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KHN First Edition: December 18, 2017

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First Edition

Monday, December 18, 2017                       Visit Kaiser Health News for the latest headlines

Today's early morning highlights from the major news organizations.

Kaiser Health News: Podcast: ‘What The Health?’ Farewell, Individual Mandate
The compromise tax bill emerging from Republican efforts in Congress appears to have jettisoned a number of contentious health-related changes. Still, it seems likely lawmakers will repeal the penalties for not having health insurance. That so-called individual mandate was considered a linchpin of the Affordable Care Act, but now it seems possible the rest of the health law could survive without it. (12/15)

The New York Times: A Last Push For Obamacare Sign-Ups — And Worries About Who Got Hurt
Denise English was one of just two employees working six days a week to handle the crowd of people signing up for health insurance under the Affordable Care Act at a neighborhood health clinic here, as the Friday deadline for open enrollment loomed. Most of the people who sat waiting wanted to speak to her co-worker, who speaks Spanish. But Ms. English — she speaks only “un poquito” — was doing her best, her phone open to Google Translate, as she tried to help clients like Ana Gonzalez and Celso Morales, who moved here from Puerto Rico in April, sign up for a subsidized health plan. (Zernike and Pear, 12/15)

The Washington Post: Americans Sprint To Get Affordable Care Act Coverage In Last Hours Before Deadline
Consumers jammed call centers and enrollment offices in the final sprint toward the Friday deadline in most of the country to get Affordable Care Act health plans for 2018, defying months of naysaying by President Trump about the law’s insurance marketplaces. In several states, enrollment helpers reported a crush of interest in recent days. Some navigator organizations, which help people sign up, received more requests for appointments than they could accommodate — a consequence of an enrollment season that is half as long as the past three years’ time frame and large cuts by federal officials in grants to those groups. (Goldstein, 12/15)

The Wall Street Journal: Affordable Care Act Sign-Ups Bump Up, But Still Fewer Expected This Year
The end of open enrollment under the Affordable Care Act Friday saw an uptick in people selecting health plans, but with a shorter window this year’s sign-ups are still expected to fall short of last year’s, an outcome that could further imperil the fragile individual insurance market. Less robust sign-ups on the federal health exchange are likely to lead to higher premiums and bolster critics who say that the law is failing. Supporters say the enrollment pace has defied expectations, given that the Trump administration shortened the sign-up window and cut millions of dollars in outreach funding. (Armour, 12/15)

The Associated Press: Sign-Ups Show Health Law's Staying Power In Trump Era
A deadline burst of sign-ups after a tumultuous year for the Obama health law has revealed continued demand for the program's subsidized individual health plans. But the Affordable Care Act's troubles aren't over. On the plus side for the overhaul, official numbers showed a sizable share of first-time customers, 36 percent, were among those rushing to finish applications in the run-up to Friday's enrollment deadline. One new challenge comes from the GOP tax bill, which repeals the law's requirement that people have health insurance or risk fines. (12/18)

CQ: State Outreach Efforts Pay Off In Health Coverage Enrollment
States and insurance companies ramped up outreach for health coverage enrollment this year to fill the gap left by a drastic funding cut by the Trump administration. In many places, the hard work is showing. A recent study by the Wesleyan Media Project showed an overall spike in advertising this open enrollment season, a surprise given the Department of Health and Human Services’ decision to slash federal funds for marketing by 90 percent and in-person outreach by 41 percent. (Clason, 12/15)

The Associated Press: Health Law Sign-Up Deadline Extended For Some People
After a rush of last-minute sign-ups, the Trump administration says it's extending the deadline for some people to finish health insurance applications for next year under the Affordable Care Act. Callers to the service center on Saturday morning got a recorded message saying "don't worry" — if they'd called and left their phone number before the deadline, they'll get a call back and still can enroll for 2018. (12/16)

The Hill: Trump Officials Decline To Extend ObamaCare Sign-Up Deadline
The Trump administration declined to extend the ObamaCare sign-up period amid the last-minute surge of enrollees, a break with the precedent set under the Obama administration. The enrollment period ended Friday at midnight. The Obama administration in previous years consistently extended the deadline for a few days to accommodate the high number of enrollees who wait until the last minute to enroll. (Sullivan, 12/16)

Politico: How Blue States Might Save Obamacare's Markets
The looming demise of Obamacare’s individual mandate is spurring talks in a handful of blue states about enacting their own coverage requirements, as state officials and health care advocates fear repeal will roil their insurance markets. Republicans in Congress are poised to kill off the individual mandate in their sweeping tax overhaul, knocking out one of Obamacare's most unpopular features — but one that health experts have said is essential to making the law's insurance marketplaces function. (Pradhan, 12/17)

The Hill: Medical Device Companies Press To Lift ObamaCare Tax This Month 
The medical device industry is pressing Congress to act before the end of the year to lift ObamaCare’s medical device tax. In a letter to lawmakers, Scott Whitaker, CEO of AdvaMed, the medical device trade group, warned against waiting until January to pass a delay of the tax, instead urging them to pass the measure this month. (Sullivan, 12/15)

The Hill: Anti-Abortion Groups Push For Stronger 'Pro-Life' Restrictions In ObamaCare Funding Bill 
Anti-abortion groups are sounding the alarm over an ObamaCare funding bill, urging lawmakers to vote against it because they say it doesn't contain "pro-life" protections. A bill sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) would fund the key ObamaCare insurer payments called cost-sharing reductions (CSRs), which reimburse insurers for giving discounted deductibles and copays to low-income patients. (Hellmann, 12/15)

CQ: House Nears Settlement In Obamacare Spending Lawsuit
The House, White House and a number of states reached a tentative settlement Friday in a lawsuit over appropriations for the 2010 health care law, which would appear to end the legal showdown between the two political branches by essentially pretending it never happened. A federal judge’s May 2016 ruling in the case set up a showdown at the U.S. Court of Appeals for the D.C. Circuit that promised to test the boundaries of separation of powers and influence when the courts can step into disputes between the branches of government. (Ruger, 12/15)

The Washington Post: Sen. Susan Collins Takes Huge Leap Of Faith With Tax Bill. Critics Say She’s Getting Played.
As GOP tax legislation nears final passage on Capitol Hill, Sen. Susan Collins is approaching the moment for a mighty leap of faith. The Maine Republican extracted key concessions in exchange for her support for the bill, including commitments from the Trump administration and Senate leaders to back two pieces of legislation pumping money into the health-care system. The problem is, House Republicans largely oppose the health-care bills. (Werner, 12/15)

The New York Times: The Winners And Losers In The Tax Bill
With the bill finally headed to a vote this coming week, taxpayers are scrambling to determine whether the legislation renders them winners or losers. ... With the repeal of the individual mandate, some people who currently buy health insurance because they are required by law to do so are expected to go without coverage. According to the Congressional Budget Office, healthier people are more likely to drop their insurance, leaving insurers stuck with more people who are older and ailing. This is expected to make average insurance premiums on the individual market go up by about 10 percent. All told, 13 million fewer Americans are projected to have health coverage, according to the Congressional Budget Office. (Drucker and Rappeport, 12/16)

The Associated Press: Tax Bill Guts Unpopular 'Obamacare' Insurance Mandate
Republicans didn't get their wish to repeal former President Barack Obama's health care law, but the tax bill barreling toward a final vote in Congress guts its most unpopular provision, the requirement that virtually all Americans carry health insurance. Politically, the move is a winner for Republicans, who otherwise would have little to show for all their rhetoric about "Obamacare." (12/16)

Stat: Final Tax Bill Holds Much To Please Biopharma
The tax overhaul that Republicans hope to send to President Trump’s desk next week is expected to lighten the tax burden on the pharmaceutical industry and provide a number of other benefits that could help drug makers boost their bottom lines. The final version of the bill, released late Friday, retains a key tax credit aimed at incentivizing research into rare disease treatments — an improvement over an early draft that repealed it for the industry. The package will also lower the tax rate companies have to pay on earnings they stockpiled overseas, though the final rate is higher than in earlier drafts. (Mershon, 12/15)

The New York Times: John McCain, Fighting Brain Cancer, Likely To Miss Vote On Tax Overhaul
Senator John McCain, who is battling brain cancer, has returned home to Arizona and is likely to miss the Senate’s vote this week to approve a sweeping tax overhaul, though President Trump said on Sunday that the senator would return if his vote was needed. Mr. McCain’s office said in a statement on Sunday night that the senator, who had been hospitalized recently in the Washington area, would undergo physical therapy and rehabilitation at the Mayo Clinic in Arizona and “looks forward to returning to Washington in January.” (Kaplan, 12/17)

The Associated Press: Judge Temporarily Blocks New Trump Rules On Birth Control
A federal judge in Philadelphia on Friday ordered the Trump administration not to enforce new rules that could significantly reduce women's access to free birth control. Judge Wendy Beetlestone issued the injunction, temporarily stopping the government from enforcing the policy change to former President Barack Obama's health care law. (12/15)

The New York Times: Court Temporarily Blocks Trump Order Against Contraceptive Coverage
In the lawsuit, filed by the State of Pennsylvania, the judge said the rules would cause irreparable harm because tens of thousands of women would lose contraceptive coverage. The Affordable Care Act contains no statutory language allowing federal agencies to create such “sweeping exemptions” to the law’s requirements to cover preventive services, Judge Beetlestone declared. (Pear, 12/15)

The Wall Street Journal: Judge Temporarily Blocks Trump Administration’s Birth-Control Rule
The judge, appointed by former President Barack Obama, said the exemptions the administration created to the contraceptive mandate were likely unlawful because they were too broad and had been implemented using improper procedures. Trump administration health officials hadn’t provided a compelling reason why the rules should take effect immediately rather than going through a more typical public comment period, she said. Judge Beetlestone’s ruling is likely to be an early step in a long court battle that could reach the U.S. Supreme Court. (Hackman, 12/15)

Politico: Judge Blocks Trump Rollback Of Obamacare Contraception Mandate
“The Commonwealth’s concern is absent available cost-effective contraception, women will either forgo contraception entirely or choose cheaper but less effective methods — individual choices which will result in an increase in unintended pregnancies,” Beetlestone wrote in her 44-page opinion. “That in turn will inflict economic harm on the Commonwealth because unintended pregnancies are more likely to impose additional costs on Pennsylvania’s state-funded health programs.” (Colliver, 12/15)

The New York Times: Uproar Over Purported Ban At C.D.C. Of Words Like ‘Fetus’
The Department of Health and Human Services tried to play down on Saturday a report that officials at the Centers for Disease Control and Prevention had been barred from using seven words or phrases, including “science-based,” “fetus,” “transgender” and “vulnerable,” in agency budget documents. “The assertion that H.H.S. has ‘banned words’ is a complete mischaracterization of discussions regarding the budget formulation process,” an agency spokesman, Matt Lloyd, said in an email. “H.H.S. will continue to use the best scientific evidence available to improve the health of all Americans. H.H.S. also strongly encourages the use of outcome and evidence data in program evaluations and budget decisions.” (Kaplan and McNeil, 12/16)

The Washington Post: Words Banned At Multiple HHS Agencies Include ‘Diversity’ And ‘Vulnerable’
The Trump administration has informed multiple divisions within the Department of Health and Human Services that they should avoid using certain words or phrases in official documents being drafted for next year’s budget. Officials at the Centers for Disease Control and Prevention, which is part of HHS, were given a list of seven prohibited words or phrases during a meeting Thursday with senior CDC officials who oversee the budget. The words to avoid: “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based.” (Sun and Eilperin, 12/16)

The Hill: HHS Pushes Back On Report It's Blocking CDC From Using Certain Words 
The Department of Health and Human Services (HHS) is pushing back on a report saying the agency was not allowing the personnel at the Centers for Disease Control and Prevention (CDC) to use words like "diversity," "transgender" and "fetus" in official documents. "The assertion that HHS has 'banned words' is a complete mischaracterization of discussions regarding the budget formulation process," HHS spokesman Matt Lloyd told The Hill on Saturday. (Manchester, 12/16)

Stat: After Report On CDC's Forbidden Words Draws Outrage, HHS Pushes Back
A spokesman for the Health and Human Services Department said Saturday the agency remains committed to the use of outcomes data and scientific evidence in its decisions, pushing back on the characterization of a Washington Post report that the Centers for Disease Control and Prevention is now banned from using words like “science-based” and “transgender” in budget documents. The spokesman, Matt Lloyd, didn’t respond to follow-up questions about whether the policy might apply more broadly, now or in the future, to other HHS agencies such as the Food and Drug Administration or the National Institutes of Health. (Mershon, 12/16)

The Washington Post: ‘We Feel Like Our System Was Hijacked’: DEA Agents Say A Huge Opioid Case Ended In A Whimper
After two years of painstaking investigation, David Schiller and the rest of the Drug Enforcement Administration team he supervised were ready to move on the biggest opioid distribution case in U.S. history. The team, based out of the DEA’s Denver field division, had been examining the operations of the nation’s largest drug company, McKesson Corp. By 2014, investigators said they could show that the company had failed to report suspicious orders involving millions of highly addictive painkillers sent to drugstores from Sacramento, Calif., to Lakeland, Fla. Some of those went to corrupt pharmacies that supplied drug rings. (Bernstein and Higham, 12/17)

The Washington Post: New Drug Law Makes It ‘Harder For Us To Do Our Jobs,’ Former DEA Officials Say
A new law supported by opioid distributors and manufacturers is making it increasingly difficult to hold companies accountable when they run afoul of the nation’s drug laws, according to recently retired Drug Enforcement Administration investigators on the front lines of the war against opioids. They join a chorus of voices — including Attorney General Jeff Sessions, 44 state attorneys general and the head of the DEA office that regulates pharmaceuticals — who are calling for changes to the law. (Higham and Bernstein, 12/15)

Stat: Pressure Builds On The DEA To Stem The Supply Of Prescription Drugs
The process was started nearly five decades ago to ensure that drug makers produced enough medicines to avoid shortages. But in the midst of a national opioid epidemic, fresh scrutiny of the quota system has spread to Capitol Hill, where Democratic lawmakers are pressing the DEA to use it for another reason — to help stem supply. ...Rarely, however, has the quota system been used to eliminate or constrain supply for a class of drugs similar to opioids — created to fill a medical need but with consequences that, in at least some cases, have outweighed the medical benefits. (Facher, 12/18)

The New York Times: In Opioid Battle, Cherokee Want Their Day In Tribal Court
Cherokee children were disappearing. At weekly staff meetings, Todd Hembree, the attorney general of the Cherokee Nation, kept hearing about babies in opioid withdrawal and youngsters with addicted parents, all being removed from families. The crush on the foster care system was so great that the unthinkable had become inevitable: 70 percent of the Cherokee foster children in Oklahoma had to be placed in the homes of non-Indians. (Hoffman, 12/17)

The Wall Street Journal: Prosecutors Treat Opioid Overdoses As Homicides, Snagging Friends, Relatives
After Daniel Eckhardt’s corpse was found on the side of a road in Hamilton County, Ohio, last year, police determined he died of a heroin overdose. Not long ago, law enforcement’s involvement would have ended there. But amid a national opioid-addiction crisis fueling an unprecedented wave of overdose deaths, the investigation was just beginning. Detectives interrogated witnesses and obtained search warrants in an effort to hold someone accountable for Mr. Eckhardt’s death. The prosecutor for Hamilton County, which includes Cincinnati and its suburbs, charged three of Mr. Eckhardt’s companions, including his ex-wife and her boyfriend, with crimes including involuntary manslaughter, an offense carrying a maximum prison sentence of 11 years. (Walker, 12/17)

The Hill: Bipartisan Senators Urge Congress To Fund Fight To Curb Opioid Crisis
A bipartisan group of senators is calling on Congress to provide significant funding to battle the opioid epidemic — and quickly. The nine senators hail from areas the epidemic has hit particularly hard, and are arguing there’s an “urgent need for Congress to provide our states with the resources they need to deal with this public health emergency” in a letter sent Friday to Senate Majority Leader Mitch McConnell (R-Ky.) and Minority Leader Charles Schumer (D-N.Y.). (Roubein, 12/15)

The Associated Press: Lifesaver Or Distraction? Police Split On Anti-Overdose Drug
The sheriff of Clermont County firmly believes it's a call of duty for his deputies to carry a nasal spray that brings people back from the brink of death by drug overdose. Less than 50 miles away, his counterpart in Butler County is dead set against it, saying it subjects deputies to danger while making no lasting impact on the death toll. The divide over naloxone, the popular overdose antidote, between nearby sheriffs in two hard-hit counties in one of the hardest-hit states for drug deaths shows just how elusive solutions are on the front lines of the U.S. opioid crisis. (12/18)

The Washington Post: The Link Between Autism And Parental Age
Older men and women are more likely than young ones to have a child with autism, according to multiple studies published in the past decade. Especially regarding fathers, this effect is one of the most consistent findings in the epidemiology of autism. The link between a mother’s age and autism is more complex: Women seem to be at an increased risk both when they are much older and much younger than average, according to some studies. Nailing down why either parent’s age influences autism risk has proved difficult, however. (DeWeerdt, 12/16)

The Wall Street Journal: Replacement Parts: Organs On Demand
Twenty Americans die every day waiting for transplants. Now researcher Harald C. Ott thinks he’s found a way to save lives and meet the demand for replacement organs. WSJ's Jason Bellini takes a look, in this latest episode of Moving Upstream. (Bellini, 12/18)

Stat: Study: Antibiotics Could Dramatically Reduce Sexually Transmitted Infections
The spread of some sexually transmitted infections could potentially be dramatically reduced by instructing people who have had unprotected sex to take antibiotics within 24 hours after the intercourse, a new study suggests. But such a strategy, which was tested in a population of men who had frequent unprotected sex with a number of male sex partners, could spark a controversy over the use of antibiotics and the general threat of growing antibiotic resistance. (Branswell, 12/18)

The Washington Post: Cancer Clinical Trials Exclude Many Desperate Patients. Should That Change?
When 29-year-old Carly Bastiansen was diagnosed in January 2016 with advanced pancreatic cancer, doctors told her a clinical trial was her best shot at slowing the notoriously quick-killing and hard-to-treat disease. She found one that appeared promising and went through the screening process. But the trial would not accept her. “Participating in a clinical trial is really my only chance at living longer,” Bastiansen, a children’s librarian in Baltimore, said this fall as she was growing weaker. “To have had that option taken off the table was devastating.” (Swartz, 12/17)

NPR: Older Adults' Forgetfulness Tied To Faulty Brain Rhythms In Sleep
Older brains may forget more because they lose their rhythm at night.During deep sleep, older people have less coordination between two brain waves that are important to saving new memories, a team reports in the journal Neuron. "It's like a drummer that's perhaps just one beat off the rhythm," says Matt Walker, one of the paper's authors and a professor of neuroscience and psychology at the University of California, Berkeley. "The aging brain just doesn't seem to be able to synchronize its brain waves effectively." (Hamilton, 12/18)

The Washington Post: Sugar Is 'powerfully Negative' For Your Health.
Who hasn’t been in a relationship we know is bad for us, but one we just can’t quit? For many people, it’s like that with sugar. Breaking up is hard to do. “People generally know that sugar isn’t good, but they don’t appreciate how powerfully negative it really is,” says Donald Hensrud, medical director of the Mayo Clinic Healthy Living Program. “If you look at all the things in our diet we can change, pulling away from refined or added sugar will do more good than anything else.” (Cimons, 12/16)

The Washington Post: A 13-Year-Old's Violent, Unexplained Seizures Were The Key To A Frightening Medical Mystery
Amy C. Hughes was looking forward to a rare luxury: a leisurely weekday lunch with a friend at a restaurant near her suburban Philadelphia home. Hughes, an engineer at Merck, had taken off the week after Christmas 2015 to spend time with her husband, Kevin, and their two children. The couple’s son, Rion, then 13, had come down with a cold on Christmas Day and complained of a headache. A few days later, his pediatrician suspected a sinus infection and prescribed a three-day course of antibiotics. (Boodman, 12/16)

The Associated Press: Lawsuit: 2 Immigrant Teens In US Custody Can’t Get Abortions
President Donald Trump’s administration is blocking two pregnant teens in the country illegally and being held in federal custody from obtaining abortions, the American Civil Liberties Union said Friday, a repeat of the situation that led to a high-profile court fight earlier this year. Both girls arrived in the country as unaccompanied minors and are being held in federal shelters, the ACLU said, though it didn’t say where. The ACLU earlier this year represented a pregnant teen in the same circumstances in Texas, helping her obtain an abortion following a lawsuit. (Gresko, 12/15)

The Hill: ACLU Fighting Trump Over Abortion Access For Two Undocumented Immigrants 
The Trump administration defended the move, with the Department of Health and Human Services's (HHS) Administration for Children and Families saying the minors could leave the country or "find a suitable sponsor." “The minors in this case—who entered the country illegally—have the option to voluntarily depart to their home country or find a suitable sponsor. If they choose not to exercise these options, HHS does not believe we are required to facilitate the abortion," it said in a statement. (Greenwood, 12/15)

The New York Times: In Bronx, Obstetricians May Find Work Inspiring, And Careers Hindered
Dr. Mark Rosing, the chairman of obstetrics and gynecology at St. Barnabas Hospital in the Bronx, is clear with every job candidate he interviews: Once they join his department, they may have trouble leaving. That’s partly because, he tells them, it is an inspiring place to work. The staff is passionate, the benefit to patients in the city’s poorest borough visible. But it’s also because they may not be able to get hired anywhere else. (Wang, 12/15)

The Associated Press: Virginia Governor Proposes Boost In Mental Health Spending
Virginia’s governor is proposing a multi-million-dollar effort to move dozens of people out of state mental hospitals. The Daily Press reported Wednesday that Gov. Terry McAuliffe’s final budget proposes boosting funding for discharge planning by $6.9 million for 80 to 90 people who are on state hospitals’ extraordinary barriers lists. Another $4.8 million would go to community mental health services intended to help people leave the hospitals. (12/15)

Los Angeles Times: Santa Ana Winds Help Clear The Smoke From The Thomas Fire, But Health Risks Remain
Raging Santa Ana winds helped clear smoke from the massive Thomas fire out of Ventura County on Sunday, but health officials cautioned residents that "non-smoky" conditions don't mean the air is safe to breathe. The winds "will cause dust particulate to stir up, resulting in air quality that is at times unhealthy," according to an advisory from the Ventura County Air Pollution Control District. (Poston, 12/17)

Los Angeles Times: California Officials Say Housing Next To Freeways Is A Health Risk — But They Fund It Anyway
It’s the type of project Los Angeles desperately needs in a housing crisis: low-cost apartments for seniors, all of them veterans, many of them homeless. There’s just one downside. Wedged next to an offramp, the four-story building will stand 200 feet from the 5 Freeway. State officials have for years warned against building homes within 500 feet of freeways, where people suffer higher rates of asthma, heart disease, cancer and other health problems linked to car and truck pollution. Yet they’re helping build the 96-unit complex, providing $11.1 million in climate change funds from California’s cap-and-trade program. (Barboza and Zahniser, 12/17)

Kaiser Health News is an editorially independent operating program of the Kaiser Family Foundation. (c) 2017 Kaiser Health News. All rights reserved.

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