In This Edition:

From Kaiser Health News:

Kaiser Health News Original Stories

2. Political Cartoon: 'Sugar The Pill?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Sugar The Pill?'" by Lee Judge, The Kansas City Star.

Here's today's health policy haiku:


Reform means improve.
So stop calling it "reform"
Unless all agree.

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

3. Trump Praises Bipartisan Efforts, But Doesn't Offer Actual Guidance On Health Bill Stalled In Senate

President Donald Trump joined Republican senators for their weekly lunch on Tuesday. They've been anxiously awaiting direction from the president -- who has given mixed signals on where he stands on the Alexander-Murray health bill -- but Trump didn't provide concrete guidance.

Politico: Trump Tells Senate To Fix Taxes — Not Obamacare
President Donald Trump on Tuesday steered Senate Republicans toward tax reform and away from health care, pushing off any deal to fund controversial Obamacare subsidies to the end of the year at best. Trump joined Senate Republicans at their weekly policy lunch but gave no direction on what he wants to see in a health care bill. He praised Sen. Lamar Alexander's (R-Tenn.) work on a bipartisan deal meant to stabilize the Obamacare markets, but his emphasis on taxes led senators in the room to believe Trump doesn't want a stand-alone Obamacare vote anytime soon. (Haberkorn and Cancryn, 10/24)

The Hill: Trump Stops Short Of ObamaCare Deal Endorsement 
President Trump expressed appreciation for work on a bipartisan ObamaCare deal in a meeting with GOP senators on Tuesday but did not endorse the bill, multiple lawmakers said."He just encouraged us to continue to work on it. He made it clear that he appreciated what Sen. [Lamar] Alexander [R-Tenn.] was doing," Sen. Mike Rounds (R-S.D.) said. (Sullivan, 10/24)

Meanwhile —

Bloomberg: Trump’s Next Chance To Wreck Obamacare: Open Enrollment
The four-year-old Obamacare marketplaces will face their toughest year yet when the window to buy coverage opens on Nov. 1. Already, even before enrollment opens, President Donald Trump has halted payments to insurers that reimburse them for reducing out-of-pocket costs for low-income people. That means those who turn up seeking health coverage, despite the steep cuts to outreach and marketing and an an abbreviated enrollment period, will face even higher premiums. The combination is likely to depress the number of people who purchase health plans, although no one can predict by how much. (Tozzi, Tracer and Rausch, 10/25)

Politico Pro: Trump's Cutting 'Bailouts' Won't Slow Insurer Profits
President Donald Trump says he won’t support any Obamacare stabilization bill that "bails out" health insurers reaping record profits. ...In fact, the five big national insurers have lost so much money, they’ve mostly fled those markets and won’t even be eligible for the “bailout” cash, as the president refers to the monthly payments that help cover the health care costs of low-income consumers. (Demko, 10/24)

4. Top GOP Lawmakers Try To Chip Away At ACA With Alternative Plan To Bipartisan Health Bill

Senate Finance Committee Chairman Orrin Hatch (R-Utah) and House Ways and Means Committee Chairman Kevin Brady (R-Texas) introduce a measure they say would get rid of the individual mandate and offer unspecified "pro-life protections."

The Associated Press: GOP Lawmakers Propose New Conditions On Health Bill
Two top Republicans announced a bill Tuesday restoring federal subsidies to insurers while including tough conditions sought by the White House. Senate Democrats have enough votes to kill it, but the measure underscores the changes the Trump administration and congressional conservatives say they want in exchange for resuming the payments. The proposal seeks changes in President Barack Obama's health care law that go far further than provisions in bipartisan legislation that is stuck in the Senate. That compromise has stalled as President Donald Trump has flashed contradictory signals about whether he supports it and conservatives — especially in the House — have complained it doesn't revamp Obama's statute strongly enough. (Fram, 10/24)

The Hill: Bipartisan Health Plan Faces New Challenge From Conservatives
The new bill, introduced by Senate Finance Committee Chairman Orrin Hatch (R-Utah) and House Ways and Means Committee Chairman Kevin Brady (R-Texas), would fund ObamaCare insurer subsidies that Democrats and some Republicans have been asking for. In that respect, it’s similar to the deal that Senate Health Committee Chairman Lamar Alexander (R-Tenn.) negotiated with Democrats. (Hellmann, 10/24)

CQ: Hatch, Brady Propose Alternative To Bipartisan Health Bill
The proposal, by Senate Finance Chairman Orrin G. Hatch of Utah and House Ways and Means Chairman Kevin Brady of Texas, would fund the cost-sharing payments through 2019 with "pro-life restrictions" and expand the maximum contribution limits to health savings accounts. The new proposal also would provide relief from the mandate that most individuals get health coverage from 2017 through 2021 and exempt employers from penalties if they didn’t provide insurance as required between 2015 and 2017. The pair said legislative text would be forthcoming. (McIntire, 10/24)

Bloomberg: Republicans Push New Proposal To Shore Up Obamacare
“If Congress is going to appropriate funds for CSRs, we must include meaningful structural reforms that provide Americans relief from Obamacare,” Hatch, a Utah Republican who heads the Senate Finance Committee, said in the statement. “This agreement addresses some of the most egregious aspects of Obamacare.” (Tracer, 10/24)

Roll Call: Hatch Moves To Reclaim Health Care Turf
Sen. Orrin G. Hatch is trying to reclaim his committee’s ownership over health care issues. The Utah Republican — who chairs the Senate Finance Committee — on Tuesday announced joint legislation with House Ways and Means Chairman Kevin Brady of Texas aimed at stabilizing the individual health insurance market created by the 2010 health law. ... The bill — for which legislative text is not yet available — would appear to meet a number of key conservative and White House demands. (Williams, 10/24)

The Hill: Conservatives Scoff At Bipartisan Health Bill 
The Senate's bipartisan health bill is a "nonstarter" in the House without significant changes, conservative lawmakers said Tuesday. "A compromise would be subsidies to stabilize the markets but somehow injecting competition in such a way that prices and premiums could come down," said Rep. Dave Brat (R-Va.), a member of the conservative House Freedom Caucus. (Hellmann, 10/24)

Roll Call: Alexander-Murray A ‘Nonstarter’ Say House Conservatives
House conservatives appear united in opposition to the health care stabilization proposal crafted by Sens. Lamar Alexander and Patty Murray. “Right now it’s a nonstarter,” House Freedom Caucus member Dave Brat said Tuesday during a Conversations with Conservatives press event. Brat, Freedom Caucus members Jim Jordan and Scott Perry, Republican Study Committee Chairman Mark Walker and Rep. Matt Gaetz all spoke to their opposition to the bipartisan accord. (McPherson, 10/24)

Meanwhile, some are seeing the same problems in tax reform efforts as they saw in the health care ones —

Bloomberg: Secrecy, Division, Complaints: GOP Tax Rollout Echoes Obamacare Repeal 
Congress is trying to ram through a bill that would reshape the U.S. economy in just a few short weeks, but its leaders have kept the plan shrouded in secrecy and released not a word of legislative text. Sound familiar? The GOP is handling its tax-overhaul rollout in almost the exact way it did Obamacare and hoping for a different result. The Republicans’ seven-year quest to repeal and replace the Affordable Care Act imploded as they tried to bypass Democrats but failed to rally their own forces amid unresolved policy disputes. (Kapur, 10/25)

5. Administration Officials Encouraged States To Apply For ACA Waivers. So Why Are They Being Turned Down?

Massachusetts is just the latest state to effectively be denied a waiver. Some say it's the administration's attempt to sabotage the Affordable Care Act, but others see the rejection as something else.

NPR: Iowa And Massachusetts Foiled In Attempts To Create Reinsurance
Two states looking for approval to customize their health insurance systems under the Affordable Care Act reversed course after the Trump administration said their applications couldn't be approved in time for next year. Iowa withdrew its proposal to the Centers for Medicare & Medicaid Services for a waiver to alter its Affordable Care Act markets. Massachusetts' proposal was effectively denied by the administration. (Kodjak, 10/24)

Boston Globe: Federal Agency Nixes Mass. Request For Special Fund To Stabilize Health Insurance Rates
Federal health officials have rejected a request from Governor Charlie Baker’s administration to establish a special fund to help stabilize health insurance rates in Massachusetts next year. Baker administration officials sent their 84-page request in early September, worried that President Trump’s administration would end federal subsidies that help insurance companies discount coverage for lower-income Americans.  (Dayal McCluskey, 10/24)

In other marketplace news —

The CT Mirror: Obamacare Open Enrollment To Begin Amid Shaky Insurance Market
Open enrollment for health care coverage next year begins next week amid uncertainty over the future of the Affordable Care Act and big increases in premiums for individuals and businesses that do not qualify for subsidies. Nevertheless, the health care law is still in effect and those required to enroll in a plan will face increasing penalties by the Internal Revenue Service if they fail to do so. (Radelat, 10/24)

Modern Healthcare: Centene Rides Obamacare To Higher Profit And Revenue In Third Quarter
While other health insurers lose money on the Affordable Care Act insurance exchanges or ditch them altogether, Centene Corp. remains the exception. The St. Louis-based insurer recorded a 9.7% increase in revenue during the third quarter of 2017 compared to last year, buoyed by membership growth on the individual insurance marketplace. Centene's membership is primarily made up of Medicaid recipients, but the health insurer also dominates the ACA marketplace. In the last year, Centene has nearly doubled its exchange membership to 1,024,000 as of the end of September from 582,600 at the same time a year ago. Its third-quarter revenue was $11.9 billion. (Livingston, 10/24)

Administration News

6. Undocumented Pregnant Girl Allowed To Get Abortion After Full Court Overturns Panel's Decision

A three-judge panel of the appeals court had earlier ruled that the government has 11 days to find a sponsor for the girl so that she could obtain an abortion outside the government's care. The full court, however, said its decision "rights a grave constitutional wrong by the government."

The Associated Press: Federal Court Clears Way For Immigrant Teen To Get Abortion
A federal appeals court on Tuesday cleared the way for a 17-year-old immigrant held in custody in Texas to obtain an abortion. The full U.S. Court of Appeals for the District of Columbia Circuit ruled 6-3 in favor of the teen. The decision overturned a ruling by a three-judge panel of the court that at least temporarily blocked her from getting an abortion. The Trump administration could still appeal the decision to the Supreme Court. (10/24)

Politico: Federal Appeals Court Clears Way For Undocumented Teen To Get Abortion
On Sunday the girl’s lawyers had asked the full court to set aside the decision, saying that they’ve exhausted their options to find a sponsor. They said the delay brings the girl, now close to 16 weeks pregnant, dangerously close to the states’ 20-week limit on abortion. The court’s full bench split along party lines with six Democrat appointed judges ruling in favor, three Republican appointees bitterly denouncing the decision and one Democratic appointee recusing herself. (Rayasam and Gerstein, 10/24)

WBUR: D.C. Appeals Court Rules For Teen Seeking Abortion While In U.S. Illegally
In a concurring opinion, Judge Patricia Millett of the U.S. Court of Appeals for the D.C. Circuit writes that the teenager has satisfied all the requirements under Texas law to obtain an abortion. She also says, "The government has bulldozed over constitutional lines" in its argument that the girl should leave the country voluntarily if she wants an abortion. (McCammon, 10/24)

Los Angeles Times: U.S. Appeals Court Rejects Trump Antiabortion Rule, Clears The Way For 17-Year-Old Immigrant To End Her Pregnancy
Although the ruling directly affects only the one pregnant teenager who brought the case, it strongly indicates that the appeals court, which has jurisdiction over federal agencies nationwide, would strike down efforts by administration officials to block abortions in similar cases. The ACLU, which represented Doe, says that in the last year, administration officials repeatedly have tried to prevent pregnant minors in detention from having abortions. (Savage, 10/24)

The New York Times: U.S. Must Let Undocumented Teenager Get An Abortion, Appeals Court Says
She was already nine weeks into her first trimester by the time she learned she was pregnant. And by then, she was already in federal custody at the border in Texas, one of the multitude of unaccompanied minors caught trying to enter the United States without their parents or relatives. She was 17 years old. That simple pregnancy test set off a dramatic legal battle between civil rights lawyers and the Trump administration, after the teenager made it known that she wanted an abortion. (Fernandez, 10/24)

In other news —

Reuters: Iowa Supreme Court Puts State's Abortion Waiting Period On Hold
The Iowa Supreme Court has maintained a block on a three-day waiting period for women seeking an abortion until a legal challenge concludes, a decision cheered by abortion-rights advocates. The provision was signed into law in May by former Republican Governor Terry Branstad, part of new regulations that also included a ban on most abortions after 20 weeks. (Kenning, 10/24)

Reuters: Stricter Missouri Abortion Rules Take Effect After Legal Fight
New abortion regulations took effect on Tuesday in Missouri that critics argue will make it more difficult for women to access the procedure. A judge on Monday declined to block a requirement that physicians performing abortions inform their patients about abortion risks at least 72 hours before their procedure. Previously, a different provider could give that mandated information. (Kenning, 10/24)

7. Put Your Money Where Your Mouth Is: Opioid Advocates Worry National Emergency Talk Is Just Empty Words

The Trump administration plans to officially declare a national emergency for the opioid crisis months after President Donald Trump said he would. But experts are worried there won't be any money to back it up. In other news on the crisis: the challenges of curbing the spread of fentanyl; how the epidemic is affecting older Americans; a special legislative task force is address opioid's impact in New York; and more.

The Associated Press: Trump Readies Opioid Plan, But Some Worry It Won't Be Enough
President Donald Trump's long-awaited declaration that the opioid epidemic is a national emergency finally arrives this week, but some advocates are worried that it won't be backed with the money and commitment to make much difference. Trump is expected to make the formal declaration and deliver a major speech on the topic Thursday, more than two months after he first announced that would be his plan. (Johnson and Colvin, 10/25)

Modern Healthcare: Experts: Trump Declaration Needs To Be More Than Funding Hike For States
As President Donald Trump gears up to formally declare the opioid crisis a national emergency, addiction medicine experts hope the hotly anticipated announcement will go beyond financing states' efforts to combat the epidemic. Months after Trump first announced plans to formally declare the opioid crisis a national emergency, the president is expected to make his first meaningful response to the issue on Thursday, which will likely include releasing millions in federal resources to respond to the epidemic. Many addiction medicine experts have praised the administration's move. (Johnson, 10/24)

The Washington Post: The Opioid Crisis: Wave Of Addiction Linked To Fentanyl Worsens As Drugs, Distribution Evolve
Michelle MacLeod died in a tough part of town known as the Tree Streets, where many of the streets have names like Ash, Palm, Chestnut and Walnut. Kevin Manchester, who provided the fentanyl that killed her, lived on Pine. After MacLeod’s death, Nashua police wired her fiance and recorded him telling Manchester that MacLeod had overdosed and died. Manchester kept selling the powerful synthetic narcotic anyway. Manchester, 27, went to prison for selling drugs that proved lethal — a “death-resulting” charge that prosecutors are using more frequently as they battle the opioid epidemic. (Achenbach, 10/24)

The Hill: Opioid Epidemic Also Hitting Older Adults
As America grapples with an opioid epidemic, senior citizens are often overlooked. Yet, older adults are highly susceptible to chronic pain and the prescription painkiller addiction is hitting this population. ... Roughly one in three beneficiaries in Medicare’s prescription drug program received a prescription for opioids in 2016. About half a million received high amounts of opioids. And nearly 90,000 are at “serious risk” of opioid misuse or overdose, according to a July report by the inspector general of the Department of Health and Human Services (HHS). (Roubein, 10/24)

The Baltimore Sun: Fentanyl-Related Overdose Deaths Continue To Soar In Maryland 
Nearly 800 overdose deaths in the first half of the year linked to the powerful synthetic opioid fentanyl helped push the number of overdose deaths in Maryland to a new high, state data released Tuesday shows. While the number of deaths from heroin and opioids generally moderated slightly, fentanyl-related fatalities jumped 70 percent over the same six-month period last year. (Cohn, 10/24)

The Star Tribune: Surge In Powerful New Synthetic Drugs Puts Minn. Authorities On Alert For Safety
Seizures of deadly synthetic opioids such as fentanyl and carfentanil have soared in Minnesota this year, forcing law enforcement agencies to adopt new procedures for collecting evidence, making drug arrests and testing samples at forensic laboratories. The synthetics are so powerful that, in some cases, scientists at the state Bureau of Criminal Apprehension (BCA) have been told not to handle drug samples without an agent nearby to administer naloxone, an antidote, in case of accidental contact. (Montemayor, 10/25)

The Philadelphia Inquirer/ Raided Urgent Care Clinics Have Been In Legal Crosshairs For Years
The Advanced Urgent Care clinic in Willow Grove was among at least five of the company’s facilities across the state raided by investigators with the DEA, the FBI, and other agencies Monday. A source said it was part of a drug-related probe into Mehdi Nikparvar-Fard, who owns at least two of the clinics. Nikparvar-Fard has been in federal custody since September for allegedly lying to and threatening U.S. marshals who visited another of his clinics, in Wynnefield, to deliver a bench warrant for a civil suit against him. (Palmer and Sapatkin, 10/24)


8. Texas And Federal Medicaid Responses To Hurricane Harvey Less Generous Than Katrina

Since Harvey hit in August, the state has not extended a special disaster benefit to storm victims, loosened financial eligibility guidelines or created a funding pool to help health care providers, according to the Dallas Morning News. In other Medicaid news, officials in both Texas and Virginia warn about the consequences of running out of federal funding for the Children's Health Insurance Program, and Wisconsin Gov. Scott Walker announces a plan to offer higher reimbursements to mental health professionals.

Dallas Morning News: Why Did Texas Medicaid Officials Request More Aid For Katrina Victims Than For Harvey?
State and federal Medicaid officials haven't provided the same generous health care benefits to individuals and communities devastated by Hurricane Harvey as they did more than a decade ago to victims of another lethal and crippling storm, Katrina. Some health care experts and providers confirmed Tuesday that they are beginning to ask why. Since Harvey struck the state's Gulf Coast in late August, the state-federal Medicaid program for the poor hasn't extended a special disaster benefit to storm victims, loosened financial eligibility guidelines or created a funding pool to help health care providers in affected areas reduce losses from treating uninsured people. (Garrett, 10/24)

Roanoke (Va.) Times: Governor Calls For Medicaid Expansion To Cover Children's Health Insurance
Virginia lawmakers will need to rethink their resistance to Medicaid expansion as federal funds that pay for children’s health care disappear, the governor said on Tuesday. “We lose $6.6 million a day, $2.2 billion per year. This is the craziest thing I have ever seen. This is our money, we should bring it back,” said Gov. Terry McAuliffe following an appearance in Roanoke to mark the expansion of the Virginia Tech Carilion Research Institute. (Rife, 10/24)

Milwaukee Journal Sentinel: Walker Announces Surprise Funding Bump For Mental Health, Substance Abuse Treatment
Gov. Scott Walker announced steps Tuesday to pay mental health professionals and substance abuse counselors more money to work with low-income Wisconsinites. Advocates hope the higher payment rates, which go into effect next year, will allow providers to offer more therapy appointments, psychiatric evaluations and substance abuse treatment for children and adults without private insurance. (Linnane and Kyle, 10/24)

Veterans' Health Care

9. Lawmakers Face Deadline To Extend Private Health Care Access For Vets

Funding for the program is projected to run out in two months. In other news, a Massachusetts senator calls for the Veterans Affairs secretary to investigate a Vietnam veteran's death at a VA medical center in Bedford, Mass.

CQ: Funding A Core Challenge For Private Veterans Health Overhaul
Lawmakers have yet to reach agreement on how to pay for an overhaul of private health care access programs for veterans with less than two months before critical funding is projected to run dry. “We still need to figure out how to pay for all these improvements, which will be no easy or pleasant feat for us, I can assure you," House Veterans Affairs Chairman Phil Roe, R-Tenn., told the panel at the outset of a hearing on consolidating private care programs managed by the Department of Veterans Affairs. (Mejdrich, 10/24)


10. Five-Year-Old Campaign To Curb Low-Value Care Shows Disappointing Results

The Choosing Wisely campaign, started by the American Board of Internal Medicine Foundation, hasn't gained traction with physicians.

Modern Healthcare: Low-Value Care Persists Five Years Into Choosing Wisely Campaign
The Choosing Wisely campaign, which launched five years ago, hasn't curbed the widespread use of low-value services even as physicians and health systems make big investments in the effort, a new report found. The analysis, released Tuesday in Health Affairs, said a decrease in unnecessary healthcare services "appear to be slow in moving" since the campaign was formed in 2012. The report found that recent research shows only small decreases in care for certain low-value services and even increases for some low-value services. (Castelluci, 10/24)

Politico Pro: Choosing Wisely Campaign Failing To Attract Physician Attention
Doctors are mostly unaware of the Choosing Wisely campaign, created in 2012 to get them to stop ordering unnecessary and harmful procedures and prescriptions, according to a study in Health Affairs released Tuesday. Surveys by the American Board of Internal Medicine Foundation, which started the program, found that awareness of Choosing Wisely had increased from 21 percent of physicians in 2014 to 25 percent in 2017. (Allen, 10/24)

Public Health And Education

11. With Dress Rehearsals, World Leaders Aim To Counter Chaos Of Previous Pandemics

The World Bank hosted a practice scenario for participants that included finance, health and tourism ministers from about a dozen countries, and officials from organizations including the World Health Organization, the Centers for Disease Control and Prevention, and the International Air Transport Association. In other public health news: selling dead bodies; arsenic in drinking water; the backstories of seven diseases; a flu vaccine patch; and more.

The Washington Post: World Financial Leaders Simulate A Pandemic Like Ebola, Marburg Or Flu
The government ministers were facing a new infectious disease outbreak. The mysterious virus was sickening and killing people with alarming speed. Some patients had to be placed on ventilators to help them breathe. The new virus seemed resistant to antibiotics and antiviral medicine. Within a week, officials had closed a major hospital and schools and quarantined thousands of people. Fear and panic spread quickly as people in neighboring countries became infected and died. (Sun, 10/24)

Reuters: Special Report: In The Market For Human Bodies, Almost Anyone Can Sell The Dead
The company stacked brochures in funeral parlors around Sin City. On the cover: a couple clasping hands. Above the image, a promise: “Providing Options in Your Time of Need. ”The company, Southern Nevada Donor Services, offered grieving families a way to eliminate expensive funeral costs: free cremation in exchange for donating a loved one’s body to “advance medical studies.” (Grow and Shiffman, 10/24)

The New York Times: Arsenic Reductions In Drinking Water Tied To Fewer Cancer Deaths
The Environmental Protection Agency’s revised rule on arsenic contamination in drinking water has resulted in fewer lung, bladder and skin cancers. In 2006, the E.P.A. reduced the arsenic maximum in public water systems to 10 milligrams per liter, from the previous level of 50 milligrams. The rule does not apply to private wells. (Bakalar, 10/24)

Stat: Why Do We Call It That? Backstories Of Seven Disease Names
Diseases get their names from a variety of sources — from Latin or Greek root words, from place names, from the clinician who discovered them, or a well-known patient who had them. But we throw disease names around so commonly these days that many of the decades- or centuries-old origins are long forgotten or overshadowed by their modern meaning. (Samuel, 10/24)

The Washington Post: The Rare Case Of A Woman Who Stunned Doctors In Italy By Sweating Blood From Her Face
Doctors were baffled when a 21-year-old woman was admitted into an Italian hospital for “sweating blood” from her face and her hands, a condition she's had for three years, according to two physicians from the University of Florence. It's a condition few doctors have seen, and some have questioned whether sweating blood is even possible. But it turns out dozens of similar cases have come to light since about 2000. (Eltagouri, 10/24)

The Washington Post: ‘Damaged For The Rest Of My Life’: Woman Says Surgeons Mistakenly Removed Her Breasts And Uterus
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. (Bever, 10/24)

Boston Globe: A Less Painful Mammogram
Massachusetts General Hospital this month became the first US hospital to launch use of a new mammography system designed by Boston-based General Electric Co. that is designed to make the experience more comfortable. The system from GE’s health care division has a hand-held remote that allows patients — not the medical professional administering the test — to control the level of pressure they feel during the exam. (Dayal McCluskey, 10/24)

State Watch

12. Single-Payer Is Hot-Button Topic In Otherwise Agreeable Calif. Gubernatorial Race

The four candidates are divided over universal health care, much like the national Democratic Party.

Los Angeles Times: Democrats Running For Governor Face Off In San Francisco Over Healthcare, Charter Schools
Reflecting a growing divide among California Democrats on single-payer healthcare and charter schools, California gubernatorial candidates landed on separate sides of those issues during a candidate forum in San Francisco Tuesday. The most heated exchange came in a clash between former Los Angeles Mayor Antonio Villaraigosa and Lt. Gov. Gavin Newsom over how to pay for a universal healthcare system that would cover all Californians and dramatically reshape medical coverage in the state. (Willon and Mehta, 10/24)

San Jose Mercury News: Dem Candidates For Governor Disagree On Charter Schools
The four Democrats running to be the next governor of California disagreed about whether the state needs more charter schools and how to achieve single-payer health care in a debate on Tuesday. But Lt. Gov. Gavin Newsom, former Los Angeles mayor Antonio Villaraigosa, state Treasurer John Chiang and former state Superintendent of Public Education Delaine Eastin seemed to agree on many issues — from affordable housing construction to climate change — at a forum at the City Club sponsored by the San Francisco Chronicle. (Tolan, 10/24)

13. State Highlights: Mass. Lawmakers Hear From Families On Proposed Patient Bill Of Rights; New York City Hit With Legionnaires' Outbreak

Media outlets report on news from Massachusetts, New York, New Mexico, Puerto Rico, Tennessee, Kansas and Arizona.

Boston Globe: Parents Make Plea For Patient Bill Of Rights At State House
The mothers told their stories before the Legislature’s Joint Committee on Public Health, where they testified in support of a proposed patient bill of rights that aims to ensure that families like theirs can find nurses. The legislation, An Act Requiring Protection for the Continuous Skilled Care of Fragile Children, would increase oversight of the state program that provides home nursing care for their children, and calls for biannual review of the program’s nursing pay rates, to ensure that rates don’t stagnate and stall recruitment, leaving desperate families without nurses. (Russell, 10/25)

The Wall Street Journal: New York Detects Legionnaires’ Disease In Queens Neighborhood
A dozen people in New York City’s Queens borough have been sickened by Legionnaires’ disease, the city’s health department said Tuesday. The outbreak has occurred in the busy downtown section of Flushing over the last two weeks, according to the New York City Department of Health and Mental Hygiene. The patients range in age from 30 to 80 years old, and most had some serious underlying health condition leaving them more prone to illness. (West, 10/24)

Albuquerque (N.M.) Journal: Audit: Insurers Owe The State Nearly $65 Million
The state failed to collect nearly $65 million in premium taxes owed by insurance companies, with the lion’s share — nearly $29 million — owed by New Mexico’s largest health insurer, Presbyterian Health Plan, according to an audit released today. State Auditor Tim Keller, who released a special audit of the Office of the Superintendent of Insurance’s collection of premium taxes, said while the dollar amount “is large in the aggregate,” it is far less money owed to the state than previously thought. (Sinovic, 10/24)

Stat: After The Storms, Restoring Puerto Rico’s Already Weak Electrical Grid Is FDA'S Top Priority
The Food and Drug Administration’s biggest concern in Puerto Rico is access to electricity, Commissioner Scott Gottlieb said at a congressional hearing Tuesday morning. “If [drug and device manufacturing plants] don’t return to the grid by the end of this year, we’re concerned we could face multiple potential shortages,” Gottlieb said. He added that the concern could be mitigated if companies temporarily shift more of their manufacturing operations off the island during the recovery process. (Swetlitz, 10/24)

The Associated Press: Gov. Cuomo Signs Bill Banning E-Cigarettes In NY Workplaces
New York has added electronic cigarettes to its indoor smoking ban, making it illegal to use the devices in bars, restaurants and most workplaces. While New York City and several other localities had already prohibited the use of e-cigarettes in areas covered by the smoking ban, the new statewide rules will provide consistency, according to Democratic Gov. Andrew Cuomo, who signed the bill into law Monday. (10/24) Community Setting For Some Norristown State Hospital Psychiatric Patients: Another Building On The Campus
When the Pennsylvania Department of Human Services announced plans in January to close the civil unit of Norristown State Hospital, the goal was to “serve more people in the community” and “reduce reliance on institutional care,” officials said. It turns out that the community setting for 16 of the severely mentally ill patients at Norristown, at least temporarily, will be another building on the campus. (Brubaker, 10/24)

Nashville Tennessean: Bordeaux Nursing Home Fined, Suspended From Admitting New Patients
The state has suspended the former Bordeaux Long Term Care facility from admitting new patients and appointed a special monitor to review that nursing home's operations. Louisville, Ky.-based operator Signature HealthCARE LLC also has to pay two state civil monetary penalties totaling $7,500, according to the Tennessee Department of Health. The orders are related to conditions found at the 419-bed facility now called Nashville Community Care & Rehabilitation Center during a complaint survey conducted from Sept. 25 to 28. (Ward, 10/24)

KCUR: KU Cancer Center One Of 16 In Nation To Offer Newly Approved Immunotherapy 
Kite Pharma, whose form of immunotherapy to treat non-Hodgkin’s lymphoma was recently approved by the Food and Drug Administration, has chosen the University of Kansas Cancer Center and 15 other cancer centers to offer the treatment. Known as CAR-T (CAR stands for chimeric antigen receptor), the therapy is customized for each patient. It works by removing T cells from a patient’s body and genetically engineering them to recognize and attack the patient’s tumors. The T cells, a form of white blood cell, are then put back into the patient. (Margolies, 10/24)

Boston Globe: State To Move Forward With New Medical Marijuana Rules
After a yearlong delay, Governor Charlie Baker’s administration said Tuesday it will move forward with a series of improvements to the state’s medical marijuana program, drawing praise from dispensaries and patients who said the changes are overdue. The new rules, which were unveiled by the Department of Public Health in September 2016 but put on hold amid uncertainty over the recreational pot law approved by voters, are meant to ease the regulatory burden on dispensaries and make it easier for patients to get access to medical marijuana. (Adams, 10/24)

Prescription Drug Watch

14. Pharma Trade Groups On Track For Record Lobbying Year, But They Weren't Talking About Health Bill

News outlets report on stories related to pharmaceutical pricing.

Stat: Biopharma Is On Track For A Record-Setting Lobbying Year — Even While Neutral On GOP Health Care Bills
The big drug industry trade groups PhRMA and BIO are still on track to spend a record amount this year lobbying the federal government — even though neither took a position on the unsuccessful Republican efforts to repeal the Affordable Care Act, the summer’s most hotly contested pieces of legislation. The two groups have collectively spent more than $26 million lobbying Congress and the executive branch in the first nine months of this year, the most since at least 2008, when organizations began to report their quarterly lobbying spending. By comparison, during the eight years of the Obama administration, the two trade groups collectively spent an average of $21 million on lobbying in the first nine months of the year. (Robbins, 10/23)

Roll Call: White House Considering Bipartisan Drug Price Task Force
President Donald Trump is considering launching a bipartisan task force to investigate the rising cost of prescription drugs, sources with knowledge of the discussion say. The announcement could come as early as next week, but the sources caution that discussions remain in the early stages and are still fluid. They say it could be part of an expected announcement on the opioid crisis that Trump hinted at earlier this week. (Williams, 10/20)

Stat: Merck Lays Off 1,800 U.S. Sales Reps To Overhaul Its Primary Care Marketing
As Merck product sales shift, the drug maker is cutting 1,800 U.S. sales reps, mostly people who call on primary doctors who prescribe cardiovascular, respiratory, and diabetes medicines. A Merck spokeswoman confirmed the move, which was disclosed to Merck employees on Thursday and is expected to be completed by early January 2018. But she declined to say how much money the drug maker expects to save. She also declined to say how many sales reps are employed in the U.S. overall. Globally, Merck currently employs about 69,000 people, including 26,500 in the U.S. (Silverman, 10/20)

Stat: How Much? In A 'Bold' Move, Celgene Raises Prices — Again And Again
Judging by the latest pricing data, Robert Hugin is still getting away with murder. Last January, the Celgene (CELG) chief executive sat alongside President Trump at a widely covered White House meeting to discuss pharmaceutical issues. The gathering was held shortly after Trump claimed drug makers are “getting away with murder” over their prices. And four months earlier, Allergan (AGN) chief executive Brent Saunders challenged other companies to hold their annual price hikes to single digits. So what does Hugin do? (Silverman, 10/24)

FiercePharma: Can Cancer Charity Efforts From Roche, Bristol, AbbVie And More Boost Pharma's Reputation?
Big pharma companies signed on to two big-name cancer efforts—the NIH’s Cancer Moonshot and celebrity-heavy charity Stand Up 2 Cancer—that just might help burnish their industry’s standing. Both cancer research groups are respected and popular causes with high-powered endorsements from well-known politicians, celebrities and researchers. But can that good will rub off onto pharma? Wendy Blackburn, executive vice president at Intouch Solutions, said the partnerships are “a smart move” by the pharma companies. (Bulik, 10/23)

Stat: Some State Medicaid Plans Still Restrict Hepatitis C Drugs
Over the past three years, state Medicaid programs have done a much better job of disclosing information about access to expensive hepatitis C medicines and fewer are restricting treatment to patients, according to a new analysis. In 2014, 12 states did not make public their criteria for treatment, but all 50 states now do so (although one state, New Jersey, does not disclose specifics for treating different stages of the disease). And in the past three years, 17 states dropped restrictions to access based on a patient’s stage of liver disease, which has been a key test for determining treatment. In 2014, all 50 states had restrictions. (Silverman, 10/23)

Stat: Doctor And Hospital Groups Fighting A Measure To Rein In State Drug Costs
In recent years, doctors nationwide have lamented ever-rising drug prices that are limiting patient access to crucial medicines and undermining hospital finances. But a ballot initiative in Ohio is flipping that script. Several prominent physician and hospital groups are joining pharmaceutical companies to oppose a proposal to rein in drug costs paid by state agencies. (Ross, 10/19)

Bloomberg: Novartis Plans To Give Ailing Alcon More Time For Turnaround
Novartis AG plans to give its ailing Alcon eye-care division an additional year and a half to rebound before deciding whether to spin it off. The business is starting to show signs of a turnaround and “has the potential to grow sales at or above market while delivering profitability at least in line with the industry,” the Basel, Switzerland-based drugmaker said in a statement Tuesday as it reported its first quarterly profit increase in almost three years. (Paton, 10/24)

FiercePharma: Without Tax Reform, Pharma M&A's Still Sluggish—But Biotech's Red Hot
Back when the year began, the prospect of U.S. tax reform had pharma companies salivating for some M&A action. But with that reform still absent, drugmakers have put on the brakes instead. Dealmaking in 2017 has so far seen a slowdown, tallying $207.6 billion across 1,040 deals in the pharma, medical and biotech sector, a new Mergermarket report (PDF) said. That's a 9.9% dip in value and 106 fewer transactions compared with the same period last year. (Helfand, 10/20)

Stat: Biogen's Blockbuster Rare-Disease Therapy Staggers After A Strong Start
Biogen’s Spinraza, a treatment for the rare and deadly spinal muscular atrophy, got off to a record-setting start, but U.S. growth is already waning, three quarters into the commercial launch. Spinraza U.S. sales totaled $198 million in the third quarter, almost flat compared to the second quarter, setting off alarms among investors. Biogen’s shares are down 7 percent on Tuesday morning following the biotech firm’s third-quarter earnings report. Ionis Pharmaceuticals (IONS), which received royalties on Spinraza sales, fell 13.5 percent. (Feuerstein and Garde, 10/24)

Cincinnati Enquirer: Will P&G Buy Advil Maker?
Procter & Gamble may bid to acquire the consumer health business that big-pharma player Pfizer said this month it is reviewing for possible sale, one Wall Street analyst says. The New York-based pharmaceutical company, which is looking to grow its core business, disclosed on Oct. 10 it was considering "strategic alternatives" for its non-prescription business that does $3.4 billion in annual sales. (Coolidge, 10/24)

Bloomberg: Shkreli Lawyer, On Trial Himself, Seeks Distance From Shkreli
Evan Greebel, a lawyer who once advised Martin Shkreli, went on trial this week on charges that he helped Shkreli defraud the company he founded, Retrophin Inc. Greebel’s first hurdle is to distance himself from Shkreli. In opening statements on Friday, Greebel’s lawyer told jurors that the 44-year-old father of three and Shkreli, a former biotech executive notorious for aggressive drug-pricing tactics, were as "different as two people can be." Greebel was by no means Shkreli’s "right-hand man," defense lawyer Reed Brodsky told jurors at the trial in Brooklyn, New York. (Smythe, 10/20)

FiercePharma: Lilly Powers Ahead With Plant Investment Even As It Cuts 3,500 Jobs
Even as pricing pressure on its diabetes portfolio led Eli Lilly to cut 3,500 jobs by year-end, the drugmaker today said it is moving forward with a $72 million upgrade to its insulin manufacturing, part of an $850 million outlay it had expected to make this year on capital projects. Lilly will replace an existing insulin vial filling line at its site in Indianapolis, where it has its headquarters. It said the project will help it meet demand for Humalog, Humulin and other insulins, and put in place new technology for pipeline projects. (Palmer, 10/23)

Stat: U.K. Government Is Urged To Widen Access For Drugs Developed With Taxpayer Funds
In response to rising drug costs, advocacy groups in the U.K. are pushing the government to make medicines that are developed with taxpayer funds more accessible. And in a new report, they suggest the U.K. government take steps that activists in the U.S. have also begun to demand. Specifically, the U.K. groups argue the government ought to require drug makers to disclose R&D costs and licensing terms for medicines that are discovered with taxpayer money. Licenses should include provisions that somehow guarantee patient access. And prices should not automatically be linked to R&D costs incurred by companies. (Silverman, 10/23)

15. Perspectives: Drug Development Doesn't Come Cheap, But Does It Really Justify Those Sky-High Prices?

Read recent commentaries about drug-cost issues.

Los Angeles Times: Gilead Says Drug Profits Must Stay High To Pay For 'Innovation,' But 100% Of Its Profits Went To Shareholders
In an interview published Friday in the Wall Street Journal, Martin listed a few reasons for the controversial pricing. One is that average Americans overestimate how much drug prices contribute to overall healthcare costs and how much drug manufacturers themselves pocket from list prices. Another is that drug makers need big profits so they can “continue to innovate.” ... To begin with, the evidence that Gilead itself uses its profits to “innovate” is thin at best. (Michael Hiltzik, 10/23)

The Wall Street Journal: The Business Of Saving Lives
‘We don’t apologize for being highly profitable until our patents run out,” says the man seated in the barest office of any corporate leader I’ve visited. There’s almost nothing on the walls, and the occupant, John C. Martin, tells me it’s because he moved into the space only “at the beginning of the summer”—long enough ago, one would think, to find an etching or two. One cannot escape the feeling that Mr. Martin, a 66-year-old chemical engineer who is executive chairman of Gilead Sciences, is not greatly given to adornment. He’s a plainspoken Midwesterner who lights up at the chance to talk about the medicines his company makes. And yes, it also makes money. (Tunku Varadarajan, 10/20)

Stat: Why A California Law To Rein In Drug Prices May Not Make Much Difference
For one, the law does not actually allow the state to control pricing. Instead, the effort is really designed to “shame and blame” companies by publicly calling out those that boost list prices for their drugs more than 16 percent cumulatively over two years. To an extent, this approach makes sense, because drug makers want to avoid scrutiny. As a result, companies “will try, at least initially, to minimize being an outlier,” Leerink analyst Geoffrey Porges wrote investors. But over time, he suggested it might backfire, as some drug makers could raise prices significantly higher than the 16 percent mark, “since if they go above the threshold, they might as well go well above it.” (Ed Silverman, 10/24)

Los Angeles Times: Lower Drug Prices? Trump Has One Idea, But Insurance Giant Anthem Has Another
The sky-high cost of prescription meds was back in the spotlight this week. First, President Trump said drug prices “are out of control” and drug companies are “getting away with murder." Then came news that the country’s second-largest health insurer, Anthem, will partner with CVS to launch its own pharmacy-benefit management business, or PBM — a move that Anthem said could save as much as $4 billion a year, which may be reflected in lower costs for patients. (David Lazarus, 10/20)

Forbes: Actually, Many New Cancer Drugs May Be Helpful And Worth Trying
You might have heard that many new cancer medicines offer little benefit. This month, the BMJ published a review finding that for most cancer drugs approved by the European Medicines Agency between 2009 and 2013, there was neither published evidence that they extend overall survival nor improve patients’ quality of life. In 2015, JAMA reported similar observations for oncology drugs approved by the U.S. FDA between 2008 and 2012. Both papers focused on evidence from randomized clinical trials. (Elaine Schattner, 10/24)

Bloomberg: Biogen Has An MS Meltdown Coming
Biogen Inc.'s third-quarter revenue, profit, and sales of a closely watched new medicine all exceeded analyst expectations. But all is not as rosy as the company's earnings press release Tuesday morning would make it seem. The market for multiple sclerosis drugs -- the source of the vast majority of Biogen's sales -- is heading for a competitive tipping point that the company will have a difficult time weathering. (Max Nisen, 10/24)

Forbes: Why Drug Makers Should Worry About Anthem's New PBM
News that Anthem will launch its own new pharmacy benefit manager in 2020 in partnership with CVS Health should worry the pharmaceutical industry. Insurers are closing ranks around a model that brings the PBM closer to the health plan in hopes of creating a savvier buyer of prescription medicines while seeking more transparency. UnitedHealth Group already owns OptumRx, a fast-growing PBM, and other insurers are looking at new relationships with PBMs. (Bruce Japsen, 10/19)

Forbes: Amazon Is About To Disrupt The Drug Industry, But Not The Way Most Think
It's now a foregone conclusion that will enter the healthcare sector. Every day there is another article on how Amazon is planning to dominate some new corner of the American economy. One day Amazon is taking down Grainger and Home Depot. The next it’s single-handedly taking down not only FedEx, but also UPS and the United States Postal Service. No sector seems safe as Amazon sails its ship into new waters. But those expecting Amazon to cannon ball into healthcare may need to bide their time. (Steve Brozak, 10/20)

Editorials And Opinions

16. Viewpoints: Take Another Look At Opioid 'Conspiracy;' Qualities HHS Secretary Needs

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

The Wall Street Journal: A Bipartisan Drug Cartel?
Perhaps you’ve heard that President Trump’s drug office nominee colluded with pharmaceutical companies to worsen the opioid crisis, based on a press dispatch this month. The resulting panic could result in reversing a useful law, so allow us to fill in the real story of this grand non-conspiracy that included 535 Members of Congress and Barack Obama. (10/24)

Los Angeles Times: The Opioid Crackdown Is Making Life Untenable For Chronic Pain Patients Like Me
President Trump recently said that he intends to declare the opioid crisis a national emergency. If he makes good on that promise, it will be the country’s first official state of emergency for a drug epidemic. That designation would make more federal funding available for curbing the crisis, and likely result in stricter limitations on new and existing opioid prescriptions. When I hear the words “opioid” and “emergency” in the same sentence, I panic: Is my prescription running out? I have stage-3 neuroendocrine cancer. For me, not having opioids would be an emergency. (Melissa Sanders-Self, 10/25)

USA Today: For His Next Health Secretary, Trump Needs A Domestic Jim Mattis
As much as anyone in the Cabinet, HHS secretaries have the day-to-day fate of ordinary Americans in their hands, particularly at vulnerable times in people's lives. What millions of Americans deal with on a daily basis — the high cost of prescription drugs, the safety of their food and medicine, finding a high quality nursing home for their parents, stemming the spread of outbreaks such as Zika or Ebola — this is the real day job of the HHS secretary. Trump would do well to appoint someone who has empathy for what it's like to be vulnerable and at the mercy of a health care system because of a chronic illness, disability, or the inability to afford care. Despite the headlines, much of the important work is not political but deeply personal. Someone who understands and can speak for and to the concerns of the public would make a good candidate. (Andy Slavitt, 10/25)

Arizona Republic: Obamacare Deal Is A Band-Aid, But It's What We Need Now
The Alexander-Murray health-care bill is a rare bipartisan effort on a topic that has generated white-hot political controversy. ...The bill isn’t perfect. It isn’t the final fix for Obamacare. But it deserves support for what it is: a needed quick fix and an opening to further bipartisan reform later. (10/24)

Bloomberg: The Right To Choose Isn't Just For Citizens
There is a range of penalties for illegally crossing the U.S. border. Being forced to carry an unwanted pregnancy to term should not be one of them. Yet that is precisely the penalty that the federal government seeks to impose on Jane Doe, an undocumented 17-year-old who, after being seized by immigration authorities, is being prevented from obtaining an abortion. ... The government's effort to force J.D. to bear a child before, presumably, it seeks to kick her out of the country altogether is a cruel parody of ideological obsession and bureaucratic myopia. J.D. has made her choice. American law, which confers rights on people in the U.S. regardless of citizenship, guarantees her right to do so. The federal government must abide by it. (10/24)

The Washington Post: The Trump Administration’s Attack On Family Planning Is An Attack On Women’s Economic Well-Being
Family planning is essential to women from an economic standpoint. It has been shown to dramatically reduce unintended pregnancy, thereby allowing women to decide when and how frequently to have children. That choice has improved economic (and health and educational) outcomes for the women and their children. ... Let’s be clear about this: There can be no successful, comprehensive anti-poverty agenda for women here or abroad that doesn’t include sufficient investment in effective forms of family planning. By rolling back years of progress on this issue, much of which was bipartisan, the Trump administration would be attacking millions of women’s economic well-being and darkening their prospects. (Jared Bernstein and Hannah Katch, 10/25)

WBUR: Why Are American Women Only Half-Liberated?
For me, the conservatism of U.S. health care (and the defunding of Planned Parenthood) illustrates a continued stifling of feminism eradicated long ago in other developed nations. Until America solves its abortion and women’s health issues, even independent American women remain stymied by a divisive instrument in American politics: control over their own bodies. (Heidi Legg, 10/25)

Modern Healthcare: Continue The Pursuit Of Value In Healthcare
While the future of the Affordable Care Act is still uncertain, a number of initiatives that began under the law have shown the kinds of results that transcend politics and will keep the focus on value over volume. Yes, we have seen that there are barriers to transitioning to a value-based approach, such as interoperability and organizational culture change, but there are also potentially huge gains to be made by including social determinants of health, for example. And we know U.S. healthcare provider organizations still receive the majority of their revenue from fee-for-service contracts. However, for these organizations to thrive under any circumstances, a focus on the quality of outcomes, efficiency of care delivery and reduction in cost should remain imperative. (Mike Boswood, 10/24)

Des Moines Register: Guarantee Vulnerable Iowans The Right To Use Video Cameras In Nursing Homes
A Des Moines Sunday Register investigation by Clark Kauffman told the story of Cheryll Scherf. The 82-year-old widow from Farmersburg suffers from Parkinson’s disease, cardiovascular disease, chronic fatigue and anxiety. Her family was concerned about the care she was receiving at the Elkader Care Center where she lived. So they installed a motion-activated camera in her room. This captured, among other incidents, staff repeatedly leaving Scherf in bed, naked from the waist down, with the door to the room left open. The video also showed she wasn't given her prescription medication. ... The story of this Iowa woman underscores the need to ensure all residents in long-term care facilities are guaranteed the explicit right to possess and use cameras in their rooms. (10/24)

The Washington Post: I Survived Cancer. So Why Was I So Sad?
I’d been cancer-free for nine months when I found myself weeping over poorly made eggs-over-easy. The yolks were hard, instead of dripping and lovely and orange. Those rigid yokes were the proverbial last straw. I’d had cancer for God’s sakes, and I was crying over eggs? I was supposed to be a survivor. ... We survivors are supposed to be happy and grateful, to embrace our second chance at life. Many survivors can point to decidedly good changes in their lives and outlooks since staring down that black tunnel called cancer. But that’s not how the story ends for some of us. (Pam Parker, 10/24)