In This Edition:

From Kaiser Health News:

Kaiser Health News Original Stories

4. Podcast: ‘What The Health?’ Tax Bill Or Health Bill?

Julie Rovner of Kaiser Health News, Sarah Kliff of Vox.com, Joanne Kenen of Politico and Alice Ollstein of Talking Points Memo discuss the inclusion of health policies into the current tax cut debate, including a possible repeal of the fines for people who fail to maintain health insurance. (11/17)

5. Shingles: Don’t Let It Get You The Way It Got Me

The painful condition caused by the chickenpox virus will strike 1 in 3 Americans during their lifetimes — most between ages 60 and 70, but those in their 50s have reason to arm themselves. (Bruce Horovitz, 11/20)

6. Political Cartoon: 'Turn Of The Screw?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Turn Of The Screw?'" by Mike Luckovich, Atlanta Journal-Constitution.

Here's today's health policy haiku:

DESPITE HEALTH LAW, TEENS STILL SKIPPING CHECK-UPS

Free preventive care
Must add free transportation
To improve results?

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

7. Repealing Mandate That Was 'Weak' In First Place May Not Radically Change Customers' Behavior

“We don’t think many people would lose insurance if the mandate goes away,” said Deep Banerjee, an analyst at Standard & Poor’s. The idea that many people who are buying insurance currently won't stop buying insurance complicates Republicans' belief that repealing the mandate will free up billions from not having to pay subsidies to customers.

Politico: Obamacare Mandate Repeal May Not Deliver Predicted Blow
Repealing Obamacare's individual mandate might not be the devastating blow to health insurance markets that supporters of the law fear. Because the tax penalty for not having insurance is far less costly than what many Americans would have to pay for coverage, many have chosen to take the fine. Eliminating it, therefore, might not radically change behavior — or fulfill the dire predictions of spiking premiums and vast increases in uninsured people that economists, health providers and politicians once predicted. (Haberkorn and Demko, 11/20)

The Hill: Study Finds Less Coverage Loss From Repealing ObamaCare Mandate
A new report from Standard & Poor’s predicts less savings and coverage loss from repealing ObamaCare’s individual mandate compared to the most commonly-used estimate. The study from S&P finds that repealing the mandate, as Senate Republicans are proposing in their tax-reform bill, would result in three to five million more uninsured people and $60 billion to $80 billion in savings over 10 years. That estimate is far less than the more commonly-used Congressional Budget Office (CBO) estimates, which predict 13 million more uninsured people and $338 billion in savings over the same period. (Sullivan, 11/17)

The New York Times: Will Cutting The Health Mandate Pay For Tax Cuts? Not Necessarily
Alexia Manon Senior is 27 and healthy — the type of person who might be most tempted to forgo health insurance if Republicans enact a tax bill that repeals the Affordable Care Act’s requirement that most Americans have coverage or pay a penalty. But Ms. Manon Senior, a graduate student in Miami, said she would hold tight to her coverage, at least as long as she keeps getting nearly $5,000 a year in government subsidies to pay for most of it. (Zernike and Goodnough, 11/19)

Meanwhile, the White House say it's open to taking the repeal of the mandate out of the tax bill —

The Associated Press: White House Open To Striking Health Provision From Tax Bill
The White House says it's willing to strike a health-care provision from Senate legislation to cut taxes and overhaul the tax code if the provision becomes an impediment to passing one of President Donald Trump's top legislative priorities. The provision would repeal a requirement that everyone in the U.S. have health insurance or pay a fine, but has emerged as a major sticking point for Republican Sen. Susan Collins of Maine, whose vote the White House needs. Collins said Sunday that the issue should be dealt with separately. (Superville, 11/20)

The Hill: Trump Met Senate Republicans On ObamaCare Fix
A group of Republican senators met with President Trump at the White House on Thursday to push him to support a bipartisan ObamaCare fix, according to a Senate GOP aide. The meeting with the president, which was first reported by Politico, was attended by Sens. Lindsey Graham (R-S.C.), Bill Cassidy (R-La.), Lamar Alexander (R-Tenn.) and Susan Collins (R-Maine). (Sullivan, 11/17)

And a look at where others stand on the issue —

The Hill: Collins: Pass Bipartisan ObamaCare Bills Before Mandate Repeal
Sen. Susan Collins (R-Maine) said Sunday that she wants two bipartisan ObamaCare bills to pass before the Senate takes up a tax bill that repeals the health law’s individual mandate. Collins, a key swing vote on the tax bill, said on CNN’s “State of the Union” that she did not think the mandate repeal should be in the tax bill, but she indicated she thinks the rise in premiums from repealing the mandate could be mitigated if two other bills passed first. (Sullivan, 11/19)

The Hill: Murkowski: ObamaCare Fix Not A Precondition
Sen. Lisa Murkowski (R-Alaska) said Friday that passing a bipartisan ObamaCare bill is not necessarily a precondition for her to support a tax bill that repeals ObamaCare’s individual mandate. The statement posted on Murkowski’s Facebook page appeared to clarify comments she made to Roll Call on Thursday, which seemed to suggest that the bipartisan ObamaCare bill from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) was a prerequisite for her vote for the tax bill. (Sullivan, 11/17)

Bloomberg: Mulvaney Says Would Be OK To Drop Mandate Repeal In Tax Plan
The White House wouldn’t oppose removing from the Senate tax plan a controversial provision to repeal the individual health-care mandate of the Affordable Care Act, budget director Mick Mulvaney said, a move that could help secure the vote of key Republicans. The provision could be dropped if it becomes “an impediment,” Mulvaney, head of the Office of Management and Budget, said on CNN’s “State of the Union.” (Krasny and Brody, 11/19)

The Hill: Cotton: I Hope We Go Back To Health Care Next Year
Sen. Tom Cotton (R-Ark.) said Sunday that he hopes the Senate revisits ObamaCare repeal next year after its tax-reform push. “I hope next year that we return to health care, but right now I’m focused on this tax bill,” Cotton told CBS News’s “Face the Nation.” (Shelbourne, 11/19)

Politico Pro: Governors React To Individual Mandate Repeal In Senate Tax Reform Bill
Vice President Mike Pence touted the GOP's tax plan during a speech at the Republican Governors Association Annual Conference in Austin, Texas, this week, portraying the Senate version that repeals the ACA's individual mandate as a "tax cut for the middle class." ..But Democratic governors panned the proposal and urged Congress to instead focus on a bipartisan deal to stabilize ACA markets. (Ehley, 11/17)

Kaiser Health News: Podcast: ‘What The Health?’ Tax Bill Or Health Bill?
Republican efforts to alter the health law, left for dead in September, came roaring back to life this week as the Senate Finance Committee added a repeal of the “individual mandate” fines for not maintaining health insurance to their tax bill. In this episode of “What the Health?” Julie Rovner of Kaiser Health News, Sarah Kliff of Vox.com, Joanne Kenen of Politico and Alice Ollstein of Talking Points Memo discuss the other health implications of the tax bill, as well as the current state of the Affordable Care Act. (11/17)

8. Odd Phenomenon Of Free Health Law Coverage May Boost Enrollment In Face Of Dire Predictions

When President Donald Trump cut off subsidies to insurers he inadvertently may have boosted the very law he was trying to undermine. Meanwhile, House Democrats trying to bolster marketing for the health law are being thwarted by arcane rules.

The Associated Press: Hard To Believe: Some Consumers Find Free Health Insurance
Consumers are getting the word that taxpayer-subsidized health plans are widely available for next year for no monthly premium or little cost, and marketing companies say they're starting to see an impact on sign-ups. "Free Obamacare Coverage in 2018," says an online pitch from insurance broker eHealth, showing a young woman with a big smile. "See if you qualify." (Alonso-Zaldivar, 11/20)

CQ: House Democrats Protest Congressional Health Care Ad Ruling
Attempts by House Democrats to promote open enrollment in the health care marketplaces are running up against arcane rules and what they call partisan politics. Lawmakers are seeking to compensate for reduced marketing on the part of the Trump administration with their own taxpayer-funded ads. The Department of Health and Human Services earlier this year slashed advertising for HealthCare.gov by 90 percent, prompting cries of “sabotage” from Democrats and consumer advocates. House Democrats are trying to fill that gap through their own ads on social media and other outlets, but are being thwarted by Republicans on the Franking Commission who say the advertisements do not comply with congressional rules. (Clason, 11/17)

The Hill: Report: Nearly 30 Million Uninsured In First Half Of 2017
About 9 percent of the U.S. population were uninsured in the first six months of 2017, according to new numbers released Friday. From January to July of this year, 28.8 million people were uninsured, according to the National Center for Health Statistics (NCHS.) That's a small change from the 28.6 million who lacked insurance last year. (Hellmann, 11/17)

In news from the states —

Health News Florida: Obamacare Enrollment Off To Strong Start In State, Nation
Obamacare enrollment is off to a strong start in Florida and around the nation, according to national data and those who help people sign up for health insurance. Compared to last year, the number of people selecting plans through healthcare.gov nationally during the first two weeks of enrollment increased by 46 percent. (Ochoa, 11/17)

The Associated Press: After Trial, Menendez Pitches Health Insurance Enrollment
A day after a mistrial was declared in his federal bribery trial, New Jersey Democratic Sen. Bob Menendez got back to work Friday and urged people to sign up for health insurance under the Affordable Care Act. Menendez appeared alongside Democratic Rep. Albio Sires and Democratic Assembly Speaker Vincent Prieto in West New York to rally those eligible for health coverage under former President Barack Obama's signature law. Open enrollment ends Dec. 15. (11/17)

The Tennessean: After A Year Of Trying To Repeal Obamacare, Has Anything Changed?
After a year of trying to repeal Obamacare, has anything changed? In some ways, it’s remarkable we made it to open enrollment at all. This time last year, repeal seemed imminent. No one could say with any certainty that the ACA would still be functioning in time for open enrollment. Repeal seemed likely throughout the year, too. Plenty of plans were proposed, but at the end of the year, all it amounted to was noise. For the fifth year in a row, open enrollment rolls on. (Tolbert, 11/17)

Concord Monitor: State Steps In After Confusing Letter About Health Insurance Mailed To 20,000 Customers
Many thousands of new Hampshire residents looking for health insurance have received letters from Anthem that imply they have been automatically signed up for a policy and are being billed for it, leading to so much confusion that the state is trying to clarify things. “We started hearing from confused consumers about the middle of this week. We also heard from a broker who does a lot of business with folks signing up on the exchange who was also hearing from clients,” said Alex Feldvebel, deputy commissioner for the New Hampshire Insurance Department. The department issued a statement Friday about the situation trying to clear up the confusion. (Brooks, 11/17)

Medicare

9. As Social Security Checks Go Up, So Do 'Part B' Premiums For Many Medicare Beneficiaries

Although the standard Part B premium will stay the same next year, many beneficiaries will still have to pay more because their Social Security checks will increase 2 percent after several years of little or no cost-of-living raise. About 42 percent of recipients will see their premium jump to $134 from $109.

The Associated Press: Higher Premiums For Outpatient Coverage For Many On Medicare
Higher monthly premiums for outpatient coverage await many Medicare beneficiaries next year, the government says. The additional expense will eat away at an increase in their Social Security checks. The news about "Part B" premiums was buried in the fine print of a notice issued late Friday afternoon by the Centers for Medicare and Medicaid Services. (Alonso-Zaldivar, 11/18)

Modern Healthcare: Medicare Part B Premiums, Deductibles To Remain Flat In 2018
Premiums and deductibles for Medicare Part B beneficiaries will remain flat, the CMS announced Friday. In 2018, seniors with incomes below or at $85,000 will pay a $134 monthly premium and face a deductible of $183, the same amounts as in 2017. Medicare Part B covers doctors' appointments and outpatient hospital care, among other services. Since 2007, seniors with incomes above $85,000, or less than 5% of the total Medicare Part B population, have been charged higher premiums. (Livingston, 11/17)

CNBC: Medicare Part B Premiums Jumping 23 Percent For Many Retirees
Many Medicare recipients should be prepared to pay more for their doctor's visits and other outpatient care next year. For the 70 percent of Medicare Part B enrollees who currently pay a lower monthly premium due to a "hold harmless" legal provision, their monthly cost will rise by as much as $25 to $134, from the 2017 average of $109, according to information released Friday by the Centers for Medicare and Medicaid. (O'Brien, 11/17)

Medicaid

10. Critical Component Of Arizona's Medicaid Expansion Upheld By State's Supreme Court

At the heart of the debate was whether a hospital assessment that was used to help pay for the program was a tax.

The Hill: Arizona Supreme Court Upholds State's Medicaid Expansion
The Arizona Supreme Court on Friday upheld a critical component to keeping the state’s Medicaid expansion and preventing the number of people in the state’s Medicaid program from dipping. The high court unanimously ruled that a hospital assessment used to help pay for Medicaid expansion — where the federal government pays a majority of the tab but states are still on the hook for a smaller percentage — is constitutional. (Roubein, 11/17)

Arizona Republic: Arizona Supreme Court Rejects GOP Lawmakers' Suit To Overturn State's Medicaid Expansion
The Arizona Supreme Court on Friday in an unanimous decision rejected a bid from a group of 36 current and former Republican lawmakers to overturn the state's Medicaid expansion. The lawmakers argued that a hospital assessment used to pay the state's portion of the Medicaid expansion is a tax that required a two-thirds legislative majority to enact. The 2013 Legislature narrowly approved the assessment. (Alltucker, 11/17)

In other news —

Des Moines Register: Iowa Medicaid Starts Paying For Mental Crisis Centers, After Centerville Program Closes
Iowa human-services officials have opened a pipeline for Medicaid money to support informal mental-health crisis centers, shortly after a lack of Medicaid money contributed to the closure of a heralded southern-Iowa program. Centerville’s Oak Place center closed Oct. 31, despite widespread praise. The “crisis stabilization” center offered an informal alternative for residents with mental-health problems, many of whom otherwise would be transported to faraway hospital psychiatric units. (Leys, 11/17)

Veterans' Health Care

11. Canceled Appointments And Lengthy Wait Times Still Occurring At VA Medical Centers

The Department of Veterans Affairs’ internal watchdog issues two reports, finding continued issues with the agency's mental health care services and wait times at a clinic. And news of more problems is reported from Georgia and Colorado facilities. Meanwhile, an advocacy group runs ads critical of the VA's use of dogs in experiments.

The Wall Street Journal: Two Critical Reports Indicate Problems Persist At VA
The Department of Veterans Affairs’ internal watchdog criticized the agency in new reports this week for problems it has struggled for years to address, including providing timely treatment for vulnerable veterans. One report from the VA’s Office of Inspector General detailed how a patient suffering from mental-health issues took his own life while waiting for treatment and after canceled appointments. (Kesling, 11/17)

The Denver Post: Federal Watchdog Finds Colorado VA Facilities Used “Unofficial Wait Lists” For Mental Health Care
A new federal investigation revealed Thursday that VA officials in Colorado broke agency rules by using an off-the-books system to track patients who wanted mental-health therapy — a violation that caused veterans to wait for care and one that recalls past abuses by the U.S. Department of Veterans Affairs. Investigators with the VA’s internal watchdog found that in three separate facilities — Denver, Golden and Colorado Springs — agency officials did not follow proper protocol when keeping tabs on patients who sought referrals for treatment of conditions such as post-traumatic stress disorder. (Matthews and Migoya, 11/16)

The Washington Post: A Dying Vet Needed CPR. Hidden Video Shows His Nurse Laughing Instead.
By the late winter of 2014, James Dempsey had served in a world war, raised children, buried a wife and seen the best of his health behind him. As he prepared for a stay at a nursing home on the outskirts of Atlanta, the 89-year-old began to feel nervous. So his family hid a camera in his room at Northeast Atlanta Health and Rehabilitation, Dempsey’s son later told WSB-TV. His father knew about it, he said, but the nurses didn’t. (Selk, 11/18)

And in news on PTSD in veterans, and cancer patients —

WBUR: The Many Forms, Faces And Causes Of PTSD
Post-traumatic stress disorder is often associated with combat, but trauma comes in many forms. About 7 or 8 percent of people experience PTSD at some point in their lives, according to the Department of Veterans Affairs. (Doubek, McDaniel and McNulty, 11/19)

Stat: 1 In 5 Shows PTSD Symptoms After Cancer Diagnosis, Study Finds
Roughly 1 in 5 cancer patients developed post-traumatic stress disorder within six months of their diagnosis — and a small percentage still experienced trauma-related symptoms six years later, according to new research. Cancer patients and psychologists have long known a cancer diagnosis can lead to post-traumatic stress disorder, even when patients manage to drive their disease into remission. (Tedeschi, 11/20)

Public Health And Education

12. A Snapshot Of Those In The Trenches Of America’s Addiction Crisis

The Associated Press puts human faces to the numbers behind the opioid epidemic. In other news, a look at how influence in Washington, D.C., has played a role in the crisis, Purdue wants to settle lawsuits with states, counterfeit pills are sending droves of people to the hospital, why medication-assisted treatment is hard for some to get, and more.

The Associated Press: ‘It Never Really Leaves You.’ Opioids Haunt Users’ Recovery
It’s hard to say whether businessman Kyle Graves hit rock bottom when he shot himself in the ankle so emergency room doctors would feed his opioid habit or when he broke into a safe to steal his father’s cancer pain medicine. For straight-talking ex-trucker Jeff McCoy, it was when he grabbed a gun and threatened to blow his brains out if his mother didn’t hand over his fentanyl patches. (Tanner, 11/20)

The Washington Post: Former Top Justice Official Went To Bat For Drug Giant Cardinal Health
In late January 2012, drug distributor Cardinal Health got word that the Drug Enforcement Administration was about to take action against the company’s Lakeland, Fla., warehouse, which supplied 36 million opioid painkillers to customers in three Southern states every month. Large numbers of pills had been leaking onto the black market and Cardinal had failed to report warning signs to the DEA, agency records show. Cardinal was concerned that the DEA was about to hit the warehouse with an “immediate suspension order” — a tactic that instantly halts all commerce in controlled substances. (Bernstein and Higham, 11/17)

Bloomberg: Purdue Approaches States In Bid To Settle Opioid Claims
Oxycontin maker Purdue Pharma LP is proposing a global settlement in an attempt to end state investigations and lawsuits over the U.S. opioid epidemic, according to people familiar with the talks. Purdue’s lawyers raised the prospect with several southern-state attorneys general who haven’t sued the company, as they try to gauge interest for a more wide-ranging deal, said four people who asked not to be identified because the talks aren’t public. (Feeley and Hopkins, 11/17)

The Washington Post: Counterfeit Opioid Pills Are Tricking Users — Sometimes With Lethal Results
More than two dozen patients were rushed into an emergency room in Macon, Ga., over two days with the same array of life-threatening symptoms, including organ failure and sepsis, flummoxing doctors. But after their breathing tubes were removed, the patients revealed a common thread: All had taken what they believed were Percocet pills they had bought on the street. Although they looked like the prescription painkillers at first glance, the pills they took were nothing like what they expected. (Zezima, 11/19)

The Wall Street Journal: Why Opioid Addicts Find M.A.T. Hard To Come By
Drug overdoses killed 64,000 Americans last year — most of them involving painkillers or other opioids. Addiction experts are in wide agreement on the most effective way to help addicts: medication-assisted treatment. They say that wider adoption of this method would save lives. But most inpatient rehab facilities in the U.S. don’t offer this option, and there’s a shortage of doctors in rural areas that are able to prescribe these highly-controlled medications. (Bellini, 11/17)

Modern Healthcare: CMS Targets Opioid Abuse, Regulatory Burden In Medicare Advantage Plans
The CMS proposed several changes aimed at combating opioid addiction among seniors and dual-eligibles and advancing the Trump administration's agenda of reducing regulatory burdens and increasing flexibility for health plans. The agency said the proposed changes to the Medicare Advantage program and Medicare Part D prescription drug plans for 2019 would save Medicare about $195 million a year over five years, helping to lower premiums and improve benefits for Advantage plan members. (Livingston, 11/17)

Bloomberg: Trump Economists Say Opioid Crisis Much Bigger Than Envisioned
The opioid epidemic sweeping the U.S. is far costlier than once thought, with the economic impact of the crisis exceeding half a trillion dollars, according to a new report by White House economists. The epidemic cost the American economy $504 billion in 2015, which was the equivalent of 2.8 percent of gross domestic product that year, according to the report by the Council of Economic Advisers, or CEA. The White House’s figures are more than six times larger than a previous study because it incorporates the value of lives lost to the epidemic. (Woods, 11/19)

The Hill: White House: Economic Cost Of Opioid Crisis About $504B
The economic cost of the opioid epidemic was about $504 billion in 2015, which is more than six times higher than other studies from previous years, according to a newly released analysis from the White House Council of Economic Advisers (CEA). This figure accounts for roughly 2.8 percent of gross domestic product. The opioid crisis has garnered the national spotlight, as it has led to a significant uptick in overdose deaths since 1999 and, most recently, was declared a national public health emergency by President Trump. (Roubein, 11/19)

13. Puerto Rico's Health System Still Reeling From Maria Two Months Later

Half of Puerto Rico’s electric grid remains down, leaving many of the island’s 3.4 million residents exposed to the heat and unable to keep food or medicines cool without generators. Doctors are trying to make house calls, but there's only so much they can do. And at the same time, the conditions have exacerbated many residents' medical problems.

The Wall Street Journal: Two Months After Maria, Puerto Rico’s Health System Struggles To Meet Needs
In western Puerto Rico, Oscar Corzo, a New York physician, was treating a woman for her chronic illnesses this month when he noticed a group of her neighbors had gathered to ask for help. “Almost kind of organically, there was a waiting room,” said Dr. Corzo, who stayed on the woman’s porch for two hours treating her neighbors. “It really struck me because it told me what need there was.” (Evans, 11/19)

The Hill: Congress Faces Growing Health Care Crisis In Puerto Rico
Puerto Rico’s Medicaid funding crisis is deepening, adding yet another issue for Congress to deal with in what is sure to be a hectic December. Hurricane Maria caused serious damage to Puerto Rico’s health-care system, and none of the federal disaster relief money to date has been earmarked for the Medicaid program. (Weixel, 11/19)

14. 'Parkinson’s Diagnosis Is Not A Stop Sign,' Jesse Jackson Says

Jesse Jackson, who has been a civil rights advocate for 50 years, announced the diagnosis on Friday. The New York Times offers a closer look at the disease.

The New York Times: Jesse Jackson Announces He Has Parkinson’s Disease
The Rev. Jesse L. Jackson, the longtime civil rights leader and former Democratic presidential candidate, said Friday he has Parkinson’s disease. In a letter posted on Twitter on Friday afternoon, Mr. Jackson, 76, shared the news and his struggle to accept it. “Recognition of the effects of this disease on me has been painful, and I have been slow to grasp the gravity of it,” he wrote. “For me, a Parkinson’s diagnosis is not a stop sign but rather a signal that I must make lifestyle changes and dedicate myself to physical therapy in hopes of slowing the disease’s progression.” (Chokshi, 11/17)

The New York Times: What Is Parkinsonism?
Parkinsonism refers to a group of movement abnormalities — such as stiffness, slowness, shuffling of the feet and often tremor — that are classic features of Parkinson’s disease but that can also be caused by medications and other disorders with overlapping symptoms, said Dr. Michael S. Okun, a neurologist and the national medical director of the Parkinson’s Foundation. He said that he makes no assumptions about the cause of parkinsonism “until I see the patient and pinpoint the diagnosis.” (Rabin, 11/17)

15. Number Of Transgender Homicide Cases For This Year Highest On Record

And the advocacy groups say their counts may be incomplete because transgender victims are sometimes misidentified in police and news reports.

The Associated Press: Advocacy Groups: Killings Of Transgender People Increase
At least 25 transgender people in the United States have been homicide victims so far this year, the highest annual total on record, according to advocacy groups that have been monitoring the grim phenomenon and seeking ways to reduce the toll. The Human Rights Campaign, in a report released Friday, calculated that 102 transgender people have been killed in the U.S. over the past five years — including 25 this year. Its report, jointly sponsored by the Trans People of Color Coalition, was issued ahead of Monday's annual Transgender Day of Remembrance observations, commemorating the hundreds of transgender people killed worldwide each year. (Crary, 11/17)

In other news —

The Associated Press: Theo’s Journey: A Transgender Child At War With His Body
Theo Ramos learned how to cut himself when he was in fifth grade, when his body seemed to revolt. Exploring online was easy, with hashtags like #scars, #hurt and #brokeninside. Nothing made sense back then, but Theo absorbed what he saw on websites like a religion. All he could focus on was how the exterior he was born with — that of a girl — didn’t look or feel right. That was six years ago, when he had another name and a different gender. (Lush, 11/20)

16. Asia's Bird Flu Putting Global Health Officials On High Alert

The flu makes worries many scientists as they see it as the virus most likely to start a pandemic that kills millions, as the 1918 Spanish flu did. In other public health news: vaccines, blood pressure, cigarette ads, standing desks, napping on the job and more.

The New York Times: Bird Flu Is Spreading In Asia, Experts (Quietly) Warn
While trying to avoid alarmism, global health agencies are steadily ratcheting up concern about bird flu in Asia. Bird viruses that can infect humans — particularly those of the H7N9 strain — continue to spread to new cities there. Since October 2016, China has seen a “fifth wave” of H7N9 infections. Nearly 1,600 people have tested positive, almost 40 percent of whom have died. (McNeil, 11/17)

Stat: A Plan To Develop A Zika Vaccine Runs Into Controversy, As Questions Swirl About Price And Conflicts Of Interest
Yet another battle may erupt over a Zika virus vaccine and the extent to which drug makers should be allowed to benefit from products that are developed — at least in part — with taxpayer funds. There is an added twist in this case, however, in the form of potential conflicts of interest. Let’s start at the top: Last month, the National Institutes of Health announced plans to issue an exclusive license to a privately held company called PaxVax to develop a Zika vaccine. Few details were disclosed, but the move is now prompting demands from advocacy groups that the federal government should not award an exclusive license or, if it does, should ensure that any vaccine is priced so it is accessible to Americans. (Silverman, 11/17)

Stat: Merck Will Miss Long-Promised Target For Filing Ebola Vaccine License With FDA
The world is going to have to wait a little longer for the Merck Ebola vaccine. Though Merck had repeatedly said it would file its licensure application with the Food and Drug Administration by the end of 2017, the company will not meet that self-imposed target, the team leader for the Ebola vaccine project told STAT on Friday. (Branswell, 11/17)

NPR: Odds Are They're Taking Your Blood Pressure All Wrong
When was the last time you were asked to sit without saying a word for five minutes before your blood pressure was measured? If your answer was "I never remember doing that," you're in good company. Yet that is one of the many rules that medical professionals are supposed to follow when measuring your blood pressure. (Harris, 11/20)

The Philadelphia Inquirer: Tobacco Industry Starts Major Ad Campaign - Against Its Own Deadly Products
Next Sunday, more than 11 years after a federal court ordered it, tobacco companies will begin running frank ads on TV and in newspapers including the Inquirer to admit their products are deadly. “More people die every year from smoking than from murder, AIDS, suicide, drugs, car crashes, and alcohol combined,” says one of the statements the companies are compelled to use. The settlement on the “corrective statement” ads was reached last month by the tobacco companies, the U.S. Department of Justice, the American Cancer Society, the American Lung Association and four other public health groups. (McCullough, 11/20)

The Washington Post: A Standing Desk Isn’t Going To Help You Lose A Lot Of Weight
From the Apple Watch to standing desks, a number of products attempt to get users to stand more and sit less. But how many more calories do you burn, and can this help you lose weight? A new study set out to answer these questions by analyzing data from nearly 50 previous studies on the topic. The studies included more than 1,100 people in total. All of these earlier studies measured the difference between calories burned while sitting vs. standing. (Rettner, 11/19)

The Washington Post: Napping On The Job May Turn Out To Be A Very Good Idea For A Sleep-Deprived Nation
President Trump prides himself on getting by with just four or five hours of sleep at night, which leaves him plenty of time early in the morning to scan cable TV news and tweet before going to work. During last year’s rough-and-tumble campaign, he scoffed at ­“low-energy” rivals Republican Jeb Bush and Democrat Hillary Clinton for carving out nap time. “No naps for Trump! I don’t nap,” the 71-year-old Trump bellowed during one campaign stop. “We don’t have time.” (Pianin, 11/19)

NPR: Young Men, Frequent Drivers Most Likely To Get Distracted While Driving
If you're reading this on your phone while driving, stop it. Especially if you're a young neurotic extroverted guy who drives a lot. Two seconds of attention to the insistent beeping and blinking of our mobile phones or simply changing the radio station accounts for at least 12 percent of car accidents worldwide and 14 percent of them in the U.S., according to the National Highway Transportation Safety Administration. (Fulton, 11/17)

Stat: Motorcycle Crashes Are Alarmingly Common — And Incredibly Costly
Motorcycle crashes are alarmingly common — and incredibly costly, according to a new study. Researchers pulled data from adults treated for motorcycle and car crash injuries at hospitals in Ontario, Canada between 2007 and 2013. The toll: Nearly 282,000 adults injured in car accidents and nearly 27,000 in motorcycle crashes during that time frame. (Thielking, 11/20)

Kaiser Health News: Shingles: Don’t Let It Get You The Way It Got Me
Shingles tried to kill me. Like an insidious invading army, the virus that more commonly causes chickenpox in children attacked the right side of my head, leaving me permanently deaf in my right ear. Shingles almost destroyed my voice box, too, and it caused my right eyelid and lower lip to temporarily droop. (Horovitz, 11/20)

Marketplace

17. Surprise Medical Bills And Balance Billing: 'It's A System Totally Rigged Against Patients'

Patients who do all the right things to go to an in-network hospital can still get stuck with thousands of dollars of surprise medical bills because the doctor treating them is out of network. The Houston Chronicle investigates why that is.

Houston Chronicle: Feud Between Doctors, Insurance Companies Leave Texas Patients With Surprise Medical Bills
[Jason] Pettit, like so many others in this country, had tumbled unsuspecting into a multimillion-dollar business practice called balance billing. The murky system allows doctors outside a patient's coverage network to set higher rates and then shift any or all of the "balance" not paid by insurers onto patients to make up the difference. It happens most often in emergency care where vulnerable patients have no way of knowing in advance who will treat them. Often they find out too late that just because the hospital is in-network does not mean the doctor will be, too. (Deam, 11/17)

In other health industry news —

CT Mirror: Anthem, Hartford HealthCare Agree On New, Retroactive Contract
Hartford HealthCare and Anthem Blue Cross and Blue Shield said early Saturday they had reached agreement on a new contract, ending a stalemate that had left Hartford HealthCare providers out of the Anthem insurance network since Oct. 1. The two sides said the agreement is retroactive so that all Anthem customers who received treatment from Hartford HealthCare providers will be covered at in-network rates as though there had been no disruption. (11/18)

Modern Healthcare: Advisory Board Finalizes Deal With UnitedHealth's Optum
Shareholders and company executives finalized the Advisory Board Co.'s $2.58 billion deal with UnitedHealth Group and a private equity firm that will split the consulting group's healthcare business from its education arm, the companies announced Friday. UnitedHealth's Optum health-services segment will take over the Advisory Board's healthcare business for an estimated $1.3 billion, including its debt. The Advisory Board provides independent research, advisory services and data analytics for more than 4,400 healthcare organizations. (Kacik, 11/17)

Modern Healthcare: EClinicalWorks Sued Over Patient Record Inaccuracies
EHR vendor eClinicalWorks is in legal trouble yet again, this time facing a putative class-action lawsuit that alleges that its software is flawed, creating inaccuracies in patient health data. The electronic health records vendor "has failed millions of patients by failing to maintain the integrity of patients' records" and has therefore breached its fiduciary duty, according to the complaint.In the suit, the relative of a deceased cancer patient alleges that eClinicalWorks misrepresented its capabilities to certifying organizations so it would be certified under the meaningful use program. (Arndt, 11/17)

California Healthline: Health Giant Sutter Destroys Evidence In Crucial Antitrust Case Over High Prices
Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge. In a ruling this week, San Francisco County Superior Court Judge Curtis E.A. Karnow said Sutter destroyed documents “knowing that the evidence was relevant to antitrust issues. … There is no good explanation for the specific and unusual destruction here.” (Terhune, 11/17)

State Watch

18. State Highlights: NYC Submitted False Lead-Paint Inspections Claims; Fla. Scrubs Its Website Of Information On Troubled Nursing Homes

Media outlets report on news from New York, Florida, Connecticut, Wisconsin, California, Texas, Georgia and Illinois.

The Wall Street Journal: New York City Mayor Bill De Blasio Knew Of Lead-Compliance Failure
New York City Mayor Bill de Blasio has known the city’s housing authority wasn’t complying with lead-inspection regulations since last year, his office said Sunday. In a report issued last week, the city’s Department of Investigation said the New York City Housing Authority submitted false claims to the federal government showing it had conducted lead-paint inspections when the required work hadn’t been done for years. (Vilensky and Gay, 11/19)

The New York Times: 2 Housing Authority Officials Resign After False Lead Paint Reports
Amid escalating outcry over false reports filed by the city related to lead paint inspections in public housing, the de Blasio administration on Friday announced that two senior officials at the city’s Housing Authority had resigned and another had been demoted. The administration also said in an emailed statement, sent late in the afternoon, that the Housing Authority would create a department to oversee regulatory compliance and the accuracy of reports. (Goodman, 11/17)

Miami Herald: Florida Wipes Inspections Of Troubled Nursing Homes From Its Website
For many years, AHCA’s website included links to inspections of nursing homes, retirement homes and hospitals. ...The agency then began to heavily redact the reports — eliminating words such as “room” and “CPR” and “bruises” and “pain” — and rendering the inspections difficult to interpret for families trying to gauge whether a facility is suitable for a loved one. (Marbin Miller and Ostroff, 11/17)

CT Mirror: Malloy Dishes Out Legislature’s Big Mandated Cuts
Connecticut got a clearer picture of the painful cuts in the new state budget Friday when Gov. Dannel P. Malloy imposed more than $880 million in spending cuts mandated by the General Assembly. Labor cost-cutting moves, as required under last summer’s concessions deal with unionized state employees, account for the biggest chunk of those savings. (Phaneuf and Rabe Thomas, 11/17)

Milwaukee Journal Sentinel: Confidential Information Of 9,500 Patients At The Medical College Of Wisconsin Compromised
Confidential medical information or other personal data of 9,500 patients at the Medical College of Wisconsin was compromised by a targeted attack on the school’s email system in July, the Medical College said Friday. ...Social Security numbers of 34 patients and the bank account information of one patient were in the affected email accounts, the Medical College said. (Boulton, 11/17)

Los Angeles Times: Tijuana Cosmetic Surgery Clinic Under Scrutiny In Downey Woman’s Death
Irma Saenz told family members she was going to Tijuana for the day. But she didn't tell them what for: The 51-year-old Downey resident had scheduled a liposuction procedure at a cosmetic surgery clinic. Four days later, Saenz was in a coma when an ambulance brought her across the border, her relatives said. She died on Nov. 11, nearly two weeks later, at Sharp Chula Vista Medical Center, after her family made the decision to take her off life support. (Dibble, 11/18)

Dallas Morning News: Lawsuit Over Urine Samples Collected In Fast-Food Restrooms Heats Up Between Insurer, Lab Company
An alleged $100 million fraud lawsuit over gift cards given to people to urinate in cups at Whataburger bathrooms is heating up in federal court, with each side accusing the other of going too far. Insurance giant UnitedHealthcare alleges that Next Health, a Dallas lab testing company, paid bribes and kickbacks to doctors and other providers between 2011 and 2016 for ordering overpriced and unnecessary drug and genetic tests under the guise of a wellness study. (Krause, 11/18)

Georgia Health News: DeKalb Medical Again Faces Federal Scrutiny Over Patient Care
For the second time in four months, DeKalb Medical Center faces a federal deadline for approval of a plan of correction after a patient care problem. ...The patient, whose chief complaint was rectal bleeding, was given a dosage of medication that was much higher than the maximum recommended limit for the drug, federal officials said. (Miller, 11/19)

Sacramento Bee: They Reported Sex Harassment In State Jobs And Found ‘Retaliation Is Alive And Well’
As the topic of sexual harassment bubbles to the surface inside California state government, and lawmakers promise reforms, former workers who say they experienced such treatment paint a grim picture of how their cases were handled. Plaintiffs who have sued the state over sexual harassment describe a kind of David-and-Goliath ordeal that, in hindsight, wasn’t altogether worth the lost sleep, strained marriages, health problems, broken work relationships, harrowing interviews and fractured careers. (Lundstrom and Koseff, 11/20)

The San Diego Union-Tribune: Local Nursing Homes Agree To Pay Up To $6.9 Million To Settle Kickback And Fraud Allegations
Four San Diego nursing homes have agreed to pay up to $6.9 million to settle civil allegations that employees paid kickbacks for referrals and submitted fraudulent bills to government healthcare programs, the U.S. Attorney’s Office announced Thursday. The nursing homes, all owned by Los Angeles-based Brius Management Co., were accused of paying kickbacks to hospital staffers in violation of anti-kickback laws, the U.S. Attorney’s Office said in a news release. (Cook, 11/16)

Editorials And Opinions

19. Perspectives On Obamacare: Mandate Repeal Is Not A Tax Increase; Who Wins If Mandate Is Gone

Opinion writers analyze the controversy about the Senate Republican tax bill's efforts to get rid of the federal health law's requirement to have insurance or pay a fine and other concerns about the law.

Forbes: Fact-Checking Democratic Claims About Repealing Obamacare's Individual Mandate
Senate Republicans have included a repeal of Obamacare’s individual mandate in the latest version of their tax reform bill. Some Democrats have reacted by claiming that the repeal of the mandate is actually a tax increase, and that mandate repeal “kicks” people off coverage they didn’t want to buy. Welcome to 2017. ... The “mandate repeal is a tax hike” argument seems ludicrous on its face. Why would repealing a tax—the fine that you pay if you find Obamacare’s coverage unaffordable—represent a tax increase? (Avik Roy, 11/16)

The New York Times: Who Really Gets A Tax Increase If The Individual Mandate Goes Away?
If Obamacare’s requirement to have health insurance is revoked by Congress, some people will choose to go without it, and the government will save money because it won’t have to pay to subsidize their plans. Almost everyone agrees on that. But precisely how much the individual mandate matters, and who would really be worse off without it, are trickier questions. (Margot Sanger-Katz, 11/17)

San Jose Mercury News: GOP Attack On Californians’ Health Is Most Brutal Yet
The House passed its version of a tax bill Thursday with zero support from Democrats. That plan is bad enough, but the one festering in the Senate is even worse. It is an attack on Californians and low- and middle-income citizens across the nation. Republicans are ready to sabotage Americans’ health care, including Medicare for senior citizens, to deliver tax breaks to the richest Americans and the corporations they control. Including Donald Trump’s. (11/17)

Milwaukee Journal Sentinel: Repeal Obamacare's Individual Mandate
Insurance companies lobbied hard for Obamacare — who wouldn’t want a law requiring every American to buy your product? In effect, Obamacare turned insurance plans into something no rational person would buy, then forced people to buy them anyway. If the Senate tax plan succeeds in repealing the mandate, individuals won’t be forced to purchase an inferior product. Those poor insurance companies will have to persuade people their plans are worthwhile, and that includes keeping premiums and deductibles low — which is how the free-market system is supposed to work. (Christian Schneider, 11/17)

Huffington Post: Nobody Is Really Sure How Obamacare Enrollment Is Going This Year
The Affordable Care Act clearly isn’t “dead,” as President Donald Trump declared a month ago. But despite some surprisingly large sign-up numbers for the first two weeks of open enrollment, it’s way too early to tell just how big a toll Trump’s war on the program has taken ― or how many people will end up with insurance by Dec. 15, the deadline for obtaining 2018 coverage. That’s what you’ll hear from most experts who follow the issue closely. It’s also what you’ll hear from people like Jodi Ray, who is the project director for Florida Covering Kids and Families, a nonprofit that has spearheaded state efforts to get residents health insurance under “Obamacare.” (Jonathan Cohn, 11/19)

Detroit News: Medicaid Due For An Overhaul
For years, doctors, patients and lawmakers have rightly complained federal rules and regulations make it all but impossible for states to reform and innovate Medicaid. But last Tuesday, Seema Verma, the chief administrator of the Centers for Medicare and Medicaid Services, promised a “new era” of flexibility and accountability for the program. By expanding access to one of Medicaid’s flexibility provisions known as Section 1115 waivers, the Trump administration is offering a bold option for states that want to improve health care for their poor and disabled citizens. (Tim Huelskamp, 11/19)

Georgia Health News: We Need To Move From Chaos To Health Security
Chaos in Washington distracts us from the political dysfunction and lost opportunities here in Georgia. Because the state has chosen not to expand Medicaid under the Affordable Care Act, more than 300,000 low-income Georgians, the majority working in low-paying jobs that don’t provide coverage, remain in the coverage gap, without affordable health insurance options. (Harry Heiman, 11/19)

20. Viewpoints: Dangerous Roads; Cracking Down On Stem Cell Clinics, Half-Hearted Fight Against Hep A

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

The New York Times: America Is Now An Outlier On Driving Deaths
This week, millions of Americans will climb into their cars to visit family. Unfortunately, they will have to travel on the most dangerous roads in the industrialized world. It didn’t used to be this way. A generation ago, driving in the United States was relatively safe. ... Over the last few decades, however, other countries have embarked on evidence-based campaigns to reduce vehicle crashes. The United States has not. The fatality rate has still fallen here, thanks partly to safer vehicles, but it’s fallen far less than anywhere else. (David Leonhardt, 11/19)

Los Angeles Times: The FDA Closes A Huge Loophole Used By Bogus Stem-Cell Clinics, But Delays Serious Enforcement For 3 Years
There was good news and bad news in the regulatory initiative the Food and Drug Administration rolled out on Thursday, aimed partially at clinics marketing unproven stem-cell therapies directly to consumers. The good news is that the FDA firmly closed a loophole exploited by many of these proliferating clinics. Those that say they’re using liposuctioned fat to produce stem cells that they reinject in a patient to treat a host of medical conditions, the FDA says, are selling a drug. That means they need to be specially licensed and subjected to inspection. Here’s the bad news: The agency is giving the clinics up to 36 months to comply with the regulations. That’s far too indulgent. (Michael Hiltzik, 11/17)

Los Angeles Times: Want L.A's Hepatitis A Crisis To Get Even Worse? Follow Venice Beach's Lead
With Southern California confronting a deadly epidemic of hepatitis A, a highly contagious ailment that spreads through contact with the feces of an infected person, urban centers ought to be doing everything possible to improve sanitation. That’s especially true in enclaves frequented by the homeless. ... Venice Beach, another hub of homelessness, has a key infrastructural advantage: Because the beach and the boardwalk are among the most visited tourist destinations in the state, there are public restrooms built to accommodate crowds on summer days. That means plenty of restrooms for the homeless .... But rather than exploit those bathrooms to help protect residents and visitors from biohazards, the powers that be close the beachside bathrooms every night at midnight, and keep them locked until 5 a.m. (Conor Friedersdorf, 11/20)

Bloomberg: Take That Scary Hypertension News With A Grain Of Salt
Since worry can increase your blood pressure, it’s counterproductive to fret about the alarming headlines declaring that hypertension now affects half of all Americans, including about 80 percent of those over 65. The numbers don’t reflect a sudden decline in the public’s health; instead, health authorities have expanded the definition of hypertension so it now includes some 30 million more people. And yet despite this dramatic shift, surprisingly little has changed in the scientific understanding of hypertension, or in what your doctor is likely to recommend. (Faye Flam, 11/17)

The Washington Post: Teenage Depression And Suicide Are Way Up — And So Is Smartphone Use
Around 2012, something started going wrong in the lives of teens. In just the five years between 2010 and 2015, the number of U.S. teens who felt useless and joyless — classic symptoms of depression — surged 33 percent in large national surveys. Teen suicide attempts increased 23 percent. Even more troubling, the number of 13-to-18-year-olds who committed suicide jumped 31 percent. (Jean Twenge, 11/19)

Modern Healthcare: We Need To Have Those Conversations About End Of Life
Death is inevitable. Clinicians know when it is imminent. Pushing against impending death not only creates undue burdens on the system and the dying patient, but is often contrary to the way most people want to die. Yet many healthcare providers continue to engage in a costly and futile battle. (Anna-Gene O'Neal, 11/15)