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5. Political Cartoon: 'Gravy Train?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Gravy Train?'" by Jeff Koterba, Omaha World Herald.

Here's today's health policy haiku:

WEDDED BLISS, HEALTH CARE OR A PAY CUT?

For better, worse or …
An affordable health plan?
Let’s stay together.

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Summaries Of The News:

Capitol Hill Watch

6. Individual Mandate Repeal Included In Senate Tax Bill Despite Dire Warnings About Market Instability

The House -- which did not include repeal of the individual mandate -- and the Senate still need to reconcile their versions of the tax legislation, but Republicans have been in favor of getting rid of the requirement since it was passed so it's likely it will make it in the final law.

The Associated Press: Tax Bill Clears Senate In Big Boost For Trump, GOP
Republicans muscled the largest tax overhaul in 30 years through the Senate early Saturday, taking a big step toward giving President Donald Trump his first major legislative triumph after months of false starts and frustration on other fronts. "Just what the country needs to get growing again," Senate Majority Leader Mitch McConnell, R-Ky., said in an interview after a final burst of negotiation closed in on a nearly $1.5 trillion package that impacts the breadth of American society. (Fram, Gordon and Ohlemacher, 12/2)

Reuters: U.S. Senate Tax Bill Accomplishes Major Obamacare Repeal Goal
The sweeping tax overhaul that passed the U.S. Senate on Saturday contains the Republicans' biggest blow yet to former President Barack Obama's healthcare law, repealing the requirement that all Americans obtain health insurance. The individual mandate is meant to ensure a viable health insurance market by forcing younger and healthier Americans to buy coverage to help offset the cost of sicker patients. It helps uphold the most popular provision of the law, which requires insurers charge sick and healthy people the same rates. Removing it while keeping the rest of Obama's Affordable Care Act intact is expected to cause insurance premiums to rise and lead to millions of people losing coverage, policy experts say. (Abutaleb, 12/2)

The Washington Post: Senate’s Huge Tax Bill Would Have Potent Ripple Effects For Health-Care System
The Republican tax overhaul that squeaked through the Senate early Saturday morning would reach deep into the nation’s health-care system, with a clear dagger to a core aspect of the Affordable Care Act and broader ripple effects that could threaten other programs over time. The measure would abolish the government’s enforcement of the ACA requirement that most Americans carry insurance coverage. It would not end the individual mandate itself but would eliminate tax penalties for flouting that requirement. The result could cause an extra 13 million people to become uninsured and drive up insurance premiums in marketplaces created under the law, according to an estimate by Congress’s nonpartisan budget analysts. Yet downstream effects of the bill that have drawn less attention could potentially damage the health care and well-being of far more people. (Goldstein, 12/2)

The New York Times: Few Hurdles Left, G.O.P. Is Confident Tax Cuts Will Be Signed This Month
Congressional Republicans, buoyed by the Senate’s approval early Saturday of a landmark tax overhaul, expressed confidence that final legislation would be sent to President Trump by the end of this month. While the tax bills approved by the House and the Senate diverge in significant ways, the same forces that rocketed the measures to passage appear likely to bond Republicans in the two chambers as they work to hash out the differences. (Tankersley and Rappeport, 12/2)

The New York Times: For McConnell, Health Care Failure Was A Map To Tax Success
For Mitch McConnell and fellow Senate Republicans, the push for a sweeping tax overhaul was never anything like the divisive internal party struggle that prevented repeal of the Affordable Care Act. “All of my members, from Collins to Cruz, were just more comfortable with this issue,” Mr. McConnell, the Kentucky Republican and majority leader, said in an interview this weekend, referring to the centrist Susan Collins of Maine and the conservative Ted Cruz of Texas. “Everybody really wanted to get to yes. There was a widespread belief that this was just a good thing to do for the country and for us politically.” (Hulse, 12/3)

The Washington Post: Another Delicate Challenge For Republicans: Reconciling House And Senate Tax Bills
Republicans will try Monday to urgently reconcile the tax overhaul bills they passed in the House and Senate, entering a delicate period where they have to retain the support of their party’s conservative and moderate members. Party leaders insist that there are no showstopping differences between their two bills, each of which features a decrease in the corporate tax rate from 35 percent to 20 percent. Still, the bills feature differences worth hundreds of billions of dollars. (Werner, Paletta and DeBonis, 12/3)

CQ: Health Lobby Frets Over Lack Of Insurance Mandate Alternative
The health care industry is increasingly concerned that lawmakers could roll back a requirement that most Americans have health insurance coverage without putting a replacement policy in place. Senate Republicans could vote to repeal the requirement that most Americans purchase health insurance or pay a fine under the 2010 health care law (PL 111-148, PL 111-152) as part of a sweeping tax bill (S 1) as soon as this week. Unlike the health care bills considered by Congress earlier this year, Republicans have not put forward an alternative policy that would incentivize people to buy health insurance coverage. (McIntire, 12/1)

7. Following Tax Victory, Republicans Start Eyeing Medicare

Republican leaders have been champing at the bit to cut government programs such as Medicare, and critics are now worried they'll use swelling deficits created by the GOP tax bill as an excuse to go after the programs.

The New York Times: Heading Toward Tax Victory, Republicans Eye Next Step: Cut Spending
As the tax cut legislation passed by the Senate early Saturday hurtles toward final approval, Republicans are preparing to use the swelling deficits made worse by the package as a rationale to pursue their long-held vision: undoing the entitlements of the New Deal and Great Society, leaving government leaner and the safety net skimpier for millions of Americans. Speaker Paul D. Ryan and other Republicans are beginning to express their big dreams publicly, vowing that next year they will move on to changes in Medicare and Social Security. President Trump told a Missouri rally last week, “We’re going to go into welfare reform.” (Zernike and Rappeport, 12/2)

The Washington Post: GOP Eyes Post-Tax-Cut Changes To Welfare, Medicare And Social Security
“You also have to bring spending under control. And not discretionary spending. That isn't the driver of our debt. The driver of our debt is the structure of Social Security and Medicare for future beneficiaries,” Sen. Marco Rubio (R-Fla.) said this week. While whipping votes for a GOP tax bill on Thursday, Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) attacked “liberal programs” for the poor and said Congress needed to stop wasting Americans' money. (Stein, 12/1)

8. Congress Still Dragging Feet Over CHIP: They're 'Playing Politics With Our Kids' Health Care'

Lawmakers have included a provision to fund the program until the end of the year in a stopgap spending plan, but many states scramble in the meantime as money starts to run out.

The Associated Press: Health Care Fallout: Fate Of 8M Low-Income Children In Limbo
TC Bell knows what life is like without health insurance after growing up with a mother who cobbled together care from a public health clinic, emergency room visits and off-the-books visits to a doctor they knew. That memory makes Bell, of Denver, grateful for the coverage his two daughters have now under the Children's Health Insurance Program — and concerned about its uncertain future in Congress. (Karnowski and Anderson, 12/1)

Bloomberg: Millions Of Poor Children Could Lose Health Care If Congress Doesn’t Act Soon
States from Oregon to Massachusetts are scrambling to help millions of poor families whose children could lose coverage if Congress fails to reinstate a health insurance program that was approved two decades ago with bipartisan support. The Children’s Health Insurance Program is on the brink of running out of money, and Congress has dragged its feet in passing a reauthorization bill since the program ended on Sept. 30. If lawmakers don’t pass a budget by Dec. 8, the federal government could shut down with the CHIP bill still in limbo. (Rausch, 12/1)

The Hill: Key Lawmaker Seeks Flexibility For States On CHIP
The chairman of the House Energy and Commerce Committee is working to lift a restriction on how much money states can get to keep their Children’s Health Insurance Programs (CHIP) running, as Congress works to reauthorize the program that lapsed Sept. 30. Chairman Greg Walden (R-Ore.) has been working with leadership on granting states more flexibility to keep their programs going, according to a GOP committee spokesperson. (Roubein and Hellmann, 12/1)

CQ: House Appropriations Unveils Two-Week Stopgap, CHIP Aid
House appropriators on Saturday morning introduced a two-week spending stopgap that would keep the government running until Dec. 22 and also help states temporarily bolster funding for the Children’s Health Insurance Program. The continuing resolution, details of which were reported Friday by CQ, is needed because the current stopgap (PL 115-56) expires this coming Friday, Dec. 8. (Mejdrich, 12/2)

Kaiser Health News: States — And 9M Kids — ‘In A Bind’ As Congress Dawdles On CHIP Funding
Last week, Colorado became the first state to notify families that children who receive health insurance through the Children’s Health Insurance Program are in danger of losing their coverage. Nearly 9 million children are insured through CHIP, which covers mostly working-class families. The program has bipartisan support in both the House and Senate, but Congress let federal funding for CHIP expire in September. (Lopez and Simmons-Duffin, 12/4)

Kaiser Health News: With CHIP In Limbo, Here Are 5 Takeaways On The Congressional Impasse
Two months past its deadline, Congress has yet to fund the Children’s Health Insurance Program, leaving several states scrambling for cash. Lawmakers grappling with the failed repeal of the Affordable Care Act allowed authorization of the program to lapse on Sept. 30. Although CHIP has always had broad bipartisan support, the House and Senate cannot agree on how to continue federal funding. And the Trump administration has been mostly silent on the issue. (Galewitz, 12/1)

Marketplace

9. If CVS's $69B Deal To Buy Aetna Holds Up To Federal Scrutiny, It Could Transform Health Care Landscape

Together, the companies touch most of the basic health services that people regularly use, and the merger could keep the transactions under one roof instead of spread out over multiple industry players.

The New York Times: CVS To Buy Aetna For $69 Billion In A Deal That May Reshape The Health Industry
CVS Health said on Sunday that it had agreed to buy Aetna for about $69 billion in a deal that would combine the drugstore giant with one of the biggest health insurers in the United States and has the potential to reshape the nation’s health care industry. The transaction, one of the largest of the year, reflects the increasingly blurred lines between the traditionally separate spheres of a rapidly changing industry. (De La Merced and Abelson, 12/3)

The Washington Post: CVS Agrees To Buy Aetna In $69 Billion Deal That Could Shake Up Health-Care Industry
If approved, the mega-merger would create a giant consumer health care company with a familiar presence in thousands of communities. Aetna chief executive Mark T. Bertolini described the vision in an interview as "creating a new front door for health care in America." "We want to get closer to the community, because all health care is local," Bertolini said. "What was going to draw people into an Aetna store? Probably not a lot. We looked for the right kind of partnership." (Johnson, 12/3)

The Boston Globe: Here's Why CVS Is Spending $69 Billion To Buy Insurer Aetna
CVS has two clear goals in making the largest purchase in its 54-year history, analysts said. The first is to accelerate the transformation of its 9,700 retail stores into health care supermarkets with wellness clinics for preventive care, vision and hearing services, telemedicine connections with doctors, and on-site nurse practitioners to assist with chronic conditions. The second is to fortify its business of managing pharmacy benefits, which oversees drug plans for employers and insurers, against a widely expected incursion by Amazon.com Inc. (Nanos, 12/4)

The Wall Street Journal: CVS To Buy Aetna For $69 Billion, Combining Major Health-Care Players
The proposed deal is the latest and most dramatic sign of how the lines between traditional segments in health care are blurring as companies, saddled with mature businesses and in many cases restricted from buying rivals, enter new areas in search of growth. Companies from insurers to hospital chains are also looking for ways to squeeze costs and bolster their leverage against other players in the food chain. That is creating opportunities, but also new fault lines as companies find themselves competing against erstwhile partners. (Terlep, Wilde Mathews and Cimilluca, 12/3)

Bloomberg: CVS To Buy Aetna For $67.5 Billion, Remaking Health Care Sector
In a joint interview, CVS Chief Executive Officer Larry Merlo and Aetna CEO Mark Bertolini said combining the companies would help CVS expand a variety of retail medical services, from vision care to nutrition advice to audiology, making basic care more convenient and less costly for consumers. Aetna will be operated as a separate business unit, and any new services will be designed to appeal broadly to customers of other insurance companies as well, the executives said. (Tracer and Langreth, 12/3)

The Wall Street Journal: Will CVS Health Deal To Buy Aetna Hold Up To Antitrust Scrutiny?
CVS Health Corp.’s planned acquisition of Aetna Inc. will face tough antitrust scrutiny, but the limited overlap between the companies’ businesses should help bolster their case for the deal, experts said. The $69 billion acquisition would involve CVS’s drugstores, some including retail clinics, and its massive pharmacy-benefit-management business. Aetna is the third-biggest U.S. health insurer, selling plans to employers as well as offering Medicare and Medicaid coverage, among other types. The two companies have some areas of direct competition, particularly in the sale of drug plans to Medicare beneficiaries. (Wilde Mathews, 12/3)

Bloomberg: CVS-Aetna Takeover May Hinge On Antitrust Approach Under Trump
CVS Health Corp.’s $67.5 billion takeover of Aetna Inc. will test the Trump administration’s approach to far-reaching corporate takeovers, just weeks after the U.S. government sued to block a major telecommunications merger. The health-care deal unveiled Sunday would create an industry giant with over $240 billion in annual sales with a hand in insurance, prescription drug plan administration, retail pharmacies and corner clinics. The companies said the combination will save $750 million in costs and bring consumers better, more efficient health care. (Langreth, McLaughlin and Tracer, 12/4)

The New York Times: Why A CVS-Aetna Merger Could Benefit Consumers
There are reasons for consumers to be optimistic about CVS’s reported purchase of Aetna for $69 billion on Sunday. It’s one of the largest health care mergers in history, and in general, consolidation in health care has not been good for Americans. But by disrupting the pharmacy benefits management market, and by more closely aligning management of drug benefits and other types of benefits in one organization, CVS could be acting in ways that ultimately benefit consumers. (Frakt, 12/3)

Stat: CVS-Aetna Deal Further Concentrates Health Care. Will It Lower Costs?
Underscoring the transformation in health care, the CVS pharmacy giant’s deal to buy Aetna, one of the nation’s largest health insurers, has the potential for lowering costs, but also further concentrating key services among a very few large companies. The $69 billion merger, which must still be approved by shareholders and regulators, would combine the vast network of 9,700 CVS pharmacies, 1,100 walk-in clinics, and its Caremark pharmacy benefits management business with Aetna’s expansive employer and government health plans. The insurer covers more than 22 million Americans. (Silverman, 12/3)

Los Angeles Times: CVS To Buy Aetna For $69 Billion In Deal That Would Shake Up Healthcare Industry
Gerald Kominski, director of the UCLA Center for Health Policy Research, said, "It remains to be seen whether this [merger] is actually going to drive costs down" for consumers but that savings could materialize "if it becomes a lower-cost alternative to sending people to a doctor's office or having people show up in the emergency room." "To the extent they can help manage the Aetna members' conditions — particularly people who might otherwise end up in the ER or were recently hospitalized — this could lower costs," Kominski said. "We'll see how it pans out." (Peltz, 12/3)

Modern Healthcare: Aetna Leadership To Stay On After CVS Deal
Pharmacy chain CVS Health has agreed to buy health insurer Aetna for $69 billion in cash and stock, retaining its current management, the companies announced late Sunday. The deal brings together one of the largest providers of pharmacy services with the No. 3 U.S. health insurer, which together would establish a healthcare giant with more than $240 billion in annual revenue. (Livingston, 12/3)

10. Coordinated Care, Choice And Health Costs -- The Myriad Challenges Of The U.S. Medical System

New outlets detail a range of dynamics within the health care system that can help and hinder patients ability to access affordable care.

USA Today: Coordinated Care With Doctors And Hospitals Can Improve Health And Save Money
Robin Gladden's most traumatic moments weren't due to her being raised by abusive, drug-addicted parents in a violence-plagued community. Instead, she says it was because of mistakes and neglect by the health care system. Gladden, 62, is a thyroid cancer survivor who also has diabetes, bursitis, high blood pressure, acid reflux and sciatica. She’s now a satisfied patient of Kaiser Permanente, a more established form of accountable care organization (ACO) that both treats and insures its patients. (Wilmore and O'Donnell, 12/2)

Modern Healthcare: How To Find $25 Million In 10 Days
Lindsey Bradley, former CEO of what was then Trinity Mother Frances Hospitals and Clinics in Tyler, Texas, had called a meeting in February 2015 to come up with a cost-cutting game plan. He told a group of the system's leadership that they needed to find a way to plug a giant hole that would be created when Blue Cross and Blue Shield of Texas made big changes to its PPO plans for 2016. ... Over a 12-month span, the system saved more than $25 million—$7 million in labor management, $6 million in non-labor control, $6 million in contract renegotiation and $6 million through shorter lengths of stay. The system produced a double-digit margin last year, which it used to reinvest in technology and four new catheterization labs. (Kacik, 12/2)

Medicaid

11. Maine Voters' Support For Medicaid Expansion Emboldens Other States

Efforts to overcome resistance to the Obamacare program are being revived in Nebraska, Idaho, Utah and Virginia. Also, Democrats in Kansas would like to block state action that ties the next governor's hands on changing the privatized Medicaid program, and companies are eager to compete for Florida's program.

Governing: Maine's Obamacare Vote Revives Medicaid Expansion Debate In Some States
The victory in Maine has re-energized Obamacare advocates hoping to replicate that success in other states. A 2012 U.S. Supreme Court ruling made Medicaid expansion optional for states. Since then, 33 have expanded. The holdout states are largely run by Republicans. In many cases, GOP governors support Medicaid expansion but can't convince their GOP legislatures to approve it. (Quinn, 12/4)

KCUR: Legislative Panel Backs KanCare Renewal Plan, But Opponents Hope To Block Implementation
Republican legislators have temporarily sidetracked an effort to block the Brownback administration from obtaining federal approval to renew KanCare, the state’s privatized Medicaid program. Democrats on a joint committee that oversees KanCare wanted the panel’s report to the full Legislature to recommend keeping the current program in place until a newly elected governor takes office in January 2019. “If we are to extend KanCare by five years, which is what this does, we are going to take this right through the entire first term of the next administration,” said Sen. Laura Kelly, from Topeka, the top Democrat on the oversight committee. “I’m not comfortable as a legislator doing that.” (McLean, 12/1)

Health News Florida: Health Plans Line Up To Seek Medicaid Contracts
More than 20 managed-care organizations are seeking state Medicaid contracts that could be worth up to $90 billion over a five-year period. A review of state records shows that a total of 21 managed-care organizations are seeking to be part of Florida's Medicaid program, which provides health coverage for the poor. (12/1)

Health Law

12. Even As Patients Assume More Health Costs, Price Details Difficult To Find

Although consumers are often counseled to shop around for cheaper health care, the effort is challenging because of the lack of price transparency. Meanwhile in other news about insurance and the health law, media outlets in Iowa and Connecticut report that enrollment is going well there, but another report points out the extremes that some people must go to when hoping to keep affordable coverage.

Roll Call: Consumers Lack Information on High-Deductible Plans Favored by GOP
As millions of Americans debate their insurance options for next year, experts are urging consumers to shop around. But without additional price transparency in a fractured and confusing delivery system, many Americans are simply rolling the dice. And the ability to shop is limited since many doctors, such as [Chris] Raymond’s, typically have admitting procedures at specific hospitals. The number of high-deductible plans has steadily increased since 2005, according to data from the insurance industry’s main interest group, America’s Health Insurance Plans, or AHIP. In 2016, approximately 20.2 million people were enrolled in high-deductible plans, an increase of nearly half a million consumers from the previous year. (Clason, 12/4)

Veterans' Health Care

13. Senate Panel Adds $1 Billion To VA Funding For Private Care For Patients

The funding boost was not publicized by leaders of the Senate Veterans' Affairs Committee. In addition, two members of the House are hoping to stop VA researchers from running tests on dogs.

CQ: Mystery $1 Billion For Private Care Emerges In Veterans Bill
Senate Veterans' Affairs Committee members may not have known they plunged an additional $1 billion into a private care access program for veterans during a markup Wednesday. The boost to private medical care would be directed to the Veterans Choice Program, a temporary program rolled out in November 2014 designed to help patients who have to wait too long or drive too far to a VA-run facility. The Senate Veterans' Affairs Committee confirmed late Thursday the $1 billion was included when asked about it by CQ. (Mejdrich, 12/1)

CQ: Lawmakers Press VA To End Medical Testing On Dogs
Representatives from both parties want to protect dogs from medical research at the Veterans Affairs Department. Disturbed that the department has subjected some dogs to lobotomies and spinal cord research, two dog lovers in the House, Nevada Democrat Dina Titus and Republican Dave Brat from Virginia, have introduced a bill (HR 3197) to prohibit any medical testing there that causes dog pain. It’s a multi-front attack. The two earlier this year got an amendment added to a spending bill (HR 3219) that would have barred the VA from spending money on dog research. (Sipkin, 12/4)

Public Health And Education

14. Advocates For Those Recovering From Opioid Addiction Fear Consequences Of Medicaid Work Requirements

Red states that have been particularly hard hit by the opioid epidemic are also the ones rushing to add work requirements to their Medicaid programs. But critics say that could backfire for those who are seeking help recovering from addiction. In other news on the crisis: Kratom bans; how cartels are getting drugs into the country; limiting opioids in court; programs to get hospital patients directly into treatment; and more.

Politico: GOP Medicaid Work Rules Imperil Care For Opioid Abusers
Red states ravaged by the opioid crisis are pushing for Medicaid work requirements that could push people out of treatment as they try to get off drugs. Kentucky, New Hampshire, Maine and Indiana are among at least eight GOP-led states seeking federal approval to require Medicaid enrollees to work as a precondition of their health coverage. All four states have been hard hit by drug addiction, which claims 140 lives a day nationally. (Pradhan and Ehley, 12/3)

Stateline: As Kratom Use Surges, Some States Enact Bans
Advocates say the substance, which does not depress the respiratory system and therefore presents little to no overdose risk, could help reduce the nation’s reliance on highly addictive and often deadly prescription painkillers. Some addiction experts also argue the plant could be used as an alternative to methadone, buprenorphine and Vivitrol in medication-assisted therapy for opioid addiction. ... Now, with growing concerns about the dangers of prescription painkillers, an estimated 3 million to 5 million people are using kratom and reporting positive results, based on information from retailers. But worries that the unregulated plant product could be abused for its mild euphoric qualities and users could become addicted are spurring federal officials to issue public health warnings — and a handful of states and cities to impose bans. (Vestal, 12/4)

The New York Times: Heroin In Soups And Lollipops: How Drug Cartels Evade Border Security
The tip came on the last day of January 2014 to special agents from Immigration and Customs Enforcement: A drug courier was about to land at the Baltimore airport with a large shipment. Hours later, the agents asked the man, Edgar Franco Lopez, a Guatemalan, to search the three large duffel bags he was loading in a car outside the airport. But agents found only food. So they bluffed, saying they had found evidence of drugs in the bags. (Nixon, 12/2)

The Associated Press: 'Take All Their Excuses Away': Hard Cases In Heroin Fight
The van was coming for Richard Rivera, but it was taking a long time. He waited inside the entrance of Saint Anthony Hospital where he had spent the past three days getting off heroin. His next stop: a sober-living facility. As his addiction counselor, DeValle Williams, kept a silent watch, the 49-year-old Rivera griped about the people who found him a bed 22 miles away, complete with meals, job training and gym access. (Johnson, 12/4)

The Associated Press: Should Opioids Be Banned In Court Over Fears Of Exposure?
The potency of certain opioid painkillers has Massachusetts’ judiciary considering whether to ban the substances from being brought into courtrooms as evidence — a move some experts say is driven by a misunderstanding of the real dangers. The chief justice of the Massachusetts Trial Court recently told prosecutors that she fears allowing fentanyl and carfentanil into courtrooms puts lawyers, jurors and defendants at risk even when the drugs are properly packaged. (Richer, 12/3)

Pioneer Press: Minnesota Leaders Detail Rules For Reining In Opioid Prescriptions
Minnesota has a new proposal for how health care providers should prescribe opioids, crafted to reduce dependency on the powerful narcotics. Lt. Gov. Tina Smith announced the new recommendations Friday with health care providers and other state leaders at Abbott Northwestern Hospital in Minneapolis. The draft guidelines were created by a group of doctors and community leaders, and the state will accept public input on them until the end of December. (Magan, 12/1)

The Boston Globe: Patients Call Plymouth Addiction Center A Mere Jail
For the past 15 years, people committed for drug and alcohol treatment had been sent to a barracks-style facility in Bridgewater, part of a sprawling prison campus that includes the state’s psychiatric hospital. In May, as the opioid crisis worsened and the need for beds increased, the addiction treatment center was moved to Plymouth, a serene wooded setting that was seen as more therapeutic. It was a well-intentioned shift, but one that left unaddressed what critics see as the addiction center’s fundamental flaw — that it is governed by prison rules and regulations that can make treatment feel like punishment, or worse. (Cramer and Freyer, 12/2)

Nashville Tennessean: Drug, Alcohol Abuse Saps $2 Billion From Tennessee Annually — An Under-The-Radar Impact Of Opioid Epidemic
Substance abuse annually costs Tennessee more than $2 billion — more than half of which is attributed to lost income from people who have fallen out of the the labor market, according to an economist. The substance abuse epidemic — most notably involving opioids — raises questions about access to treatment, how to stem the illicit use of prescription painkillers and staunch the use of illegal drugs. (Fletcher, 12/3)

Bloomberg: Once-Monthly Opioid Addiction Injection Cleared For U.S. Sales
Efforts to combat the opioid epidemic killing thousands of Americans each year got a boost from U.S. regulators with the approval of a first-of-its-kind monthly treatment for addiction to opiates including pills and heroin. The treatment, Indivior Plc’s Sublocade, is an injection of buprenorphine, a drug that lessens withdraw symptoms in addicted patients. Its infrequent dosing, once a month, could help patients better adhere to the regimen compared with existing versions that come in dissolvable tablets or films, the Food and Drug Administration said. (Edney, 12/1)

15. Uterine Transplant Program Hits Major Milestone With First Baby Born In U.S.

The successful delivery of the baby gives hope to millions of women who struggle with infertility. The transplant is only meant to be temporary, kept in just long enough for the woman to conceive one or two children.

The Washington Post: A Woman With A Transplanted Uterus Just Gave Birth — A First For The U.S.
The success marked another step forward for transplant surgery aimed at improving a person’s life, not just saving it. Doctors have performed penis transplants for wounded troops, given a young boy two new hands and given a new nose, lips, palate, eyelids and jaw to a woman who was gruesomely disfigured after she was shot in the face. The fact that the uterus transplant success in Sweden can be replicated is a promising sign for thousands of women who have been unable to conceive. And doctors at Baylor have sought to expand the limits of the procedure, using donated uteri that didn’t come from family members and, in some cases, organs that came from cadavers. (Wootson, 12/3)

Dallas Morning News: Baylor Doctors Deliver First Baby Born In U.S. After Uterine Transplant 
All the women enrolled in the Baylor study suffer from absolute uterine infertility, a condition that affects about 1 in every 500 women. That means they had no uterus and childbirth would never have been an option. Many said they often felt incomplete, embarrassed and isolated — until now, said Dr. Colin Koon, a transplant team surgeon whose expertise is in gynecologic cancers. “It gives hope to women who didn’t feel like they had hope,” he said. (Rice, 12/2)

In other news, private equity firms are pouring money into the infertility market —

Stat: Investors See Big Money In Infertility. And They're Transforming The Industry
Sensing a lucrative market, private equity firms are pouring money into building national chains of fertility clinics. Some are spending on splashy advertising and a deliberate strategy of reaching out to young women who are not yet trying to conceive. Venture capitalists are getting into the business, too; this year alone, PitchBook has tallied more than $178 million flowing into startups developing fertility products, such as a test that promises a credit score-style rating of a woman’s fertility. (Robbins, 12/4)

16. When It Comes To Chemo, What Does Not Kill Cancer Makes It Stronger, New Study Confirms

But doctors aren't saying don't seek treatment, and the study might offer a way out of the conundrum. In other public health news: red wine, Tylenol and emotional pain; cancer gene tests; HIV; migraines; and more.

Stat: Cancer Drugs Can Make Surviving Cells More Aggressive, Study Finds
If proponents of cancer quackery exulted in July when a study described how chemotherapy before breast cancer surgery might fuel metastasis — the findings put “a final nail in the coffin” of chemo, one alternative medicine website gloated — research reported last week is going to make them think Christmas came early. A new study has found more evidence that cancer treatment can be a double-edged sword, triggering biological responses that can spur aggressive tumor growth. (Begley, 12/4)

The Washington Post: Drinking Red Wine Is Good For You — Or Maybe Not
At the end of a long week, people are opening wine bottles in bars, restaurants and homes around the world, ready to kick back and relax. This relationship with wine has a long history. The oldest known winery, dating to 4100 B.C., was discovered in 2010 by archaeologists in an Armenian cave. Just recently scientists reported finding jugs that had been used for storing wine from 6000 B.C. Wine was used in ceremonies by the Egyptians, traded by the Phoenicians and honored by the Greek god Dionysus and the Roman god Bacchus. By 2014, humanity was consuming more than 6 billion gallons of wine every year. (Baranchuk, Alexander and Haseeb, 12/2)

NPR: Tylenol May Help Ease The Pain Of Hurt Feelings
Nobody likes the feeling of being left out, and when it happens, we tend to describe these experiences with the same words we use to talk about the physical pain of, say, a toothache. "People say, 'Oh, that hurts,' " says Nathan DeWall, a professor of psychology at the University of Kentucky. (Aubrey, 12/4)

The Associated Press: FDA Approves First-Of-A-Kind Test For Cancer Gene Profiling
U.S. regulators have approved a first-of-a-kind test that looks for mutations in hundreds of cancer genes at once, giving a more complete picture of what's driving a patient's tumor and aiding efforts to match treatments to those flaws. The U.S. Food and Drug Administration approved Foundation Medicine's test for patients with advanced or widely spread cancers, and the Centers for Medicare and Medicaid Services proposed covering it. (Marchione, 12/1)

The Baltimore Sun: About 15 Percent Of Americans With HIV Don't Know They're Infected, CDC Says
Half of the Americans recently diagnosed with HIV had been living with the virus for at least three years without realizing it, missing out on opportunities for early treatment and in some cases spreading it to others, according to a new report by the U.S. Centers for Disease Control and Prevention. What’s more, of the 39,720 Americans newly diagnosed with HIV in 2015, one-quarter had been infected for seven years or more without knowing they were ill. (Healy and McDaniels, 12/1)

NPR: New Drugs Could Prevent Migraine Headaches For Some People
People who experience frequent migraines may soon have access to a new class of drugs. In a pair of large studies, two drugs that tweak brain circuits involved in migraine each showed they could reduce the frequency of attacks without causing side effects, researchers report in the New England Journal of Medicine. (Hamilton, 12/4)

Los Angeles Times: Early-Life Stress, Especially In War, Can Have Consequences Across Multiple Generations
The wartime evacuation of Finnish children more than 70 years ago might have been an historical footnote, its cost to human health and happiness lost in the passage of time. More than 70,000 Finnish children were separated from their parents in a frantic rout and whisked away to institutions and foster families in Sweden and Denmark. The aim of this mass migration of unaccompanied children was to shield them from harm, as Finland had become a battleground for clashing Soviet and German forces. But studies by an international group of experts in child development have found that its effect was not wholly protective. (Healy, 12/1)

The Associated Press: Sex Cases Put Spotlight On Sex Addiction, But Is It Real?
Is sex addiction a true addiction, a crime, or a made-up condition used by misbehaving VIPs to deflect blame or repair tarnished images? A tide of high-profile sexual misconduct accusations against celebrities, politicians and media members has raised these questions — and sowed confusion. Sex addiction is not an officially recognized psychiatric diagnosis, though even those who doubt it's a true addiction acknowledge that compulsive sexual behavior can upend lives. (Tanner, 12/3)

State Watch

17. State Highlights: In Calif., L.A. County Launches New HIV Prevention Effort; Court Sides With Hospitals In Fla. Medicaid Rate Dispute

Media outlets report on news from California, Florida, New York, New Hampshire, Massachusetts, Tennessee, Minnesota, Ohio, Maryland, Georgia, Texas and Iowa.

Los Angeles Times: L.A. County Officials Launch Effort To Curb HIV
Los Angeles County public health officials on Friday announced an effort aimed at reducing the annual number of HIV infections by more than two-thirds and bringing an end to the virus that causes AIDS. More than 60,000 people in the county live with HIV, the second-largest such population in the nation. Around 1,850 new cases are diagnosed here each year, the majority among LGBTQ residents, Latinos and African Americans. (Etehad, 12/1)

The Wall Street Journal: Some New York City Workers Lacked Training For Lead-Paint Repairs
At least some of the city workers who fixed and repainted walls with possible lead paint in New York City public-housing apartments after the units had gone years without required inspections weren’t federally certified to perform the work. New York City Housing Authority Chairwoman Shola Olatoye said on Friday that the agency has been out of compliance with the U.S. Environmental Protection Agency rules requiring training for work involving lead paint since 2014. (Gay, 12/1)

The Washington Post: A Man Collapsed With ‘Do Not Resuscitate’ Tattooed On His Chest. Doctors Didn’t Know What To Do.
Doctors in Miami faced an unusual ethical dilemma when an unconscious, deteriorating patient was brought into the emergency room with the words “Do Not Resuscitate” across his chest. The 70-year-old man was taken earlier this year to Jackson Memorial Hospital, where doctors made their startling discovery: a chest tattoo that seemed to convey the patient's end-of-life wishes. The word “Not” was underlined, and the tattoo included a signature. It left the medical team grappling with myriad ethical and legal questions. (Bever, 12/1)

Concord Monitor: Report: Insurance Payment Differences For Mental Vs. Physical Health Is Highest In N.H.
Insurance payments for office visits related to mental health procedures are often lower than those related to physical health procedures, and a national study says that in some cases the discrepancy is bigger in New Hampshire than in any other state. “The number is probably a little fuzzy. If you use a different approach you’d probably get a little different number ... but it agrees with what we’ve found,” said Tyler Brannen, health care policy analyst with the New Hampshire Insurance Department, which has found similar discrepancies regarding Medicare payments. “It’s good to have more evidence: Yeah, somebody else says so, too.” (Brooks, 12/4)

Nashville Tennessean: The Doctor Will See You Now — Via Skype
Why will telemedicine take off in Tennessee next year? Both carriers on Nashville’s individual market cover the service. In fact, it’s a key piece of newcomer Oscar Health’s value proposition to consumers. It isn’t just the individual market, either. Most carriers now cover telemedicine, and 30 states, including Tennessee, require private insurers to reimburse for the service. Even so, more consumers are interested in using telemedicine than have actually used it. According to a survey by Deloitte, half of consumers would be willing to use telemedicine, but tech consulting company Accenture reports just 21 percent of Americans have actually received care via telemedicine. (Tolbert, 12/1)

The Columbus Dispatch: Ohio's Abortion Clinic Inspections More Frequent Under Kasich
ince Republican Gov. John Kasich took office, state health inspectors have reported 17 times as many violations a year in Ohio abortion clinics as during the tenure of his predecessor, Democrat Ted Strickland. Although no one can prove a cause and effect absolutely, hundreds of records examined by The Dispatch show that not only the number of violations but also the types of violations found at abortion clinics during the health department’s inspections during the past 10 years have differed greatly depending on who is the governor. (Henry, 12/2)

Modern Healthcare: Scripps Will Cut Hospital Leadership Positions And $30 Million In Corporate Services
Scripps Health is eliminating chief executive positions and cutting corporate services by $30 million in order to remain "relevant and viable in a new health care era," according to the San Diego-based system's CEO. The CEO positions at each of the system's four hospitals will be cut. Scripps instead will have one CEO overseeing Scripps Encinitas, Green and La Jolla campuses, another chief executive for the Scripps Mercy San Diego and Chula Vista campuses and one CEO over ancillary services. These leaders will supervise chief operations executives at the facilities.In another move, Scripps will create a joint leadership model between hospital executives and physician leaders "to further align physician and hospital objectives." (12/2)

Los Angeles Times: Is This What The Doctor's Office Of The Future Will Look Like?
The new Forward medical clinic in Century City does not have a waiting room. The initial check-up with a doctor at Parsley, a new medical center in Playa Vista, involves a 75-minute meeting with a doctor and a session with a health coach. Loom, in Los Angeles, has a cozy space for clients to chat with a counselor about trying to get pregnant or dealing with a miscarriage. As people tire of long wait times, rushed visits, a reliance on prescription medicines and dealing with the morass that is the insurance system, some doctors, practitioners and entrepreneurs — especially those trying to attract millennial customers — are finding another way to deliver wellness. (Daswani, 12/2)

The Cleveland Plain Dealer: Quest Diagnostics Finalizes Purchase Of Cleveland Clinic Spinoff Cleveland HeartLab
Quest Diagnostics today finalized its acquisition of Cleveland Clinic spinoff Cleveland HeartLab. Cleveland HeartLab, a cardiovascular diagnostic testing company, has proprietary tests that use biomarkers to predict cardiovascular disease. With the deal, Quest, a New Jersey-based medical testing laboratory with locations around the world, adds those diagnostic tests, and others, to its offerings. (Christ, 12/1)

The Washington Post: Medical Marijuana Has Arrived In Maryland, And Sales Have Begun
At least 200 would-be customers were lined up outside Rockville’s first medical marijuana dispensary Friday afternoon when one of the owners announced that a cannabis shipment — including elixirs, tablets and flowers — had arrived. Bill Askinazi promised that everyone in line would go home with at least some marijuana, then said computer issues were delaying the start of sales, and rushed back inside. (Nirappil, Siegel and Gregg, 12/2)

Los Angeles Times: Porter Ranch Residents Informed Of Brief Surge In Methane Levels At Aliso Canyon Gas Storage Facility
Methane levels briefly surged Friday night at the Aliso Canyon gas storage facility in the San Fernando Valley, prompting Southern California Gas Co. to notify nearby residents in Porter Ranch. The company sent out the notice late Friday night, saying that increased levels of methane had been found earlier that evening on two fence-line monitors along the facility border. (Reyes, 12/2)

Houston Chronicle: Texas Officials Issue Alert About Typhus Threat
Texas officials have issued a health alert about the rising threat of typhus in Houston and other parts of the state. The alert by the Texas Department of State Health Services calls on healthcare providers to increase their "clinical suspicion" for typhus symptoms, including fever, headache, muscle pain, anorexia, rash, nausea and vomiting. Such symptoms are often confused with many viral ailments. (Ackerman, 12/1)

Des Moines Register: Medical-Marijuana Firms May Have Been Dissuaded By Iowa's Fees And Restrictions
Potential medical-marijuana production companies might have shied away from Iowa’s new program because of high fees and a relatively small number of patients who could qualify, a top state administrator said Friday. Just one company, MedPharm Iowa, applied for a state license to grow marijuana plants and produce medications from them. The Iowa Department of Public Health announced this week that it intended to grant a license to the Des Moines company, which is owned by the president of the food supplement company Kemin Industries. A new state law allows the Iowa Department of Public Health to license up to two medical-cannabis production companies. (Leys, 12/1)

Editorials And Opinions

18. Viewpoints: What The Tax Bill Does To Obamacare, Other Health Policies; Congress Is 'Rolling The Dice' On CHIP

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

The New York Times: How The G.O.P. Tax Bill Will Ruin Obamacare
As part of their giant tax bill, Republicans in Congress are about to eliminate the Affordable Care Act’s individual mandate. Their objective is not sensible health care reform but rather insensible arithmetic that could satisfy the byzantine rules governing the Senate’s reconciliation process. The purpose of the mandate is to evenly distribute risk among healthy and unhealthy Americans on the individual insurance market so that costs are shared and no one is left out. (J.B. Silvers, 12/4)

Los Angeles Times: The GOP's Big Tax Win Is A Loss For The Rest Of Us
Now that the Senate has joined the House in passing versions of a bill to cut taxes — with the support of virtually all Republicans and no Democrats — there’s little doubt that the GOP majority will work out a measure that Republicans in both chambers can support, and send it to President Trump to be signed into law. But the first big win for Republicans in Washington is a loss for the rest of us. ... The biggest beneficiaries, though, will be businesses with the highest profits and individuals with the highest incomes, and some of the biggest losers could be those who can scarcely afford the higher tab — graduate students, for example. More broadly, the measure will cause either much larger deficits or large cuts to Medicare and other federal programs, quite possibly accompanied by higher interest rates for borrowers. (12/2)

The Milwaukee Journal-Sentinel: Tax Proposal Has Unintended Consequences For Nonprofits
“These are my principles," the comedian Groucho Marx once proclaimed. “If you don’t like them, I have others.” The same might be said for lawmakers who’ve built careers out of condemning budget deficits, but who now seem intent on passing a tax bill that, absent cuts to Medicare and Social Security, could add at least $1.4 trillion to the national debt over the next decade. (Tom Saler, 12/1)

Forbes: Will GOP Cut Social Security And Medicare Before Or After The 2018 Election?
Assuming the Trump Family and Friends Tax Cut approved by the Senate ... is enacted, big cuts to Social Security and Medicare will be the next target for the White House and congressional Republican leadership. The only question is when. My former blogging partner Bruce Bartlett -- who in a previous life was chief economist for Republican economic icons Representatives Jack Kemp (R-NY) and Ron Paul (R-TX) -- for weeks has been shouting from the mountaintop the extreme likelihood of the GOP training its sights on Social Security and Medicare. To paraphrase Bruce's wisdom ... the Republican deficit hawks that have been in the budget version of the witness protection program during the current mega deficit-increasing tax cut debate will reemerge with a vengeance to demand Social Security and Medicare cuts to reduce the deficit they just created. (Stan Collender, 11/3)

RealClear Health: Congress, Repeal The Individual Mandate. It's Only Fair.
Imagine the outcry if Congress compelled all individuals to purchase a new automobile. Moreover, let’s say Congress didn’t just command Americans to buy cars, but in Henry Ford-like fashion told us everybody must buy one of a very small number of identical cars, the features of which would be dictated by the government. What if Congress told us exactly what food, clothing, housing, legal or dental services we were required to procure? That is exactly what Congressional Democrats did for health insurance when they enacted the Affordable Care Act (ACA) and its mandate that all individuals purchase one of but a few health plans these legislators deemed permissible. (Roger Klein, 12/4)

Detroit Free Press: Washington's So Dysfunctional It's Rolling The Dice With Children's Health Care
Come January, barring a pre-Christmas miracle in Washington, the State of Michigan will begin notifying parents of the 116,000 child recipients of the federal Children's Health Insurance Program that time is running out. That's how toxic the dysfunction in our nation's capital has become — for the first time since its creation in 1997, the short-term future of a program that provides low-cost health care for low-income kids is in jeopardy. (Nancy Kaffer, 12/3)

Modern Healthcare: Kids Need More Than A Health Insurance Program
The Republican strategy of delaying reauthorization of the Children's Health Insurance Program serves their broader agenda. By forcing advocates to defend kids' human right to see a doctor, they deflect attention from how their tax plan and social service cuts will harm the health of America's young. (Merrill Goozner, 12/2)

The San Jose Mercury News: Congress Abandons Community Health Centers, Hurting Thousands In Bay Area
On Sept. 30, critical funding for federally qualified community health centers expired. This perceived lack of urgency endangers the health of our nation’s most vulnerable. Now, every community health center in California faces drastic cuts in federal funding that will cause many services to be discontinued, patients to be sent to emergency rooms, clinic staff laid off and some health center doors closed permanently. (Rep. Anna Eshoo and Dolores Alvarado, 12/2)

The Washington Post: What The Opioid Epidemic Looks Like On The Screen Of A Brain Scan
I recently received the sad news that a colleague of mine had lost his daughter. Reading the obituary, I found out the cause. It was not shrouded in code, like “died suddenly” or “unexpectedly.” Her parents spelled it right out: She was a victim of her addiction to opioids. Her funeral was jarring, full of young people, friends in their 20s. They were not joking over fond memories or talking about a good long life; they were in shock. At the front of the receiving line, I met her father, my colleague. What could I say? I hugged him. I told him it was brave to put the truth in the newspaper, not to hide it as some shameful fact. And he nodded, his eyes desperate. “I wanted to be honest. Because, you know, we didn’t know how to help her. No one could. We tried everything. Nothing worked.” (Sandra Block, 12/1)

Cleveland Plain Dealer: Federal Nursing Home Regulations Need To Be Tougher, Not Weaker
Ohio faces two incontestable facts when it comes to nursing-home care -- facts that lobbyists for nursing homes (and their Capitol Hill allies) want Congress to ignore. First, two of every five Ohio nursing homes provide care deemed substandard under federal regulations. That's as of 2015, the latest year for which data are available. Second, the graying of Ohio is raising demand for nursing homes at the very time their quality is falling short: About 16 percent of all Ohio residents are age 65 or older now; the proportion was just 14 percent in 2010. (12/3)

RealClear Health: Feds Owe The Public 'Corrective Statements' On Vaping
Major tobacco companies, such as Altria and R.J. Reynolds Tobacco, have unveiled primetime television commercials and full-page ads in over 40 newspapers telling Americans something they already know: Smoking kills. ... They are a long-overdue correction by an industry that long tried to suppress the truth about the lethal effects of smoking. Now would be a good time for the Centers for Disease Control and Prevention (CDC) and the Surgeon General – two entities entrusted to give the public credible health information – to make their own corrective statements. Both agencies have committed public health malpractice by trying to scare people who can’t or won’t give up smoking while withholding or distorting data about viable alternatives. (Sally Satel and Guy Bentley, 12/4)