In This Edition:

From Kaiser Health News:

Kaiser Health News Original Stories

3. Breathing Fire: Health Is A Casualty Of Climate-Fueled Blazes

As the planet warms, wildfires such as the latest disastrous blazes in Northern California have increased in frequency and scope. Beyond the environmental effects, people suffer health repercussions that can be disabling and even deadly. (John Upton, Climate Central and Barbara Feder Ostrov, 11/9)

5. Political Cartoon: 'Big Problem?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Big Problem?'" by Nate Beeler, The Columbus Dispatch.

Here's today's health policy haiku:

Republicans’ Tax Plan A Mixed Bag For Health Care

Retired or sick?
We cut your health safety nets,
To serve big donors.

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:

Medicaid

6. Maine Governor Balks At Expanding Medicaid Even After Voters Had Their Say

Gov. Paul LePage (R), who has vetoed similar plans five times, says his administration will only implement expansion if it's fully funded by the state Legislature.

The Associated Press: Governor Says Voters Wrong to Approve Medicaid Expansion
Maine's governor said Wednesday that residents of his state made an expensive mistake when they voted to expand access to Medicaid under the federal health care law, and he's hesitant to implement it. Gov. Paul LePage, an opponent of "Obamacare" like his ally and fellow Republican, President Donald Trump, has vetoed five different attempts by the state Legislature to expand the program. But Maine voters decided the issue at the polls Tuesday, approving a Medicaid expansion under former President Barack Obama's signature Affordable Care Act. (Whittle, 11/8)

The Washington Post: Maine Voters Just Resoundingly Approved A Medicaid Expansion. Their Governor Is Trying To Stop It From Going Into Effect.
LePage issued a statement Wednesday saying he will open Medicaid to new people only if the state legislature fully funds it without raising taxes, without pulling from the state's rainy day fund or without taking money from the elderly or disabled. That's despite the fact Maine residents voted on the initiative knowing it would likely raise taxes. "Credit agencies are predicting that this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget," LePage said. (Phillips, 11/8)

Kaiser Health News: Maine Voters Greenlight Medicaid Expansion, But Governor Says Whoa
LePage has long been a staunch opponent of Medicaid expansion. The Maine Legislature has passed bills to expand the insurance program five times since 2013, but the governor vetoed each one. That track record prompted Robyn Merrill, co-chair of the coalition Mainers for Health Care, to take the matter directly to voters Tuesday. The strategy worked. Medicaid expansion, or Question 2, passed handily, with 59 percent of voters in favor and 41 percent against. (Wight, 11/9)

The Hill: Maine's Governor Won't Expand Medicaid Despite Approval Of Ballot Measure
Maine's House Speaker Sara Gideon (D) said in a statement that the legislature would implement the Medicaid expansion measure, and will fight the governor if he tries to intervene. "The legislature will move swiftly to fund Medicaid expansion as required by law. The governor and DHHS commissioner will implement its requirements as well, as they are obligated to do," Gideon said. (Weixel, 11/8)

Bangor (Maine) Daily News: What’s Next For Medicaid Expansion As LePage And Democrats Dig In
Tuesday’s Medicaid expansion vote was a rebuke to LePage, who has vetoed Medicaid expansion five times. But there are many ways to stall a law. The governor said in a Wednesday statement that he wouldn’t implement expansion unless the Legislature achieves hard-to-meet and disputed goals. Here’s how the fight to give health coverage to 70,000 Mainers could go. (Shepherd, 11/8)

7. Victory In Maine Breathes Life Into Other's Efforts To Get Medicaid Expansion On State Ballots

Advocates in Idaho and Utah are already working on their own measures, and the impact of health issues in both the Maine and Virginia 2017 elections may provide a path for others as well.

The New York Times: Election Results Invigorate Medicaid Expansion Hopes
The election results in Maine and Virginia have energized supporters of expanding Medicaid under the Affordable Care Act in several holdout states. After months of battling Republican efforts to repeal the law, they now see political consensus shifting in their direction. Groups in Idaho and Utah are already working through the process of getting Medicaid expansion initiatives on next year’s ballots, hoping to follow Maine’s path after failing through the legislative route. (Goodnough and Sanger-Katz, 11/8)

Modern Healthcare: Election Results Bolster Medicaid Expansion Hopes In Maine, Virginia And Other States
Tuesday's elections in Maine and Virginia brought victories for supporters of expanding Medicaid to low-income adults, bolstering the hopes of expansion advocates across the country. Maine voters overwhelmingly approved a binding ballot initiative to expand Medicaid to adults with incomes up to 138% of the federal poverty level, as authorized by the Affordable Care Act. Republican Gov. Paul LePage has vetoed expansion five times and has vowed to do so again. (Meyer, 11/8)

The Associated Press: Nebraska Lawmaker Seeks Medicaid Expansion After Maine Vote
Nebraska voters could get the chance to decide whether to expand Medicaid coverage as part of the federal health care law after Maine voters defied conservative opponents and overwhelmingly approved a similar measure. State Sen. Adam Morfeld said Wednesday he will propose a resolution next year to have lawmakers place the issue on the November 2018 general election ballot. Morfeld announced his intentions after Maine on Tuesday became the first state to expand coverage through a statewide referendum. (Schulte, 11/8)

8. Medicaid Chief Says Federal Officials Seeking To Relieve Paperwork Burdens On States

Brian Neale, who heads the Center for Medicaid and CHIP Services, tells state Medicaid directors that he wants to help states get away from cumbersome chores. In other news, Montana lawmakers stop a plan to cut Medicaid reimbursement rates, and Iowa lawmakers hear that state officials knew one insurer was leaving the Medicaid managed care program a month before alerting the public.

MedPage Today: Relieving Paperwork Burden a Top Priority, Says Medicaid Director
The Trump administration is doing its best to relieve the administrative burden for Medicaid plans, Brian Neale, director of the Center for Medicaid and CHIP Services, said here Wednesday. "Medicaid directors say they are devoting way too much time responding to CMS [Centers for Medicare & Medicaid Services-]required tasks," Neale said at the annual meeting of the National Association of Medicaid Directors. "We're going to help them free up those resources. ... At CMS, we've heard from states that our business processes at CMS can be administratively cumbersome. We are often told [that we] ask too many unnecessary questions and that our response times [are too long]." (Frieden, 11/8)

Helena (Mont.) Independent Record: Legislative Committee Halts Cuts To Medicaid Reimbursement To Maintain Access To Care
After hearing objections from hundreds of people on Medicaid, as well as the doctors and caseworkers who help them, a legislative committee Wednesday halted proposed cuts to Medicaid reimbursement rates. Earlier this year, the Department of Public Health and Human Services, which sets Medicaid rates, proposed lowering how much providers are reimbursed — first by 3.47 percent and then, after public outcry, 2.99 percent. (Michels, 11/8)

Montana Public Radio: Montana Lawmakers Block Medicaid Provider Rate Cuts
Members of the Children, Families Health and Human Services Interim Committee said Wednesday that state lawmakers only authorized a one percent cut to health care provider pay when they passed a triggered budget-cutting law this spring. They voted 7-1 to tell the Department of Public Health and Human Services that it has failed to give reasonable details about how it came up with the proposed 3.47 percent cut to Medicaid provider pay. (Cates-Carney, 11/8)

Des Moines Register: DHS Waited 30 Days To Disclose AmeriHealth's Possible Exit From Iowa's Medicaid Program
AmeriHealth gave state administrators 60 days’ notice that it intended to quit helping manage Iowa’s giant Medicaid program, but state officials waited 30 days to inform the public, a top administrator told legislators Wednesday. AmeriHealth’s abrupt departure from the system is happening because its leaders and state officials failed to agree on how much the company should be paid to cover care for about 215,000 poor or disabled Iowans. Many families and care-service providers are now scrambling to figure out what will happen when AmeriHealth members' coverage shifts to another company Dec. 1. (Leys, 11/8)

Bangor (Maine) Daily News: As Mainers Endorse Expanding MaineCare, Feds Back LePage Methods To Shrink It
At Maine Equal Justice Partners, an Augusta-based nonprofit that advocates for Mainers living in poverty, attorney Jack Comart said Tuesday’s comfortable win for Question 2 demonstrates widespread support for expanding MaineCare, despite uncertainties related to the ACA and how the program is administered. “This isn’t just a Portland thing or a southern Maine thing,” he said. “It won in rural towns and across the first and second districts. People want access to health care and they want their neighbors to have access to health care.” (Haskell, 11/9)

Health Law

9. Repealing Individual Mandate Would Do Less To Chip Away At Deficit Than CBO First Projected

In its revised analysis, the Congressional Budget Office also finds that the move would mean 13 million more people would be uninsured and premiums would rise by about 10 percent most years over the next decade.

Reuters: Repeal Of Individual Mandate Would Increase Uninsured, Premiums: CBO
The Congressional Budget Office said on Wednesday that repealing the Obamacare individual mandate would increase the number of uninsured by 13 million by 2027 and reduce the federal budget deficit less than initially forecast. The CBO, the nonpartisan budget-scoring agency, said that eliminating the Obamacare mandate that all Americans purchase health insurance or else pay a fine would lower the deficit by $338 billion over the next decade, not $416 billion as it estimated in December. (Brice and Abutaleb, 11/8)

The Hill: Repealing ObamaCare Mandate Means Millions Fewer Insured: CBO
Getting rid of the individual mandate means fewer people with health insurance. That means fewer subsidies the government will pay to help people afford their ObamaCare health plans, and thus, savings. Premiums in the individual insurance market would increase by about 10 percent in most years of the decade, CBO concluded, because repealing the mandate means less healthy people will buy insurance. That would leave sicker, older people to share the costs in the market, resulting in higher premiums. (Roubein and Hellmann, 11/8)

Politico: CBO: Obamacare Mandate Repeal Would Cut Deficit By $338 Billion
The new analysis finds that repealing the mandate would not have as big of an impact as the estimates CBO made nearly a year ago. A December 2016 CBO analysis found that undoing the mandate would reduce the budget deficit by $416 billion over nearly a decade and result in 15 million more uninsured Americans in 2026 than under current law. (Haberkorn, 11/8)

NPR: CBO: Repealing Health Coverage Mandate Would Save $338 Billion
House Republicans are toying with the idea of repealing the so-called individual mandate — a key part of the Affordable Care Act — as part of their plan to overhaul the tax code. Including the provision could be a win-win for Republicans. The move would allow them to offset more of the tax cuts they want in their tax plan and give them the chance to claim they repealed one of the most hated parts of the Affordable Care Act, also known as Obamacare. (Kodjak, 11/8)

Modern Healthcare: CBO: Axing ACA Mandate Would Give GOP $338 Billion More For Tax Cuts
If Republicans repeal the Affordable Care Act's individual mandate as part of their tax cut bill, that would give them $338 billion in cost savings over 10 years to soften the bill's rollback of popular tax breaks like the mortgage interest deduction, according to a Congressional Budget Office report released Wednesday. There would be 13 million fewer people with health insurance in 2027 due to repealing the mandate, and average premiums in the individual market would be 10% higher than if the mandate were preserved. (Meyer, 11/8)

Bloomberg: Repealing Obamacare Mandate Would Save $338 Billion, CBO Says
Rolling back Obamacare’s requirement that all Americans have health insurance would save the U.S. $338 billion over 10 years, according to the Congressional Budget Office, a smaller benefit than previously projected for a plan favored by the White House. Republicans are considering repealing the coverage rule in the Affordable Care Act as a way to pay for far-reaching changes in the tax code. The savings would come from the government spending less to subsidize Obamacare plans as more people opt to forgo health coverage. (Edney, 11/8)

CQ: CBO Projects Fewer Savings From Repealing Health Law's Mandate
Repealing the requirement that most Americans purchase health insurance coverage would reduce the federal deficit by $338 billion over a decade, an analysis by nonpartisan analysts expected later Wednesday will show. The Congressional Budget Office is set to publish an updated estimate of the effects of repealing the individual mandate included in the 2010 health care law (PL 111-148, PL 111-152). Republicans are considering including a repeal in tax legislation (HR 1) they hope to clear by the end of the year. (McIntire, 11/8)

10. In Aftermath Of Election Success, Democrats May No Longer View Health Care As A Liability

"There has been a major change here," says Robert Blendon, an expert on public opinion about healthcare at Harvard's Kennedy School. "Democrats for years wouldn't talk about healthcare. … Now, the implication is that if you are a Democrat running in 2018, you can talk about protecting healthcare for millions of Americans."

The Associated Press: In Election Glow, Dems See Health Care As A Winning Issue
Democrats are starting to see a political edge in health care — particularly the idea of widening Medicaid access for more low-income people — after big election victories Tuesday night. In Virginia, Democrat Ralph Northam promised a vigorous push as governor to expand Medicaid. Voters who said health care was important went decisively for Northam. (Alonso-Zaldivar, 11/9)

The Wall Street Journal: Democratic Wins Dent Efforts To Roll Back Health Law’s Individual Mandate
Democratic wins in Tuesday’s elections make it less likely that Republicans, as part of their tax package, will seek to repeal the Affordable Care Act’s requirement that most people have health coverage, according to congressional aides. Voters in Maine this week decisively backed a referendum to expand Medicaid under the ACA, and exit polls showed health care was a central issue for Virginians who elected Democrat Ralph Northam as their state’s governor. (Armour and son, 11/8)

Politico: Battered By Trump, Obamacare Triumphs At The Polls
As Democrats now look to the 2018 midterms that will decide control of the House, Senate and key governorships across the country, they can begin to more confidently embrace the law that’s covering 20 million Americans and that emerged politically stronger after surviving months of concentrated Republican repeal attacks. (Pradhan, 11/8)

Los Angeles Times: Healthcare, For Years A Political Winner For GOP, Now Powers Democratic Wins
Tuesday's elections don't ensure healthcare will remain a winning issue for Democrats in 2018, when party leaders hope they can retake the majority in at least one chamber of Congress. But the emergence of healthcare as a political liability for Republicans marks a dramatic turnabout for the GOP, which for years reaped huge electoral gains by playing on the unpopularity of the 2010 law. (Levey, 11/8)

Kaiser Health News: Election Night Surprise: Health Care Galvanizes Voters
Health care appears to have played an unexpectedly robust role in Tuesday’s off-year elections, as Democrats swept statewide races in Virginia and New Jersey and voters told pollsters it was a top concern. The health headline of the night came in Maine, where voters by a large margin rebuked Republican Gov. Paul LePage and approved a referendum expanding Medicaid under the Affordable Care Act. Maine is one of 19 states that has not expanded the program to people with incomes up to 138 percent of the federal poverty line, or about $16,600 for an individual. An estimated 70,000 to 90,000 Mainers could gain insurance under the expansion. (Rovner, 11/8)

Meanwhile, a look at what went wrong for advocates in Ohio's drug prices ballot initiative —

11. GOP Senators Want To Give Governors Power To Waive Health Law Restrictions Under New Bill

Legislation from Senate Finance Chairman Orrin Hatch (R-Utah) and Sen. Michael Crapo (R-Idaho) shows Senate Republicans are continuing to pursue ways to modify the current health care law after failing earlier this year to repeal large portions of it.

Roll Call: Governors’ Obamacare Waiver Power Would Broaden Under GOP Proposal
Legislation from two Republican senators would allow governors to implement a waiver under the 2010 health care law without approval from state legislatures, a departure from current law, according to a discussion draft obtained by Roll Call. The bill from Senate Finance Chairman Orrin G. Hatch and Idaho Sen. Michael D. Crapo would end the requirement for states to pass legislation to implement a so-called 1332 waiver. It would also let governors unilaterally end the program and would mandate that the Department of Health and Human Services secretary make a determination on a waiver application within 100 days. (Williams, 11/8)

In other health law news —

The Baltimore Sun: Enrollments In The Maryland Health Exchange Up In First Week
Enrollments in Maryland’s health exchange are well ahead of last year in the first week of the sign-up period, exchange officials said. Those buying policies for the first time are up 15 percent to about 4,020. And total enrollments, which includes new and returning consumers, are double the number at this time last year, at 10,420. (Cohn, 11/8)

Capitol Hill Watch

12. Republicans, In Search Of Revenue, May Target Orphan Drug Tax Break

The tax credit is part of a popular plan to encourage the development of drugs for rare disease. But ending it could save the government an estimated $54 billion over the next decade

The New York Times: Congress Weighs Repeal Of Tax Credit For Rare Disease Drugs
A decades-old tax credit designed to spur cures for rare diseases has been so successful that it’s now become a target in the House Republican tax plan. The proposal under consideration would end the tax breaks for development of what are called orphan drugs. Ending the credit used by big and small drug companies could save the government an estimated $54 billion over the next decade, an effort to help offset some of the anticipated losses in revenue if other Republican tax cut provisions become law. (Thomas and Kaplan, 11/8)

In other news on the GOP tax overhaul —

The New York Times: Ending Medical Tax Break Could Be A ‘Gut Punch’ To The Middle Class
Suzanne Hollack tried to care for her husband at home after he was diagnosed with frontotemporal dementia at age 69. But it got to the point where she couldn’t take a shower for fear he would stray out of the house. So 18 months ago, she moved him to a memory care community near their home in Scottsdale, Az., which like most long-term care, is not covered by Medicare. That, plus his other medical expenses, cost the couple $90,000 last year. (Zernike and Goodnough, 11/8)

13. Despite Concerns About Provisions On Use Of New Drugs, Defense Bill Moves Toward Vote

Politico Pro reports the bill is moving along and lawmakers will continue talks on addressing concerns from some members of health committees that the bill would allow the military to use drugs and products that haven't been approved by the Food and Drug Administration.

Politico Pro: NDAA Moves Forward As Lawmakers Discuss Separate Fix For Drug Approval Provision
Must-pass defense policy legislation will move forward unchanged despite protests from health committees over a provision that would shift some approvals for drugs and medical products from the FDA to the Pentagon. Instead of delaying a vote on the National Defense Authorization Act, H.R. 2810, to make changes, the House Armed Services and Energy and Commerce committees will continue talks on a potential fix, an Armed Services aide told POLITICO. (O'Brien, 11/8)

The Hill: GOP Chairmen Seek Hold On Giving Defense New FDA Powers
Three GOP chairmen are asking for a delay in moving the defense policy bill’s conference report over concerns the measure would let military personnel receive devices and drugs that haven’t won Food and Drug Administration (FDA) approval. At issue is a provision in the Senate’s National Defense Authorization Act that would let the Pentagon sign off on unapproved medical products for emergency use on the battlefield. Currently, the FDA is responsible for such approvals, and its commissioner, Scott Gottlieb, believes that shouldn’t change. (Roubein, 11/8)

In other FDA news --

Administration News

14. Potential HHS Pick's Ties To Pharma Raise Questions About Trump's Mission To Curb High Prices

Alex Azar served at Eli Lilly for a decade, including five years as president of its U.S. Lilly USA, LLC unit.

Reuters: Ex-Pharma Exec Azar Is Top Choice to Run U.S. Health Agency: Sources
Alex Azar, a former pharmaceutical company executive, is U.S. President Donald Trump's top pick to run the Department of Health and Human Services, two sources with knowledge of the confidential process said on condition of anonymity on Wednesday. Azar served at Eli Lilly for a decade, including five years as president of its U.S. Lilly USA, LLC unit. (Abutaleb, 11/8)

Bloomberg: Trump Expected To Name Ex-Lilly Executive Azar HHS Secretary
Azar, who worked at Eli Lilly & Co., would be the administration’s point person on running -- or dismantling -- Obamacare, the health program enacted by Trump’s predecessor that insures millions of Americans. He will also oversee Medicare and Medicaid, along with dozens of public health programs and sub-agencies. Trump is in Asia for an extended trip and could still change his mind before a replacement is officially named. At Lilly, Azar ran U.S. operations. Trump has been highly critical of the drug industry, saying that companies are “getting away with murder” and threatening to use the federal government’s buying power to bring down prices. However, he’s taken no concrete action yet to do so. (Edney, 11/8)

Women’s Health

15. Proposed Provision Would Allow Providers Who Object To Abortion To Sue If They Face Discrimination

Some Capitol Hill lawmakers want to work the language into the end-of-the-year spending bill Congress will consider. Meanwhile, outlets report on other news pertaining to women's health care from Massachusetts and Texas.

The Hill: Anti-Abortion Lawmakers Push ‘Conscience Protection’ Bill
Anti-abortion lawmakers in the House and Senate are pushing for language in the end-of-year spending bill that they say would protect health-care professionals who don’t want to take part in abortions because of their personal objections. The Conscience Protection Act would allow health-care providers like nurses and doctors to sue if they’re coerced into participating in abortions or if they face discrimination at work for refusing to do so. (Hellmann, 11/8)

Boston Globe: Mass. House Approves Bill That Ensures Free Birth Control
House lawmakers Wednesday overwhelmingly approved a bill that would ensure access to free birth control in the state and shield state residents from changes to federal law regarding contraceptive coverage requirements. The bill is headed to the Senate after the 138-16 vote. (McDonald, 11/9)

Texas Tribune: Benefits, Burdens Of Texas Abortion Procedure Ban Debated In 5-day Trial
In a five-day trial that concluded Wednesday, lawyers for the state defended part of a Texas law that bans the most common second-trimester abortion procedure unless the fetus is deceased. Abortion rights groups sued the state in July, arguing the provision restricting the dilation and evacuation procedure imposes an undue burden on Texas women seeking second-trimester abortions. (Najmabadi, 11/8)

Boston Globe: Midwives Debate Bill That Could Regulate Home Births Around The State
Dozens of midwives and mothers with babies in slings and toddlers in strollers gathered at the State House this week to offer their take on a bill that, if passed, would require home-birth midwives to be licensed by the state. Out-of-hospital midwives currently have no state oversight in Massachusetts, according to proponents of the legislation. (Guerra, 11/8)

Public Health And Education

16. China, U.S. To Focus On Fentanyl In Efforts To Curb Opioid Epidemic, Trump Says

"Today President Xi and I discussed ways we can enhance coordination to better counter the deadly drug trade and to stop the lethal flow of poisonous drugs into our countries and into our communities," President Donald Trump said.

Reuters: Trump Says He And China's Xi To Try To End Opioid Crisis
U.S. President Donald Trump said on Thursday that he and Chinese President Xi Jinping would be focusing "very strongly" on the U.S opioid crisis, which he has declared a public health emergency. Trump said shortly before arriving in Beijing he would discuss as a "top priority" stopping the "flood of cheap and deadly" fentanyl "manufactured in China" when he meets Xi. (Holland and Wen, 11/9)

In other news on the crisis —

Modern Healthcare: Pharmacies, PBMs, Insurers Call For Opioid Prescription Policy Changes
Drug prescribers throughout the country should establish a seven-day supply limit for initial opioid prescriptions, and they should be written electronically to slow the abuse of the addictive painkillers, a group of pharmacies, pharmacy benefit managers and health plans wrote in a letter to President Donald Trump Wednesday. The group pledged to support the federal government and states in clamping down on behaviors that have allowed opioid abuse to swell into a national epidemic.

The New York Times: Alternatives To Opioids For Pain Relief
A combination of Tylenol and Advil worked just as well as opioids for relief of pain in the emergency room, a randomized trial has found. Researchers studied 416 men and women who arrived in the E.R. with moderate to severe pain in their arms or legs from sprains, strains, fractures or other injuries. (Bakalar, 11/8)

17. Scientists Genetically Modify Stem Cells To Grow Skin For 7-Year-Old Boy With Fatal Disease

The doctors were able to reconstruct fully functional skin for 80 percent of the boy’s body. The success story may offer hope to burn victims and others with severe skin conditions.

The Washington Post: Genetically Modified Skin Grown From Stem Cells Saved A 7-Year-Old Boy’s Life
Scientists reported Wednesday that they genetically modified stem cells to grow skin that they successfully grafted over nearly all of a child's body — a remarkable achievement that could revolutionize treatment of burn victims and people with skin diseases. The research, published in the journal Nature, involved a 7-year-old boy who suffers from a genetic disease known as junctional epidermolysis bullosa (JEB) that makes skin so fragile that minor friction such as rubbing causes the skin to blister or come apart. (Cha, 11/8)

Stat: ‘Extraordinary’ Tale: Stem Cells Heal A Young Boy’s Lethal Skin Disease
The doctors were ultimately able to reconstruct fully functional skin for 80 percent of the boy’s body by grafting on genetically modified cells taken from the boy’s healthy skin. The researchers say the results of this single-person clinical trial, published on Wednesday in Nature, show that transgenic stem cells can regenerate an entire tissue. De Luca told reporters the procedure not only offers hope to the 500,000 epidermolysis bullosa patients worldwide — but also could offer a blueprint for using genetically modified stem cells to treat a variety of other diseases. (Blau, 11/8)

The Wall Street Journal: New Skin for 7-Year-Old Boy Marks Advance In Gene Therapy
The new skin remains functional after 21 months, and doesn’t blister or require ointment or medication, according to the team of scientists and doctors from Austria, Germany and Italy who described the case in a paper in the journal Nature. The child in the study has Junctional Epidermolysis Bullosa (JEB), part of a family of rare, often lethal, skin-blistering diseases. Epidermolysis Bullosa affects only around 1 in every 20,000 births in the U.S.; JEB is a severe form of the disease, often leading to death in early childhood. (Dockser Marcus, 11/8)

Los Angeles Times: 9-Year-Old Boy With Rare Disease Now Has Engineered Skin Covering 80% Of His Body
Over a five-month period in the fall and winter of 2015, they harvested some of the boy's few remaining healthy skin cells. Using a virus to invade the cells, they introduced a corrected version of the mutated gene that had caused the catastrophic failure of his epidermis, the body's largest organ. They cultured the corrected cells and, on sheets backed with plastic and a naturally-occurring adhesive, used them to build many square meters of healthy new epidermis. Then, ever so delicately, they clothed his small body in a new set of skin. (Healy, 11/8)

NPR: Genetically Altered Skin Saves A Boy Dying Of A Rare Disease
After eight months in the intensive care unit, the boy was well enough to go home. And, two years later, he is in school, even playing soccer. "The kid is doing quite well," Rothoeft said. "The skin is of good quality, it doesn't need any ointments or stuff like that. It's perfectly smooth and it is quite stable. And if he gets any bruises, they just heal like bruises in every other kid." (Harris, 11/8)

18. After Mass Violence, Rhetoric Tends To Focus On Mental Health. But Most Perpetrators Aren't Mentally Ill.

More often, the shooters fall into the category of disgruntled and aggrieved, with perceived humiliation fueling their acts. In other public health news: weight loss supplements, pesticides, brain implants, double-booked surgeries, sudden infant death syndrome, and more.

The New York Times: Are Mass Murderers Insane? Usually Not, Researchers Say
If what people do is any reflection of who they are, then Devin P. Kelley, who slaughtered 26 churchgoers on Sunday in Texas, surely was a madman. Before the atrocity, he had attempted to sneak weapons onto an Air Force base after making death threats to his superiors, according to a local police report. In 2012, he had escaped from a mental hospital in New Mexico to which he had been sent after assaulting his wife and fracturing his stepson’s skull. (Carey, 11/8)

Stat: Risky Stimulants Turn Up — Again — In Weight Loss And Workout Supplements
Dr. Pieter Cohen, the Harvard internist and noted supplement detective, took the case. He and his collaborators purchased and analyzed six supplements marked as containing one of the mystery ingredients. They expected that, however they were listed, all the ingredients would turn out to be a stimulant known as octodrine, which the Food and Drug Administration approved decades ago, in inhaled form, as a treatment for bronchitis, laryngitis, and other conditions. (Robbins,11/8)

The New York Times: Pesticides Tied To Problems In Assisted Pregnancies
Eating fruits and vegetables high in pesticides may lower the chance of successful birth with assisted reproductive technology, according to a new report. Researchers studied 325 women undergoing fertility treatment in Boston. They collected data on medical and lifestyle factors and had the women fill out food frequency questionnaires. (Bakalar, 11/8)

Stat: New Brain Technologies Pose Threats To Privacy And Autonomy That Are All Too Real, Experts Warn
With Elon Musk aiming to build brain implants so people can communicate telepathically, fMRIs already (approximately) reading minds, under-the-radar companies working on computer chips to control brain activity that generates intentions, and technologies promising to boost brain performance like Bradley Cooper’s in “Limitless,” it might seem like neuroscience has become neurofiction. But the advances, and the threats they pose, are all too real, experts warned on Wednesday. In an essay in Nature, 27 neuroscientists, physicians, ethicists, and artificial intelligence experts argue that these and other powerful “neurotechnologies,” originally conceived to help people who are paralyzed or have other neurological disorders, could “exacerbate social inequalities and offer corporations, hackers, governments or anyone else new ways to exploit and manipulate people.” (Begley, 11/8)

Boston Globe: More Researchers Weigh In On Double-Booked Surgeries
Neurosurgeons can safely run two operations at once without endangering patients, a study from Emory University in Atlanta concluded, part of a growing body of research in response to a Globe Spotlight Team report that found surgeons sometimes do simultaneous surgeries without telling patients. (Saltzman, 11/8)

Modern Healthcare: Overlapping Neurosurgeries Don't Hurt Patient Outcomes
Overlapping surgery, a well-established practice in which a surgeon performs critical parts of a procedure and then departs to perform another procedure just beginning, has received intense scrutiny in recent years by critics who argue the practice is unsafe. But a new JAMA study found outcomes for neurosurgery patients who received overlapping surgery were the same as those of patients who didn't receive such treatment. (Castellucci, 11/8)

Pioneer Press: Sudden Infant Deaths Attributed To Unsafe Sleep Practices, Health Officials Say
For a few days this week, commuters driving past the Lowry Avenue Bridge in Minneapolis will see its lights colored blue, light blue and pink in honor of Infant Safe Sleep Week, an initiative to encourage safe sleep practices for infants. ... According to data released Wednesday from the Minnesota Department of Health, unsafe sleeping environments contribute to almost all sudden infant deaths. According to a page on Mayo Clinic’s website, SIDS is commonly thought to have no explanation, but data from 2015 found that 53 of the 54 sudden infant deaths in Minnesota involved unsafe sleeping conditions. (Johnson, 11/8)

Star Tribune: Infant Deaths Linked To Sleep Positions
Minnesota recorded 54 unexplained infant deaths in 2015 — about the same as prior years — and all but one involved a child in an unsafe sleeping environment, according to an analysis from the Minnesota Department of Health. State health officials used the findings to renew their warnings to parents to place their babies to sleep on their backs and in uncluttered cribs. (Olson, 11/8)

Concord Monitor: Former N.H. Chief Justice Urges Kids To REACT To Mental Illness
John Broderick, a former chief justice on the Supreme Court, has crisscrossed the state for nearly two years, giving speeches and meeting students in an effort to destigmatize mental illness as part of the national Change Direction campaign. He’s given approximately 160 talks and spoken to some 20,000 people. But now there’s a new twist in his now familiar story. Broderick is now asking kids to REACT. The acronym stands for “Recognize” the signs of emotional suffering, “Express” concern and offer support, “Act now” and tell someone you trust, “Care enough” to follow up, and “Text” or call a number for extra support. (Duffort, 11/8)

State Watch

19. State Highlights: Minn. Nurses Union Challenges 2 Health Systems' Flu Shot Policies; Several Ill. Health Plan Administrators Face Legal Action After Failing To Pay Millions In Medical Bills

Media outlets report on news from Minnesota, Illinois, Massachusetts, Texas, Pennsylvania, California and Ohio.

Pioneer Press: Nurses Union Hits Duluth Health Care System Over Requiring Flu Shots
As Essentia Health was in court with one union over its new mandatory flu shot policy on Tuesday, another was challenging the Duluth-based health system over the same policy. The Minnesota Nurses Association, which represents 2,000 Essentia nurses, charged in a statement on Monday that the health system hadn’t made good on a promise to hold off on enforcing the policy until negotiations took place. Instead, the MNA said, Essentia was ignoring that process and threatening to fire nurses who did not comply. (Lundy, 11/8)

Chicago Tribune: Feds Allege Illinois Company, Others, Failed To Pay $26 Million In Medical Bills
A federal court has ordered several companies to stop administering health plans for small businesses in Illinois and across the country after they allegedly failed to pay $26 million in members’ medical bills while keeping large amounts of money for themselves. Illinois-based Black Wolf Consulting, along with Texas-headquartered AEU Holdings and one of its subsidiaries, allegedly failed to pay medical bills for many of the 14,000 members of health plans administered by the companies for small businesses in Illinois and across the country, according to the U.S. Department of Labor, which investigated after complaints from members. Black Wolf is based in Monee, according to court documents. (Schencker, 11/8)

Houston Chronicle: TMC Venture Fund Launches With $25M For Med Startups
The Texas Medical Center is launching a $25 million venture fund to support early-stage companies developing technologies in the health-care field. "The TMC Venture Fund is a quintessential example of the Texas Medical Center's ongoing commitment to driving collaboration across our medical city and further establishing Texas as the 'third coast of life sciences' in the United States," said Bill McKeon, TMC president and CEO in a statement Wednesday. (Najarro, 11/8)

Philadelphia Inquirer: Genesis Healthcare Takes $532 Million Write-Down, Warns Of Possible Bankruptcy
Genesis Health Inc., one of the nation’s largest nursing home operators, warned Wednesday that without relief from creditors it may have to file for bankruptcy protection. “As currently structured, it is unlikely that the company will be able to generate sufficient cash flow to cover required financial obligations, including its rent obligations, its debt-service obligations and other obligations due to third parties,” the Kennett Square company said in its quarterly report to the Securities and Exchange Commission. (Brubaker, 11/8)

Kaiser Health News: Breathing Fire: Health Is A Casualty Of Climate-Fueled Blazes
As the deadliest fires in California history swept through leafy neighborhoods here, Kathleen Sarmento fled her home in the dark, drove to an evacuation center and began setting up a medical triage unit. Patients with burns and other severe injuries were dispatched to hospitals. She set about treating many people whose symptoms resulted from exposure to polluted air and heavy smoke. “People were coming in with headaches. I had one. My eyes were burning,” said Sarmento, the director of nursing at Santa Rosa Community Health, which provides health care for those who cannot afford it. But respiratory problems — coughs and shortness of breath — were among the biggest risks. “We made sure everyone had a mask.” (Upton and Feder Ostrov, 11/9)

Cleveland Plain Dealer: Cuyahoga County Churches Mobilize To Reduce Infant Mortality
Ministers in Cleveland and inner-ring suburbs are preaching the gospel about prenatal care and safe sleep in an initiative to reduce infant mortality. ...The city-county collaborative was formed in December 2015 by a coalition of elected officials and health leaders to address the region's abysmal infant mortality rate, which is among the highest in the nation. (Farkas, 11/8)

Kaiser Health News: Grass-Roots Network Of Doctors Delivers Supplies To Puerto Rico
After Hurricane Harvey flooded her city of Houston in August, Dr. Jennifer McQuade planned to donate socks to those affected. Instead, surprised by the lack of medical care at a nearby shelter, McQuade, an oncologist, became the unofficial leader of a group of physicians and mothers providing emergency aid at the George R. Brown Convention Center in Houston. She triaged patients, solicited donations and recruited more doctors to join. (Martyn, 11/9)

The Washington Post: Chuck Norris Claims His Wife Was Poisoned During MRI Scans, Sues For $10 Million
Actor and martial artist Chuck Norris is suing several health-care companies, claiming his wife was poisoned by a chemical used during magnetic resonance imaging scans. In a lawsuit filed last week in San Francisco Superior Court, Chuck and Gena Norris argued that gadolinium, a metal used as a contrast agent in MRI scans, caused Gena to sustain gadolinium deposition disease, experiencing “multiple, debilitating bouts of pain and burning throughout her body” and suffering long-term damage. (Bever, 11/8)

Weekend Reading

20. Longer Looks: Mass Shooting Contagion; The Future Of Hospitals & The Origins Of The Opioid Epidemic

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

Politico: Agenda 2020: The Hospital Issue
As America reconsiders how to pay for health care, hospitals would seem to be the unshakable center of the system — beloved local institutions that are often seen as one-stop shops for health care services. But as the Hospital issue of Agenda 2020 has discovered, the hospital of the future is likely to be much different, reshaping itself under pressures from both payers and health reformers. For one thing, it’s likely to be more of a health network than a building —a system of clinics and other community providers designed to prevent illness more than to treat it, and to keep the ailing out of the hospital as much as possible. (11/8)

Vox's The Impact: How Well-Intentioned Doctors Helped Create The Opioid Epidemic
On this episode of The Impact, we explore a story about well-meaning doctors trying to do the best thing for their patients. These doctors developed and spread new policies that urged all other doctors to treat pain way more seriously. Those well-intentioned policies did not go as planned. They helped create the nationwide opioid epidemic we’re dealing with today. Podcast. (Sarah Kliff, Byrd Pinkerton, Jillian Weinberger, and Amy Drozdowska, 11/7)

Vice: Cracking Down On Opioids Hurts People With Chronic Pain
Before he broke his back in a 1980s accident that ultimately triggered years of chronic pain, Jay Lawrence had to make a split-second decision. He was on a bridge with a car in front of him and the brakes on his truck had failed. "He saw a baby seat in the car and he hit the bridge," says his widow, Meredith Lawrence. She lost her husband to suicide earlier this year after his doctor abruptly decided to cut down his opioid pain medication. (Maia Szalavitz, 11/6)

The New Republic: The New Coal Crisis
Weeks after Hurricane Maria’s landfall, the status of Guayama’s coal-ash pile remains unclear. How much of this waste—the leftovers from burning coal—got into the floodwater or into the air? The company that owns the pile, AES Puerto Rico, did not respond to requests for comment. But scientific researchers have long raised concerns that the coal ash, which contains high levels of arsenic, mercury, and chromium, represents a massive health hazard—one that Maria has now likely exacerbated. (Emily Atkin, 11/3)

Slate: Stock Photos Are Terrible At Depicting Illness, Mental Or Physical
Stock photos are ubiquitous—and infamous. The concepts are often laugh-out-loud absurd. The models are disproportionately white, not to mention atypically young, beautiful, and able-bodied. Outdated gender norms seem to be readily reinforced. Article after article has shown that stock photographs generally suck. But the place where the limitations of stock photography are most obvious—and deserve special scrutiny—is in depicting mental and physical illness. (Eleanor Cummins, 11/6)

Editorials And Opinions

21. Parsing The Policies: Voters Embrace Medicaid Expansion - But GOP Leaders Don't; Analyzing Health Care Spending

Commentary pages across the country take a look at the role health issues -- most notably, Medicaid expansion -- played in this week's election. Editorials also offer views on the factors and dynamics of U.S. health spending as well as ongoing efforts to combat the opioid epidemic.

The Washington Post: Voters Just Sent A Message: Republicans Are Way Out Of Step On Health Care
There's a long list of issues on which the Trump administration, and Republicans generally, are out of step with most Americans, yet on few of them is the chasm so broad or so deep as on health care. On Tuesday, voters made that clear in a pair of purple states, Virginia and Maine, while for the past week Americans across the country have been surging to sign up for health-care coverage under the Affordable Care Act, which the White House and congressional Republicans have tried to repeal and, failing that, sabotage. (11/8)

The Washington Post: Americans Love Medicaid. Republicans Hate It. Here’s Where The Fight Is Going Next.
Democrats won pretty much everywhere in Tuesday’s election, but there is a reason beyond the effect President Trump has on their fortunes for Republicans to be unnerved by the results. It has to do with both politics and policy, and it could mean trouble for them in 2018. I’m talking about Medicaid. As you might have seen, voters in Maine approved a ballot initiative Tuesday to accept the Affordable Care Act’s expansion of Medicaid by a margin of 59 percent to 41 percent. The expansion has been resisted by Paul LePage (R), to whom I fondly refer as America’s Worst Governor™. (Paul Waldman, 11/8)

Los Angeles Times: Trump's Medicaid Chief Attacks Her Own Program, On The Very Day It Scored A Huge Win At The Polls
Republicans who think the American public is clamoring to repeal or roll back the Affordable Care Act have another think coming. Voters in Maine overwhelmingly enacted Medicaid expansion for their state Tuesday, overturning a string of five successive vetoes by their right-wing governor, Paul LePage. The vote was roughly 60%-40%. Maine thus becomes the 33rd state (including the District of Columbia) to expand Medicaid under the Affordable Care Act, the first to do so during the Trump administration, and the first to do so by ballot initiative. (Michael Hiltzik, 11/8)

Kansas City Star: Expand Medicaid In Missouri? There’s A Petition For That
On Tuesday, the state’s voters approved Medicaid expansion by an enormous 18-point margin. The proposal was placed before the state’s voters by a petition drive, bypassing recalcitrant GOP legislators and controversial Gov. Paul LePage. Regrettably, Page said Wednesday he would not implement the expansion if it is not funded. (11/8)

JAMA: Factors Associated With Increased US Health Care Spending
In this issue of JAMA, Dieleman and colleagues1 report findings from their study in which they examined trends in US health care spending from 1996 to 2013. The authors evaluated the association between 5 factors—population growth, population aging, disease prevalence or incidence, service utilization, and service price and intensity of services—and health care spending over time and also analyzed trends overall and across major conditions. This report is a significant contribution to the literature because trends in health care spending over time, by major categories of spending, accounting for prevalence of disease, and across conditions have not been previously reported. (Patrick H. Conway, 11/7)

JAMA Forum: Five Ethical Values To Guide Health System Reform
The US health system is so mired in politics, with positions hardened by rigid ideologies, that we can’t even seem to talk with one another civilly about difficult tradeoffs. If the polity could agree on core ethical values to guide discourse, we would make hard health system choices based on which values we prefer and why. Herein, I offer 5 critical values for health system reform—universal access, equitable access, affordable access (cost), quality, and choice—explain the tradeoffs, and provide reasons why certain values should take priority. There will be disagreement across the political spectrum, but alternative visions should be justified by reasoned argument. (Lawrence Gostin, 11/8)

The Wall Street Journal: Koskinen’s Parting Gift From The IRS
IRS Commissioner John Koskinen has made no secret of his contempt for Republicans who tried to hold his agency to account for Tea Party targeting. His payback as he walks out the door is a major hit on employers. The IRS confirmed Tuesday that it is now for the first time beginning to enforce the Obama Care employer mandate, issuing thousands of penalty letters to noncompliant companies. The letters are on the way to firms with more than 50 employees that have failed to provide what ObamaCare defines as qualifying coverage to its workers. The letters reach back to 2015, setting up companies for years of penalties. (11/7)

JAMA: Opioid Vs Nonopioid Acute Pain Management In The Emergency Department
The United States is experiencing a serious epidemic of opioid-related drug addiction that includes a 200% increase in the number of opioid-related overdose deaths from 2000 to 2014. In 2015, there were 52 404 drug overdose deaths in the United States with 33 091 (63.1%) involving an opioid. An important contributor to this epidemic is semisynthetic prescription opioid pain medications (eg, oxycodone and hydrocodone) that are frequently used for nonmedical purposes and are implicated in many opioid overdose deaths. (Demetrios N. Kyriacou, 11/7)

22. Perspectives: Birth Control, Abortion Rights And What The Future Holds

Opinion writers offer their thoughts on recent developments and what might happen next regarding these issues.

Los Angeles Times: Notre Dame, Reentering 21st Century, Restores Employees' Access To Birth Control
The University of Notre Dame, in an abrupt reversal, says it will continue to allow its employees access to contraception under their insurance policies. Only a week ago, the university said it would cancel all birth control coverage for students and employees next year. That includes contraception provided to those recipients for free, under government auspices and at government expense. (Michael Hiltzik, 11/8)

The New York Times: The Worrisome Future Of Abortion Rights
Sheriff Joe Arpaio used to require pregnant inmates in the Arizona jails he controlled to get a court order before being allowed out of their cells to obtain a desired abortion. Needless to say, he was sued, and needless to say, he lost. (The sheriff appealed to the Supreme Court, which refused to hear the case.) So he switched tactics to require any inmate who wanted an abortion to prepay the transportation and security costs, something not required for any other off-site medical procedure. The American Civil Liberties Union took the sheriff back to court and won again. (Linda Greenhouse, 11/9)

USA Today: To Be Really Pro-Choice, You Must Protect Each Doctor's Choice To Not Perform Abortions
In a society where many issues divide Americans from each other, abortion is often called one of the most divisive and intractable. For many years, about half of Americans who hold a definite view have identified themselves as “pro-life” and half as “pro-choice.” While there are variations by age, race and so on, the most important factor influencing Americans’ views on abortion is religion — not denomination, but religious commitment. (Timothy Dolan and Russell Moore, 11/8)

23. Viewpoints: Calif. Anti-Vaxxers Find A Work-Around; What's Become Of Maternity Care In Rural America?

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

Los Angeles Times: Anti-Vaxxers Have Found A Way Around California's Strict New Immunization Law. They Need To Be Stopped
Two years ago the state Legislature passed a law banning so-called personal belief exemptions that many parents were using to keep their children from being vaccinated because they believed — wrongly — that vaccines were linked to autism and other serious health problems. But even as the number of personal belief exemptions fell to zero, the number of medical exemptions has skyrocketed. That's fishy. (11/8)

The Washington Post: Rural America’s Disappearing Maternity Care
Life in rural America can be tough, with challenges starting right from birth. Increasingly, rural women lack access to maternity services, jeopardizing their health and that of their newborns at a time when U.S. maternal mortality is rising. Giving birth is hard enough, but racing 100 miles to the nearest hospital down winding country roads is a particularly harrowing way to experience labor. Evidence confirms what common sense suggests: Drive time affects outcomes. A Canadian study shows that the babies of mothers who travel more than an hour to give birth are more likely to require intensive care or to die within their first year of life. (Katy B. Kozhimannil and Austin Frakt, 11/8)

Miami Herald/Florida Times-Union: Make Plan For Florida Nursing Homes Realistic
Florida Gov. Rick Scott acted decisively with his administration’s rules to protect nursing home residents from power outages. The tragic deaths of 14 residents at the Rehabilitation Center at Hollywood Hills nursing home in during Hurricane Irma shocked the nation — and rightfully so. ... Scott was right to make sure that nursing homes have enough backup power in hurricanes. But his rules were unrealistic, according to a Florida court. ... Moving away from the initial, but understandable, knee jerk reaction, the nursing home industry ought to be consulted in order to come up with a workable solution. Cost is a factor, as well. Many nursing homes operate on a slim profit margin. (11/9)

JAMA: Evidence Supports Action To Prevent Injurious Falls In Older Adults
With the aging of the population, the occurrence of falls among older adults is increasing in the United States and worldwide. In 2014, the incidence of falls among people older than 65 years was 672 per 1000 population in the United States, and the incidence increases with age. Among people older than 85 years, the fastest growing segment of the US population, fall incidence was 820 per 1000 population in 2014. In addition, the risk of falls increases substantially among individuals as they develop dementia. (Eric B. Larson, 11/7)

San Francisco Chronicle: Battle Over Veterans’ Health Care Comes Down To VA Choice
To address problems of long wait times at Veterans Health Administration hospitals, in 2014 Congress established the Veterans Choice Program, which provides private health care options for eligible veterans at government expense. ... Advocates, however, had long warned that private-sector options increase the cost of veterans’ health care. Now this has proven true. (Michael Blecker, 11/8)