulators have given two insurance carriers permission to substantially raise monthly premiums on some plans in a direct response to a Trump administration decision to halt certain subsidies under the Affordable Care Act. The steep increases will raise costs by as much as 76 percent over last year for silver-level individual plans on the state exchange and come atop already approved increases for 2018. (Itkowitz, 10/25)

The Baltimore Sun: Maryland Insurance Regulators Increase Rates To Cover Trump Subsidy Cuts 
Maryland insurance regulators said Wednesday that they approved last-minute rate increases requested by health insurers for individual plans sold under the Affordable Care Act. The Maryland Insurance Administration decided to consider rate rises after the Trump administration said earlier this month that it would no longer pay insurance companies subsidies that helped cover the cost of co-payments and other out-of-pocket expenses for low-income policy holders. (McDaniels, 10/25)

Charlotte Observer: Some NC Obamacare Letters Announce Hefty Premium Hikes Before Subsidies
Kayte Thomas received a letter from Blue Cross and Blue Shield of North Carolina in October that said her monthly health insurance premium is set to more than double from $208 a month to $585 a month. The quoted $377-a-month hike startled Thomas, who lives in Morrisville and covers herself and three children on her Affordable Care Act plan. That’s half the food budget for her family of five, she said. (Cope, 10/26)

Detroit Free Press: Obamacare Rates Will Skyrocket 27% In Michigan In 2018
The sticker price for health insurance plans sold on Michigan's Affordable Care Act exchange will jump an average 26.9% next year under new rates announced Wednesday by state officials. The rates will be in effect Nov. 1, when the annual enrollment period begins for individuals and family households on the Healthcare.gov exchange. Open enrollment runs to Dec. 15, which is half as long as last year. (Reindl, 10/25)

Georgia Health News: Georgia ‘Silver’ Coverage Shows Higher Increase Than U.S. Average
Georgia’s average premium for the “silver’’ plans in the insurance exchange will rise by 48 percent for 2018, higher than the average increase nationally, a consulting firm reported Wednesday. The analysis from Avalere found that premiums will increase by an average of 34 percent nationwide for silver plans, the most popular exchange policies. Georgia’s premium hike for silver policies will be exceeded by just seven states in the Avalere study. (Miller, 10/25)

Health News Florida: What You Need To Know To Enroll In Obamacare For 2018
Open enrollment for the Affordable Care Act, or Obamacare, begins in less than a week. It comes as President Donald Trump has made big changes– including ending subsidies to lower out-of-pocket costs for low-income Americans. Even if federal lawmakers come through on a fix, Florida insurance rates are locked in for 2018 and are going up in a big way. (Aboraya, 10/26)

The Hill: Trump Administration Will Not Set ObamaCare Sign-Up Goal 
The Trump administration does not plan to release projections for how many people will sign up for ObamaCare, breaking from past years. The Obama administration used to release a projection for enrollment, which then served as a target goal for the yearly push. But the Trump administration will not be following suit, a Department of Health and Human Services official told The Hill on Wednesday. (Sullivan, 10/25)

And Anthem will see a big drop in ACA business —

Reuters: U.S. Insurer Anthem Says Obamacare Business Improving; Stock Jumps
Anthem Inc reported better-than-expected quarterly earnings as its Obamacare individual insurance business broke even and forecast a slight 2018 profit for the government plans despite uncertainty about the market's future. Anthem's outlook takes into account President Donald Trump's efforts to undercut former President Barack Obama's health reform law, which he has described as "dead." (Humer and Banerjee, 10/25)

6. Alexander-Murray Bill Would Reduce Deficit By Nearly $4B, Have Little Effect On Number Of Insured

The projections from the Congressional Budget Office bolster the bill's chances, said authors Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.). But President Donald Trump has sent mixed messages about the legislation, and Republican leaders are waiting to move on the measure until the president says he favors it. Meanwhile, House Speaker Paul Ryan said that health care is something that should be looked at next year, instead of in the remaining months of this one.

The Wall Street Journal: Bipartisan Senate Health Bill Would Reduce Deficit By About $4 Billion Over Decade
A bipartisan Senate health bill would reduce the deficit by almost $4 billion over the next decade without significantly affecting the number of people who have coverage, the Congressional Budget Office found in a report released Wednesday. Sens. Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.), the bill’s co-sponsors, said the findings strongly bolster the case for their legislation. But a standoff between the White House, which wants more provisions to undo the Affordable Care Act, and Democrats, who reject such provisions, has left the measure stalled for now, with no clear path forward. (Armour and son, 10/25)

Modern Healthcare: CBO: Bipartisan Bill To Stabilize Insurance Would Reduce Budget Deficit 
Passing the Alexander-Murray bill actually would reduce the budget deficit because insurers—which have already set their 2018 premiums higher due to uncertainty about CSR funding—would have to rebate excess revenue to the government. Those rebates would total an estimated $3.1 billion from 2018 through 2027, the CBO said. But the bill's fate is in doubt after Trump and some Republican senators insisted that any package that funded the CSRs also include conservative provisions Democrats are almost certain to reject. (Meyer, 10/25)

Bloomberg: Bipartisan Obamacare Bill Saves Little Money On Technicality 
“If CSRs are not paid, premiums in 2018 will go up an average of 20 percent, the federal debt will increase by $194 billion over ten years, due to the extra cost of subsidies to pay the higher premiums, and up to 16 million Americans may live in counties where they are not able to buy any insurance in the individual market,” Alexander and Murray said in a joint statement shortly after the CBO released its report. (Tracer and Wasson, 10/25)

Reuters: U.S. Lawmakers Will Not Tackle Healthcare This Year, Ryan Says
Republican lawmakers will not take up a bipartisan plan to stabilize Obamacare insurance markets or try again to repeal and replace the law this year, House of Representatives Speaker Paul Ryan said on Wednesday, signaling his party was shelving the matter until the 2018 U.S. congressional election year. ... "I think that is something we should do next year," Ryan said in an interview with Reuters when asked about prospects of the House passing a bipartisan bill that would reinstate federal subsidies to private insurers to help lower-income people buy medical coverage through the Affordable Care Act, dubbed Obamacare. (Chiacu, Cowan, Brice and Abutaleb, 10/25)

CQ: Advocates Push Passage Of Health Deal As Open Enrollment Nears
Democrats concerned about the confusion surrounding individual health insurance are urging a vote on bipartisan legislation to stabilize the marketplaces as a sign-up period next week creeps closer. Still, it appears increasingly likely that lawmakers won’t consider such a proposal until closer to the end of the year. And many experts say that the bill’s impact for 2018 would be modest, anyway. (McIntire, 10/25)

And in other news from Capitol Hill —

The Hill: Democrats Introduce Public Option Health Care Bill 
Congressional Democrats are introducing legislation to allow states to set up a public option for health-care insurance. The legislation, spearheaded by Sen. Brian Schatz (D-Hawaii) and Rep. Ben Ray Luján (D-N.M), is the latest idea from Democrats as the party tries to plot its next steps after blocking the GOP effort to repeal and replace ObamaCare. (Carney, 10/25)

Administration News

7. Trump To Officially Declare U.S. Opioid Epidemic A Public Health Emergency

President Donald Trump will direct the Department of Health and Human Services to declare a nationwide public health emergency under the Public Health Service Act. The declaration is not expected to come with specific funding.

USA Today: Opioids: Trump To Order Public Health Emergency On Addiction Epidemic
President Trump will order his health secretary to declare the opioid crisis a public health emergency Thursday — but will stop short of declaring a more sweeping state of national emergency, aides said. In an address from the White House, Trump will also try to rally the nation to a growing epidemic that claimed 64,000 American lives last year, and will advocate for a sustained national effort to end to the addiction crisis. (Korte, 10/26)

The Washington Post: Trump Plans To Declare The Opioid Crisis A Public Health Emergency
President Trump plans to declare Thursday afternoon that the opioid crisis — which is killing more than 100 people each day — is a public health emergency. By doing so, the federal government will waive some regulations, give states more flexibility in how they use federal funds and expand the use of telemedicine treatment, according to senior administration officials who briefed reporters on Thursday morning. (Johnson, 8/26)

Stat: What's In The Emergency Declaration On Opioid Epidemic — And What's Not
President Trump will instruct the Department of Health and Human Services to declare the opioid crisis a public health emergency, the administration said Thursday. It is a major step in combating the drug epidemic and a major follow-through on a longstanding presidential promise. But White House officials were quick to caution that the administration’s response won’t end with the declaration, within a number of new rules and actions expected to be issued in the coming weeks. As of Thursday: What does the emergency declaration entail? (Facher, 10/26)

Meanwhile —

The Hill: Senate Dems Want $45B To Address Opioid Epidemic 
Senate Democrats introduced a bill on Wednesday to invest $45 billion to fight the opioid epidemic, just a day before President Trump is slated to announce how his administration will combat the crisis. “The Trump administration’s plan to address the opioid epidemic has been little more than empty words and broken promises,” Sen. Edward Markey (D-Mass.) said in a press release. “What we need to fight this scourge is continued and reliable long-term investments in prevention, treatment, recovery and monitoring.” (Roubein, 10/25)

8. Undocumented Girl Gets Abortion Following Intensely Watched Court Case

The case -- at the crossroads of two hot-button topics: abortion and immigration -- captured the attention of the country. The girl was able to obtain the procedure after a full appeals court overturned an earlier decision by a panel of three judges.

The New York Times: Undocumented Teenager Obtains Abortion After Court Victory
The teenager, who is 17 and is identified in court documents as Jane Doe, illegally crossed the border in Texas in early September and was apprehended. Her pregnancy was discovered during a physical exam, and since then she had been fighting in court to have an abortion. In a statement released by her lawyers and her court-appointed guardian, Jane Doe, who had been nearly 16 weeks pregnant, wrote of coming to the United States with dreams of one day becoming a nurse, and of not being ready to be a parent. (Fernandez, 10/25)

The Washington Post: Jane Doe, Undocumented Teen In U.S. Custody, Aborts Her Unwanted Pregnancy
The abortion ended the girl’s individual court challenge in a case that drew widespread attention and evoked the incendiary issues of abortion rights and illegal immigration. But the broader legal battle over whether the federal government may continue to dissuade, and even block, undocumented teens in its custody from having abortions is still pending in U.S. District Court in Washington. (Sacchetti and Marimow, 10/25)

The Wall Street Journal: Undocumented Teenager Has Abortion After Court Ruling
Though the abortion took place, the case is not over. The ACLU still is challenging the underlying HHS policy on behalf of a class of other teens who may be similarly situated. “The administration’s efforts to interfere in women’s decisions won’t stop with Jane,” said Brigitte Amiri, an ACLU lawyer for the teenager. “With this case we have seen the astounding lengths this administration will go to block women from abortion care.” (Kendall, 10/25)

And in other news —

Medicaid

9. Forget Congress: CMS Chief To Take Medicaid Overhaul Into Her Own Hands

Centers for Medicare and Medicaid Services Director Seema Verma wants to give states a "unprecedented level of flexibility." Outlets offer other Medicaid news out of New Mexico, New Hampshire and Wisconsin.

Stat: Seema Verma’s Plan To Upend The Medicaid Expansion, Without Congress
With a broad overhaul of Obamacare stalled in Washington, one of President Trump’s top health care leaders is drawing the outlines of sweeping changes to Medicaid that could pare enrollments and cut costs without congressional approval. Seema Verma, director of the federal Centers for Medicare and Medicaid Services, is promising to give states an “unprecedented level of flexibility” to design their Medicaid programs as they see fit. In an appearance in Cleveland this week, she pledged to reduce scrutiny of state requests for waivers from federal rules meant to preserve access and quality standards. (Ross, 10/26)

Governing: HHS Secretary or Not, Seema Verma Could Redefine Medicaid
When the Congressional Budget Office released estimates in July that Republicans’ proposed health-care changes would result in 22 million people losing health coverage, Verma publicly spoke out against the CBO’s numbers, saying they overstated the impact that repeal would have. She maintains that she is going to uphold Medicaid as it stands. But she is nonetheless implementing changes that could radically remake the way America cares for its poorest citizens for decades to come. ... At the heart of Verma’s goals for Medicaid is the desire to loosen bureaucratic restrictions while emphasizing that recipients “take personal responsibility” for their own health care. (Mattie Quinn, 10/24)

Albuquerque (N.M.) Journal: Medicaid Cost Jump Threatens State Budget
New Mexico faces about $82 million in extra Medicaid costs next year – far outpacing the amount of new revenue expected to be available. The extra costs are possible partly because Congress has not reauthorized funding for the Children’s Health Insurance Program, or CHIP. It would cost the state about $31 million to cover those children, although there’s still a chance the federal government will renew CHIP funding. (McKay, 10/25)

Concord Monitor: Analysis: Managed Care Model Could Cut N.H.’s Costs In Half For Some Health Plans
One system change could save New Hampshire 50 percent or more for some Medicaid recipients’ health insurance. But making that change, critics point out, would give the state a projected drop in tax revenue and shift more health care costs onto providers. A new analysis of New Hampshire’s individual health care market projects that if the state moved Medicaid expansion recipients off the market and into a managed care program run by the state, the costs to insure those patients could be cut in half. (DeWitt, 10/26)

Wisconsin State Journal: Two Thirds Of Medicaid-Covered Children Not Getting Required Tests For Lead Poisoning In Wisconsin
Less than a third of Wisconsin children on Medicaid were tested for lead poisoning at ages 1 and 2 last year, despite a federal requirement that all such children get the testing, a new state report says. Children on Medicaid are three times as likely to have lead poisoning than other children, so many children who could face developmental problems from lead exposure are not being identified, a Madison pediatrician said. (Wahlberg, 10/26)

10. Inaction Over CHIP Funding Worries Experts: 'States Are Really Walking On A Tightrope'

A new study looks at how states will be affected by Congress' delay renewing funding for CHIP.

CQ: States Risk Exhaustion Of Children's Coverage Funds
Inaction on passing legislation to extend funding for the Children’s Health Insurance program is causing further uncertainty for states and families, according to a new report. The findings from the Georgetown Center for Children and Families underscore previous concerns from advocates that the delay in renewing CHIP funding will negatively impact states. The report said five states – Arizona, California, Minnesota, Ohio and Oregon – as well as the District of Columbia are projected to exhaust funds before or shortly after December. (Raman, 10/26)

And in Pennsylvania —

The Philadelphia Inquirer/Philly.com: By Seeking To Limit CHIP Care For Transgender Youth, Pa. Senators May Defer Benefits For Low Income Kids Statewide
A move by Pennsylvania Senate Republicans to limit state- and federally funded medical care for transgender youth is drawing fire from LGBTQ and child advocates, as well as state Democrats. The issue also stands to delay renewal of a popular program that has provided health care for low-income children throughout the state for 25 years. At issue is the reauthorization of the Children’s Health Insurance Program (CHIP), a largely federally funded program that pays for health care for about 176,000 Pennsylvania children from families with limited incomes. (Giordano, 10/25)

Pharmaceuticals

11. Lawmakers Introduce Legislation To Allow Medicare To Negotiate Drug Prices

PhRMA is already pushing back on the measure saying it would let the government decide what medicines patients can get. In other news, an advocacy group is challenging Gilead's patents on the hepatitis C drug Sovaldi.

The Hill: Frustrated With Trump, Dems Introduce Drug Pricing Bill 
Several high-profile Democrats on Wednesday introduced a bill to let Medicare negotiate drug prices, saying they are frustrated the measure hasn’t received a full-throated endorsement from Trump. "Well, the campaign is over,” Sen. Bernie Sanders (I-Vt.) said at a press conference. “He’s president now. We need him to join us in taking on the pharmaceutical industry." (Roubein, 10/25)

Stat: Gilead Faces Challenge To U.S. Hepatitis C Patents From Advocacy Group
In the latest attempt to attack the cost of hepatitis C drugs, an advocacy group is challenging several U.S. patents for the Sovaldi treatment that is sold by Gilead Sciences (GILD). The group wants to overturn six patents for the drug, which is the oldest of several Gilead hepatitis C medicines, in hopes of spurring lower-cost generic versions to become available sooner than might otherwise be possible. The group contended that U.S. taxpayers can save $10 billion and generics can get to market 14 years faster if it succeeds. (Silverman, 10/25)

Bloomberg: Gilead’s Patents On Hepatitis C Drug Challenged By Consumer Group 
Gilead Sciences Inc.’s U.S. patents on the blockbuster $84,000 hepatitis C treatment Sovaldi were challenged by a consumer group that’s battled the drugmaker around the world over the pricing. The Initiative for Medicines, Access & Knowledge, a nonprofit focused on how patents affect access to medicine, said that it’s filed petitions with the U.S. Patent Trial and Appeal Board seeking to challenge intellectual-property rights that would keep generic versions of Sovaldi from entering the market. (Decker and Koons, 10/25)

12. Advisory Committee Comes Down In Favor Of GSK's Shingles Vaccine Over Older, Less Effective One

Meanwhile, recent mumps outbreaks have prompted the Centers for Disease Control and Prevention to recommend that people at risk get a third dose of the vaccine.

The Washington Post: Expert Panel Recommends New Shingles Vaccine That Gives Increased Protection
In a rare move, the Advisory Committee on Immunization Practices also recommended, by an 8-to-7 vote, that the new Shingrix vaccine be preferred over the existing Zostavax vaccine because it provides far greater protection and is expected to prevent significant disease, especially among the elderly. The Food and Drug Administration approved the new vaccine, made by GlaxoSmithKline PLC, on Friday. Shingrix is the first new vaccine for shingles in a decade, and it's the first time the panel is recommending that adults between 50 and 59 be vaccinated — a group that numbers about 42 million Americans. (Sun, 10/25)

Stat: GSK Shingles Vaccine Endorsed Over Competitor By Expert Panel
Dr. Leonard Friedland, vice president for scientific affairs and public health for GSK’s North American vaccines unit, hailed the decisions as good for patients. He said GSK expects to have the vaccine on the market in the U.S. by the end of November, but it will take until sometime next year before agreements can be worked out with insurance plans to reimburse for the cost of the vaccine. (Branswell, 10/25)

Stat: Third Mumps Vaccine Dose Endorsed For At-Risk Populations In Outbreaks
With the U.S. facing a growing number of mumps outbreaks, an expert panel that advises the Centers for Disease Control and Prevention recommended Wednesday that people who are at risk during outbreaks should receive an additional, third dose of vaccine. The Advisory Committee on Immunization Practices unanimously voted to approve a third dose of mumps-containing vaccine as a tool for outbreak control, despite acknowledging evidence to support the practice is limited. (Branswell, 10/25)

Public Health And Education

13. To Help Curb Opioid Crisis, FDA Head Wants To Promote Medication-Assisted Treatment

The FDA will issue guidance for development of new MAT options, promote efforts to decrease the stigma surrounding medication used to treat substance abuse disorders, and take further steps to promote the use of existing therapies, Commissioner Scott Gottlieb said. Meanwhile, lawmakers want the DEA to take on more authority to help fight the epidemic.

The Washington Post: FDA’s Gottlieb Calls For Greater Use Of Medication-Assisted Treatment To Fight Opioid Epidemic
Scott Gottlieb, commissioner of the Food and Drug Administration, called Wednesday for the expanded use of medication-assisted treatments for opioid addiction, saying they could reduce overdoses and deaths. During a House hearing on the federal response to the opioid epidemic, Gottlieb said the agency will issue new guidance to manufacturers to promote the development of novel therapies, including ones that treat a wider range of symptoms. Medication-assisted treatment (MAT) combines drugs and counseling to combat addiction. (McGinley, 10/25)

Bloomberg: FDA Aims To Destigmatize Drugs As Treatment For Opioid Addiction
Some in the medical community, including former Health and Human Services Secretary Tom Price, have looked down on using drugs to treat addiction to other drugs, instead favoring an approach that emphasizes changing behavior. Insurance companies have also been reluctant to cover drug-assisted therapy. (Edney, 10/25)

The Hill: FDA Commissioner Pushes For Use Of Meds To Combat Opioid Crisis 
"This stigma serves to keep many Americans who are seeking a life of sobriety from reaching their goal," Gottlieb said. "In this case, in the setting of a public health crisis, we need to take a more active role in challenging these conventions around medical therapy." Gottlieb has frequently said that combatting the opioid crisis is one of his top priorities. (Hellmann, 10/25)

The Washington Post: Lawmakers To DEA: Use More Legal Muscle Against Opioids
Lawmakers urged the Drug Enforcement Administration to seek more legal authority if it is needed to battle the nation’s opioid epidemic, telling an official they are awaiting suggestions on how they can help stem the worst drug crisis in U.S. history. “Give us suggestions. Talk to us. We want to do the right thing,” Rep. Gus M. Bilirakis (R-Fla.) implored at a hearing held Wednesday by the House Energy and Commerce Committee. “We need to know the tools that you need to handle this. We’re on the same team with regard to this.” (Bernstein and Higham, 10/25)

The Hill: GOP Chairman Threatens To Subpoena DEA Over Investigation Into 'Pill Dumping' In West Virginia 
Rep. Greg Walden (R-Ore.) on Wednesday threatened to subpoena the Drug Enforcement Administration (DEA) for data on "pill dumping" in West Virginia that could be contributing to the state's opioid crisis. Walden said the agency is taking too long to comply with the Energy and Commerce Committee's May 8 request for information regarding drug suppliers pumping millions of opioids into the state West Virginia. (Hellmann, 10/25)

And in the states —

The Wall Street Journal: Purdue Is Under Investigation For Opioid Painkiller OxyContin
Purdue Pharma L.P. said it is the subject of a probe by federal prosecutors related to its opioid painkiller OxyContin, adding to the mounting litigation the company already faces over its marketing of the addictive drug. Purdue said it has been cooperating with an investigation by the U.S. Attorney’s Office in Connecticut and “will continue to do so until the matter is resolved.” It added that the company “is committed to being part of the solution to our nation’s opioid crisis.” (Randazzo and Whalen, 10/25)

NPR: Court Weighs Addicted Opioid Users' Ability To Quit And Stay Drug-Free
Julie Eldred has been struggling with addiction to opioids for more than a decade and she says the criminal justice system punishes her for it. Eldred, a part-time pet caretaker in Acton, Mass., was put on probation last year for theft. She knew staying drug-free would be tough — especially at first, when she was going through opioid withdrawal. But, she says, she didn't have much of a choice. (Becker, 10/26)

Kansas City Star: Body Cam Video Shows Parents Passed Out With Baby In Backseat
The Volusia County Sheriff’s Office in Florida released a body cam video from one of its deputies that shows a couple unconscious in a car with an 8-month-old baby in the backseat. Both adults were arrested. The female passenger was charged with child neglect and drug possession. The male was charged with possession of drug paraphernalia and driving with suspended license. The baby was found with a soiled diaper and was placed in the care of the Department of Children and Families. (Davis, 10/25)

Miami Herald: Miami 10-Year-Old Died From Heroin And Fentanyl, Autopsy Shows
A 10-year-old from Overtown who mysteriously collapsed in June after walking home from a park was killed by a toxic combination of heroin and the powerful painkiller fentanyl, according to an autopsy released Wednesday. The finding confirmed that Alton Banks is the youngest known victim in South Florida of an opioid epidemic that has killed thousands nationwide in the past few years alone. (Rabin and Neal, 10/25)

Columbus Dispatch: Suboxone Linked To Probe Of Whitehall Detox Center
Dozens of people receiving addiction treatment through Braking Point Recovery Centers — many of them in the process of detoxing from heroin — have been transferred or referred to other providers in the wake of state and federal investigations that hobbled the agency’s operations. (Price, 10/26)

Cleveland Plain Dealer: Summit County Unveils Aggressive Plan To Combat Opioid Epidemic, Including Lawsuit Against Drug Manufacturers, Distributors
Summit County Executive Ilene Shapiro today announced an aggressive plan to combat the opioid epidemic in the Akron area during her state of the county address at the John S. Knight Center.Shapiro said she signed a proclamation earlier in the day declaring a state of emergency as it relates to opiates and overdoses. The document outlines specific requests of the state and federal government should additional funds become available to help fight the epidemic. (Conn, 10/25)

14. 'This Is A Crisis': African-American Women Dying Due To Pregnancy-Related Causes At Stunningly High Rates

There's not one factor that experts can point fingers at--rather it's a host of issues, including bias from doctors and less care in early trimesters.

Los Angeles Times: The Quiet Crisis Among African Americans: Pregnancy And Childbirth Are Killing Women At Inexplicable Rates
Three weeks after Cassaundra Lynn Perkins gave birth to premature twins, she returned to the hospital, feeling unwell. She phoned her mother from her hospital bed at 3:30 in the morning. “I’m just not feeling good,” she said. Surely it was just another bout of the mysterious illness her daughter had been suffering from for most of her pregnancy, Cheryl Givens-Perkins thought as she rushed over to San Antonio’s North Central Baptist Hospital. (Simmons, 10/26)

Los Angeles Times: Black Doulas, Midwives And Reproductive Health Advocates Step Up In Response To Rising Black Maternal Deaths
It wasn’t just the disproportionate number of pregnancy-related deaths among black women in the United States that alarmed Darline Turner when the crisis first hit the headlines. It was the seeming nonchalance surrounding the issue. Why hadn’t the federal government declared this phenomenon a public health emergency, professed it a pressing human rights concern, or ordered a nationwide investigation, wondered Turner, a physician’s assistant and certified doula — a person trained to help women through childbirth and serve as their advocate. (Simmons, 10/26)

15. Scientists Able To Alter Single Letter In DNA Sequence With New Gene-Editing Technique

It might not sound impressive, but tens of thousands of human diseases can be traced back to a mistake with just one letter in the DNA. In other public health news: more from Reuters in its series on selling dead bodies; the legacy of abuse toward minorities in health studies; gun safety; cholesterol; arsenic; and more.

Los Angeles Times: New Gene-Editing Technique May Lead To Treatment For Thousands Of Diseases
Scientists from Harvard University have just unveiled a new gene editor that uses the revolutionary CRISPR-Cas9 technology to target and change a single letter in a string of DNA bases — no cutting necessary. Considering that there are billions of letters in the human genome, converting one letter to another may not sound like much. But tens of thousands of human diseases can be traced to these tiny mistakes, scientists say. (Netburn, 10/25)

The Washington Post: Scientists Announce New Gene-Editing Techniques Aimed At Common Mutations
Genetics is having a moment in the sun. Last year, biologists at the University of Bath in England created mice with neon feet. Scientists edited human embryos for the first time in the United States in August, cutting out a mutation for a heritable heart disease. Earlier this month, research spearheaded by the Chinese Academy of Sciences produced leaner pigs — a harbinger, one imagines, of low-fat bacon. (Guarino, 10/25)

Reuters: How One Company Made A Fortune Selling Bodies Donated To Science
In 2008, a thriving company named Science Care Inc developed a 55-page national expansion plan. The internal document projected the yield on raw material to the decimal point and earnings to the dollar. The goal: to maximize profits from the sale of human bodies donated to science. The company’s model for ensuring quality: McDonald’s Corp. (Grow and Shiffman, 10/26)

Reuters: Special Report: Reuters Buys Human Remains, And Learns A Donor's Tragic Story
Cody Saunders was born in 1992 with failing kidneys and a hole in his heart. When he died on his 24th birthday, he had endured 66 surgeries and more than 1,700 rounds of dialysis, his parents said. Some days, he hid the pain in upbeat selfies on Facebook. Other days, he shared an excruciating reality, posing in a hospital bed with bandages strapped across his scarred chest. (Grow and Shiffman, 10/25)

Reuters: Special Report: How And Why Reuters Purchased Bodies For Its Investigation
Reuters spent more than a year examining the workings of a multimillion-dollar industry that dissects, rents and sells the donated dead. Such firms are sometimes called body brokers, but they prefer to be known as non-transplant tissue banks. They acquire, usually for free, bodies that have been donated to science. Then they often cut those bodies into pieces and sell the parts for hundreds or thousands of dollars each. The buyers are typically medical researchers, device makers and groups that train doctors. (Grow and Shiffman, 10/25)

NPR: Troubling Legacy Of Tuskegee Study, Henrietta Lacks Still An Obstacle In Medical Research
It's a Sunday morning at the Abyssinian Baptist Church, a famous African-American church in the Harlem area of New York City. The organist plays as hundreds of worshippers stream into the pews. The Rev. Calvin O. Butts III steps to the pulpit. "Now may we stand for our call to worship," says Butts, as he begins a powerful three-hour service filed with music, dancing, prayers and preaching. "How good and pleasant it is when all of God's children get together." (Stein, 10/25)

The CT Mirror: Murphy Introduces Background-Check Gun Bill As ‘Long-Haul Strategy’
Sen. Chris Murphy on Wednesday reintroduced a background-check gun bill he’s been trying to make law since a gunman killed 20 first graders and six educators in Newtown at the end of 2012. Nearly five years later, Congress has yet to approve a substantive gun control measure, even the least controversial of those gun control advocates have proposed – a bill that would expand FBI background checks of gun buyers. (Radelat, 10/25)

The Washington Post: Pat Yourself On The Back, America. Your Cholesterol Levels Are Holding Steady, CDC Says.
When it comes to our health as a nation, we’re not doing so great. Some cancer rates are climbing sharply. Nearly one in eight Americans has diabetes. And we are ballooning in weight, with obesity rates at record highs. Amid that grim picture, government researchers on Thursday had a glimmer of good news: Our cholesterol numbers, which have improved significantly over the past 17 years, are holding steady. (Wan, 10/26)

San Jose Mercury News: How Much Arsenic Was Found In Baby Food?
A scary new study found that many popular baby foods test positive for arsenic, including a whopping 80% of infant formulas. That’s a pretty terrifying fact to wrap your mind around if you’re a new mom or dad and you’ve just been up all night trying to take care of your bundle of joy. Now, in between middle-of-the-night diaper changes and breast-feeding issues, you also have to worry about the poisons that may be hiding in your baby’s food. So sit down, get some coffee and take a deep breath. (D'Souza, 10/25)

NPR: Scientists And Surgeons Team Up To Create Virtual Human Brain Cells
Scientists in Seattle have created three-dimensional computer reconstructions of living human brain cells by studying tissue that is usually discarded during surgery. The virtual cells, unveiled Wednesday by The Allen Institute for Brain Science, capture not only the shape and anatomy of living cells, but also the electrical signals they produce. (Hamilton, 10/25)

NPR: It's Never A Good Idea To Stick Magnets Up Your Nose
Kids stick things in their nose, ears, and mouth all the time; it may be another way for them to explore and learn. But getting those objects out be challenging, and can take some creativity. Like when an 11-year-old boy put button magnets up both nostrils, where they locked tightly onto his septum. (Jochem, 10/25)

State Watch

16. Despite Hospitals' Eagerness For Mergers, It's Not Always Good For Consumer Care

Chicago-area hospitals are joining forces but what effect will it have for patients? Meanwhile, a new Massachusetts health bill would pit large hospitals in the state against smaller ones.

Chicago Tribune: Chicago-Area Hospitals Have Merger Fever. Is It Good For Patients?
Chicago-area health systems have merger fever, excitedly scooping up hospitals and joining forces in what they say is an effort to improve patient care and lower industry costs. But is it good for consumers’ care or pocketbooks? Not always, according to research and real-life examples. The list of Chicago-area hospitals teaming up with one another is ever-expanding. Just this month, Loyola Medicine announced plans to buy MacNeal Hospital in Berwyn and Rush said it would acquire Little Company of Mary Hospital and Health Care Centers. (Schencker, 10/25)

Boston Globe: Senate Bill Sets Large Hospitals Vs. Small Ones
A big new health care bill moving through Beacon Hill is pitting small community hospitals against industry giants owned by Partners HealthCare, as lawmakers try to control soaring costs in part by reducing the stark disparities at which hospitals are paid. The bill has already drawn stern objections from executives at two Partners hospitals, Massachusetts General and Brigham and Women’s, which could face fines under the legislation, but lawmakers are insisting they will move ahead with it. (McCluskey, 10/25)

And elsewhere, in hospital news —

Modern Healthcare: Trinity Health Ponders Acquisitions Through Debt Offering
Trinity Health is considering a debt offering to fund acquisitions, the company said in a regulatory filing. The Catholic-sponsored health system, which is one of the nation's largest not-for-profit hospital systems, said it is looking at converting all or a portion of $1.36 billion of bonds. Separately, Trinity is also contemplating issuing $300 million in debt to acquire, construct, renovate or outfit new and existing facilities, plus an additional $300 million to acquire a "new regional health ministry," according to the filing. (Kacik, 10/25)

Bloomberg: There’s A $10 Billion Fight To Keep You From Dying In The Hospital
The line between symbiosis and mortal combat is a fine one, both in the C-suite and at the cellular level. Michael Singer and Ben Favret thought they had the former when they began making plans for a better, safer line of medical apparel—a super scrub, if you will. Singer is chief executive officer of Strategic Partners, a manufacturer that controls an estimated 40 percent of the U.S. market for scrubs. Favret, a former pharmaceutical executive, is founder of Vestagen Protective Technologies, a startup launched in 2009 with the goal of making a bacteria-proof medical uniform. (Stock, 10/26)

The Associated Press: Born In Sandy-Flood Hospital, Kids 'Stronger Than The Storm'
Their lives began with one of the most dramatic stories of Superstorm Sandy: the evacuation of 32 newborn babies from a major New York City hospital that got flooded and lost power. Hospital staffers tended to laboring women in the dark and carried mothers and tiny infants — 21 of them in intensive care — down stairways into the thick of the 2012 storm. Doctors and nurses squeezed air pumps by hand to fill some of the most fragile babies' little lungs. (Peltz, 10/26)

WBUR: Mass. General Dilemma: Separate Conjoined Twins To Save One, Or Let Both Die?
The East African twins were born conjoined into a sort of a Y shape: They had separate heads and torsos, but they were connected lower down, at the abdomen and the pelvis. They shared a liver and a bladder and other lower-body organs, and had just three legs in all. And one of them, "Twin A," had heart and lung disease so serious that she was likely to die soon — and kill her sister in the process. (Goldberg, 10/25)

17. State Highlights: Jury Acquits Pharmacist Tied To Meningitis Outbreak Of Murder Charges; Flesh-Eating Bacteria Claims Second Victim In Texas

Media outlets report on news from Massachusetts, California, Pennsylvania, Texas, Puerto Rico, Maryland, Colorado, Minnesota and Florida.

The Associated Press: Pharmacist In Deadly Meningitis Outbreak Cleared Of Murder
A pharmacist at a facility whose tainted drugs sparked a nationwide meningitis outbreak that killed 76 people was cleared Wednesday of murder but was convicted of mail fraud and racketeering. Jurors said prosecutors failed to prove Glenn Chin was responsible for the deaths of people who were injected with mold-contaminated drugs produced by the now-closed New England Compounding Center in Framingham, just west of Boston. As the supervisory pharmacist, Chin oversaw the so-called clean rooms where the drugs were made. (10/25)

Boston Globe: Pharmacist In NECC Meningitis Outbreak Case Acquitted Of Murder
The supervisor of a former Framingham compounding pharmacy was acquitted Wednesday by a federal jury of murder charges but convicted of racketeering and other crimes in connection with a meningitis outbreak that killed dozens of people across the country. Glenn Chin had been charged with killing 25 people in 2012 after they received tainted epidural steroid shots made at the now-closed New England Compounding Center (NECC). As the supervisory pharmacist at the center, Chin once oversaw 20 people. (McDonald, 10/25)

The Philadelphia Inquirer/Philly.com: Universal Health Services Details Hurricane Impact
Universal Health Service Inc. said Wednesday that recent hurricanes cost the King of Prussia company’s operations in Texas, Florida, South Carolina, Georgia, Puerto Rico, and the U.S. Virgin Islands $8 million to $9 million on an after-tax basis. Hurricanes Harvey, Irma, and Maria did not cause extensive property damage to the 28 behavioral health-care facilities and three hospitals in the path of the storms, and most of them have resumed normal operations, UHS said. A portion of the beds in a behavioral-health facility in Houston remain closed, and three behavioral health facilities in Puerto Rico are open but operating on auxiliary power. (Brubaker, 10/25)

WBUR: Tesla Turns Power Back On At Children's Hospital In Puerto Rico
Tesla has used its solar panels and batteries to restore reliable electricity at San Juan's Hospital del Niño (Children's Hospital), in what company founder Elon Musk calls "the first of many solar+battery Tesla projects going live in Puerto Rico." The project came about after Puerto Rico was hit by two devastating and powerful hurricanes in September, and Musk reached out about Tesla helping. (Chappell, 10/25)

The Baltimore Sun: Child Lead Poisoning Cases In Maryland Drop To Lowest Levels On Record 
Childhood lead poisoning in Maryland decreased last year to the lowest level since 1994, when the state began tracking cases, but health advocates said that more work needs to be done to prevent the serious and sometimes debilitating condition. Fewer than 0.3 percent of the state’s children tested in 2016 had an elevated blood lead level that was 10 micrograms per deciliter or higher, the amount considered dangerous under state law, according to a report released Wednesday by the Maryland Department of the Environment. (McDaniels, 10/25)

Denver Post: Mistake In Interpreting Test Results Led To Removal Of Breasts, Uterus, Oregon Woman Says
Elisha Cooke-Moore had been told she had cancer-causing genes. The 36-year-old mother said an obstetrician-gynecologist noted that the results of her genetic testing showed she had a 50 percent chance of getting breast cancer and up to an 80 percent chance of getting uterine cancer, so she underwent a recommended double mastectomy and hysterectomy to try to beat the odds. But Cooke-Moore, 36, from Gold Beach, Oregon, said that months after she had the surgeries, she learned that her medical team was wrong – the test results were negative. (Bever, 10/25)

Pioneer Press: Union Sues Duluth Health Care System Over Employee Flu Shot Mandate 
A union representing about 2,000 employees of Essentia Health is asking a federal court to block the health care system from requiring its workers to get flu shots until a labor grievance is resolved. “The union is not understanding why there would need to be this across-the-board mandatory requirement,” said Justin D. Cummins, a Minneapolis attorney representing United Steelworkers Locals 9460 and 9349 in the action filed on Friday in U.S. District Court. (Lundy, 10/25)

Pioneer Press: Minneapolis Veterans Home Getting Permanent Dental Clinic, Nation’s First
Construction on the nation’s first fixed dental clinic at the Minneapolis Veterans Home should be completed this spring, according to an announcement Wednesday by the Minnesota Department of Veterans Affairs. Most veterans homes rely on mobile clinic dentistry programs to provide care, which can be limited and inconvenient. The proposed clinic is being built with three major grants totaling $210,000 from Delta Dental of Minnesota Foundation, Minnesota Veterans 4 Veterans Trust Fund and the Disabled American Veterans of Minnesota Foundation. (Weniger, 10/25)

San Francisco Chronicle: 3 San Francisco Public Schools Show High Levels Of Lead In Water
Water samples from taps and drinking fountains at three San Francisco public schools contained elevated levels of lead, potentially exposing students to the toxic metal, district officials said Wednesday. District officials immediately shut down the taps and this week notified parents at West Portal and Malcolm X elementary schools and San Francisco International High School that water samples from at least one faucet or fountain at each site were too high - or above the recommended federal threshold of 15 parts per billion. (Tucker, 10/25)

Miami Herald: A 4-Year-Old Boy Gets Life-Saving, Stem-Cell Treatment
If it weren’t for the wheeled IV stand that squeaks behind him as he moves, Jovon Moss might seem like any other 4-year-old boy. Wearing a tot-sized costume modeled after the comic book character, The Flash, he races through the Sylvester Comprehensive Cancer Center clinic so quickly that nurses have to make sure he doesn’t trip on the tube administering his twice-monthly immunoglobulin drip. He regularly swipes his mother’s iPhone to watch YouTube videos during his treatment, yet is so eager to share his Scooby Doo gummy treats that his toothy smile disappears if someone says no thanks. (Koh, 10/24)

Los Angeles Times: Activists Occupy City Hall Bathroom Stalls To Protest Skid Row Toilet Shortage
Protesters took graffiti-covered toilets to Los Angeles City Hall and occupied bathroom stalls on Wednesday to highlight what they called a severe hygiene shortage for homeless people on skid row. The activists tried to deliver the toilets, scribbled with slogans, to Mayor Eric Garcetti. But they were stopped at the security checkpoint by Los Angeles police, who cited safety concerns with hauling the ceramic thrones through the gilded Art Deco hallways and elevators of the landmark building. (Holland, 10/25)

Weekend Reading

18. Longer Looks: An Obamacare Nightmare; A Pain Empire & Predicting Pandemics

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

Politico Magazine: How Iowa Became An Obamacare Horror Story
Nick Podhajsky plans to get married this year for an unusual reason: health insurance coverage. The 44-year-old farmer had expected to tie the knot next year. But because Iowa’s individual health insurance market is in chaos—with competition disappearing and prices skyrocketing—his fiancee was potentially going to be left with no affordable coverage options for next year. So they’ve decided to hold the ceremony before the end of the year, allowing his bride-to-be to get coverage through his plan. (Paul Demko, 10/23)

The New Yorker: The Family That Built An Empire Of Pain
According to Forbes, the Sacklers are now one of America’s richest families, with a collective net worth of thirteen billion dollars—more than the Rockefellers or the Mellons. The bulk of the Sacklers’ fortune has been accumulated only in recent decades, yet the source of their wealth is to most people as obscure as that of the robber barons. While the Sacklers are interviewed regularly on the subject of their generosity, they almost never speak publicly about the family business, Purdue Pharma—a privately held company, based in Stamford, Connecticut, that developed the prescription painkiller OxyContin. (Patrick Radden Keefe, 10/23)

The Atlantic: Is It Possible To Predict The Next Pandemic?
It’s been two years since an epidemic of Zika began in Brazil, three since the largest Ebola outbreak in history erupted in West Africa, eight since a pandemic of H1N1 flu swept the world, and almost a hundred since a different H1N1 flu pandemic killed 50 million people worldwide. Those viruses were all known, but no one knew when or where they’d trigger epidemics. Other diseases, like SARS, MERS, and HIV, emerged out of the blue. (Ed Yong, 10/25)

Vox: What Declaring A National Emergency Over The Opioid Epidemic Could Actually Do
The move would also be unprecedented; such declarations are typically held for immediate, short-term crises like hurricanes and contagious disease epidemics, not long-term public health issues like the opioid crisis. But a declaration could potentially unlock some support to address the crisis, including a bit of funding and special regulatory waivers that could bolster prevention programs as well as access to addiction treatment and the opioid overdose antidote naloxone. (German Lopez, 10/23)

Politico's The Agenda: The Workforce Issue
When we think about the future of American health care, we tend to imagine a future full of cool new things — high-tech gizmos, miracle drugs and fancy machinery all designed to fix whatever ails us. But the truth is that what matters most in health care isn’t things. It’s people. (10/25)

Editorials And Opinions

19. The Health Debate: Congress' Waiting Game Didn't Pay Off; Medicare For All's Timetable

Opinion writers examine aspects of the health reform debate.

Los Angeles Times: CBO: Congress Waited Too Long To Avoid Obamacare Premium Increases For 2018
The good news is that the so-called Alexander-Murray compromise, named after its godparents, Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), would accomplish its goal of reducing premiums and would even cut the federal deficit, without raising the number of Americans without health coverage. The bad news is that it’s already too late for the measure to affect premiums for 2018. Insurers already have set their premium rates for the six-week 2018 open enrollment period that starts on Nov. 1, and the CBO says it assumes the legislation won’t be enacted by then. (Michael Hiltzik, 10/25)

Lexington (Ky.) Herald-Leader: Trump Cuts Off Self-Employed To Spite Obama
Self-employed people — the entrepreneurs prized by vibrant economies — would be hurt most by President Donald Trump’s latest attempt to undermine the already rattled individual insurance market. Kentuckian Betsy Foster, for example, fears rising premiums will force her to abandon her health-care consulting business and seek a job with a larger company just to be able to afford insurance. Also hurt would be taxpayers. Trump’s move would cost the government more than it would save, which by any definition is irrational. (10/24)

The New England Journal of Medicine: How To Think About “Medicare For All”
In April 1946, President Harry Truman introduced a single-payer health plan and met the same reaction that would greet Senator Bernie Sanders (I-VT) and his colleagues when they proposed “Medicare for All” in September 2017. ... but 13 years later President Lyndon Johnson signed the Truman revision into law as Medicare, declaring that the United States was finally harvesting “the seeds of compassion and duty” that his predecessor had sown. A proposal with no chance in one era had become law in another. Medicare proved so popular that it came to be a third rail of American politics — dangerous to touch. What lessons does Truman’s success hold for today’s “no chance” Medicare for All? (James A. Morone, 10/25)

The New England Journal of Medicine: Which Road To Universal Coverage?
According to a June 2017 poll, Americans agree by a 60-to-39 margin that the federal government bears a responsibility to ensure health care for all Americans; 33% said that they favored a “single-payer” health system, 12% more than in 2014.1 The prevailing belief that the government should actively promote broader health insurance coverage contrasts strikingly with the nearly successful effort this year to repeal the Affordable Care Act (ACA), executive orders that threaten to destabilize ACA marketplaces, and repeated calls by the majority party in Congress to slash Medicaid spending. (Henry J. Aaron, 10/25)

Stat: As America's Future Doctors, We Support A Medicare-For-All Health System
Private insurance subsidies are Band-Aids on an already oozing wound, an inefficient private industry that prioritizes the depth of shareholder pockets over patient health. And while subsidies are short-term fixes inadequate for a long-term solution, removing them altogether, as has been the procedure in the latest GOP bills, would further limit patient access to affordable, comprehensive care. This worse-worst situation could be healed with an improved Medicare-for-all system that eliminates profit motives and preferentially places health above all else. ( Augie Lindmark, Vanessa Van Doren, Bryant Shuey and Andy Hyatt, 10/25)

USA Today: What If Democrats Were In Charge? I'd Let People Buy Medicaid Coverage
Even as we defend the ACA, we must be ready to actually legislate the day the gavels in Congress are back in our hands, and that requires serious, progressive and practical proposals. The good news is that Democrats are already hatching substantive ideas to expand access to quality, affordable health care. Several senators have plans that build on Medicare. ... My own proposal, which I introduced Wednesday with 18 other senators and Rep. Ben Ray Lujan, is the State Public Option Act. It would let states unlock their Medicaid programs to anyone who wants the coverage, giving Americans a public health insurance option on their state’s exchange. (Sen. Brian Schatz, 10/25)

The Hill: One-Size-Fits-All Medicaid Approach Wrong For Massachusetts
Massachusetts — one of 32 states to expand Medicaid under the Affordable Care Act (ACA) — usually is praised for providing healthcare for people living with chronic diseases and other serious health conditions. Unfortunately, the Commonwealth has requested an 1115 Waiver from the Centers for Medicare and Medicaid Services (CMS) that would significantly reduce access to life-saving medications for Medicaid beneficiaries. (Kelsey Rupp, 10/25)

McKnight's Long Term Care News: Looking At Massachusetts In LTSS Reform
In Massachusetts, there are three major separate initiatives directed at doing things differently to impact Medicaid. The three initiatives are in behavioral health, acute care and long-term care. The focus is on efforts to reform long term care. In many cases, the constituencies are the same, necessitating a real shift to a person-focused, constituent-based, collaborative system that works together more as a social system than a “medical” one. However, the strategy is to work through each system separately with the initial goal of collaboration and consolidation within each sector before merging them. While initial efforts direct a substantial amount of effort toward LTSS, it will be necessary to coordination and integration of the institutional component to reform the system. (James Lomastro, 10/20)

20. Viewpoints: Fentanyl's Role In Epidemic; HHS Conception Mission; Simple Fix For Medicare

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

USA Today: Opioid Crisis Has A New Leading Killer: Fentanyl
The drug overdose epidemic you’ve been hearing so much about has a new leading killer. It is potent, speedy and unpredictable — making it all the more lethal. Fentanyl, in all its many forms, is a synthetic opioid that’s easy to make, cheap for traffickers to buy, phenomenally profitable and popular on the street because it offers a powerful high that surpasses that of heroin. ... If, as expected Thursday, President Trump declares an emergency, the most urgent element of that emergency is the spread of fentanyl. And that should mean stronger action on both the demand side, meaning stepped-up efforts to treat users, and the supply side, meaning more aggressive crackdowns on the sources of fentanyl and its traffickers. (10/25)

Los Angeles Times: Three Weeks And Counting: As Congress Dithers On Children's Health Program, More States Face Crisis
Congress has hardly slathered itself with glory in its current session, but among its most shameful failures surely is its failure to renew funding for the Children’s Health Insurance Program, which provides coverage for about 9 million low-income children and pregnant women. As we’ve reported before, Congress failed to renew CHIP before its previous two-year reauthorization expired on Sept. 30. The clock has now ticked off more than three weeks without a vote, with nothing further scheduled for at least another week. (Michael Hiltzik, 10/25)

Los Angeles Times: Why The Department Of Health And Human Services Should Stop Saying Life Begins At Conception
Last week, the Department of Health and Human Services released a draft of its latest strategic plan, which will guide the agency from 2018 to 2022. Near the top of the document, the agency presents its mission statement: HHS activities “cover a wide spectrum of activities, serving and protecting Americans at every stage of life, beginning at conception” .... This is a religious definition of life, not a scientific one. Health and Human Services is a government organization. Its actions should be evidence-based, not faith-based, and this decidedly unscientific language should be eliminated from its strategic plan. (Richard Paulson, 10/26)

Forbes: Finally, Congress Is Considering A Simple Solution To The Medicare Enrollment Mess
Enrolling in Medicare Part B should be simple. But for years the government has been making enrollment nearly impossible for millions of seniors, especially those who are still working or who have delayed taking their Social Security benefits. ... Bipartisan bills in the House and the Senate would take steps to finally fix the problem. People about to turn 65 would get a notice clearly explaining Part B’s enrollment rules, and the Medicare enrollment period would become aligned with those of other insurance programs. (Howard Gleckman, 10/25)

The New England Journal of Medicine: DACA And The Dream Of Becoming A Physician
Teaching institutions and graduate medical education (GME) program directors must do some soul searching this recruitment season. Discontinuation of the Deferred Action for Childhood Arrivals (DACA) program — announced in September and due to take effect next March — threatens the ability of medical school graduates in this program to begin residency and the ability of those already in GME programs to continue. It remains unclear whether Congress will act in time for these physicians to complete their training. While we wait, hoping for that outcome, GME programs and potential applicants have tough decisions to make. (Debra F. Weinstein and Fidencio Saldana, 10/25)

Stat: Allergan Invokes Victim Defense To Protect Restasis From Generic Challenge
Let’s remember who these self-proclaimed “victims” are: Allergan is a highly profitable Irish drug corporation that garners more than $1.5 billion in revenue from Restasis. Its CEO was paid $62 million from 2014 to 2016. It is the same company that participated in an evasive legal maneuver last year in an attempt to avoid paying U.S. taxes. Joining in support of Allergan are the Pharmaceutical Research and Manufacturers of America and the Biotechnology Innovation Organization, trade associations that spent almost $20 million lobbying Congress last year. (David Mitchell, 10/25)

Los Angeles Times: Latest Apple Watch Shows Potential As Very Sweet Medical Device
I went into a test drive of the Apple Watch Series 3 thinking it could be a real game changer for diabetes management. Now I’m thinking it should be considered by anyone with a chronic illness. I’ll tell you why in a sec. First, the most important Series 3 feature for people with diabetes isn’t available yet, but it will be soon, maybe within the next few months, after the Food and Drug Administration gives its blessing. (David Lazarus, 10/26)