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3. Political Cartoon: 'Short Work?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Short Work?'" by Dan Piraro.

Here's today's health policy haiku:

Why Do People Hate Obamacare, Anyway?

We Americans
Do not much appreciate
When told what to do.

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Summaries Of The News:

Capitol Hill Watch

4. House, Senate's Negotiated Tax Package Includes Repeal Of Individual Mandate

The agreement will also allow taxpayers to continue to deduct high out-of-pocket medical expenses. Senate Majority Whip John Cornyn (R-Texas) tells reporters that he was confident the final bill would be approved next week.

The New York Times: Republican Tax Bill In Final Sprint Across Finish Line
The day after suffering a political blow in the Alabama special Senate election, congressional Republicans sped forward with the most sweeping tax rewrite in decades, announcing an agreement on a final bill that would cut taxes for businesses and individuals and signal the party’s first major legislative achievement since assuming political control this year. ... In a break from the House bill, the agreement would allow taxpayers to continue to deduct high out-of-pocket medical expenses, and it would retain a provision allowing graduate students who receive tuition stipends to avoid paying taxes on that benefit. Also included in the consensus bill is the Senate’s repeal of the Affordable Care Act requirement that most Americans have health insurance or pay a penalty and a provision that opens the Arctic National Wildlife Refuge in Alaska to energy exploration. (Tankersley, Kaplan and Rappeport, 12/13)

Bloomberg: GOP Tax Compromise Would Repeal Obamacare’s Individual Mandate
Republican lawmakers will overturn a key piece of the Affordable Care Act in their tax overhaul, a victory in a long GOP campaign against the health law. Senate Majority Leader Mitch McConnell said the compromise tax bill from House and Senate negotiators will end the health law’s requirement that all individuals buy insurance or pay a fine. Doing so could jeopardize Obamacare’s already-shaky marketplaces, by reducing the number of healthier people who sign up for insurance. (Tracer and Rausch, 12/13)

The New York Times: Last-Ditch Effort To Sway Senator On Tax Bill Involves Personal Pleas
As a group of progressive activists and constituents prepared for a 15-minute meeting on Wednesday with Senator Susan Collins, Republican of Maine, they sat in the lobby of her office and developed a last-ditch strategy to persuade her to vote against the $1.5 trillion tax bill barreling through Congress: tears. “If Senator Collins actually saw you as a human, saw me as a human, then she wouldn’t pass any of this,” said Ady Barkan, a member of the Center for Popular Democracy, who recently learned he had amyotrophic lateral sclerosis, or A.L.S., and uses a wheelchair. (Rappeport, 12/14)

Meanwhile, states are watching the negotiations unfold —

Sacramento Bee: What Will GOP Tax Plan Mean For Jerry Brown's 2018 Budget?
Before he terms out of California’s highest office, Gov. Jerry Brown has one more budget to negotiate – a deal that may be complicated by actions taken far outside the state’s borders. Republicans in Congress are in the final stages of a massive overhaul of the federal tax code, which they are eager to pass before Christmas. It could have profound implications for Californians’ pocketbooks, particularly if the cherished deduction for state taxes is eliminated, but the impact on California’s overall fiscal health is not yet clear. (Koseff, 12/13)

Health Law

5. With Enrollment Deadline Only Days Away, Sign-Ups Are Surging Over Last Year's Pace

But the total numbers for 2018 are still likely to fall short of this year's because of the shorter enrollment period. So far, about 1.4 million new customers have signed up this year, and 3.3 million people re-enrolled.

The New York Times: Strong Demand For Health Insurance As Deadline Looms
More than one million people signed up last week for health insurance under the Affordable Care Act, pushing the total in the federal marketplace to nearly 4.7 million, the Trump administration said Wednesday, days before the annual enrollment period is scheduled to end. The number of sign-ups on from Nov. 1 through Saturday was about 17 percent higher than the same time last year. But the final tally is likely to fall short of the 9.2 million who were in plans at the end of the last open enrollment period, which was twice as long as the current one. (Pear, 12/13)

Modern Healthcare: Signups For 2018 Exchange Coverage Hit 4.7 Million In First Six Weeks
Nearly 4.7 million people signed up for an insurance plan through in the first six weeks of the Affordable Care Act's open enrollment this year. At the same time last year, a little more than 4 million people had signed up for a plan. But because this year's open enrollment period is half as long as in previous years, the ACA exchanges have a lot of catching up to do to reach last year's enrollment total of 9.2 million plan selections. (Livingston, 12/13)

Reuters: Obamacare Sign-Ups Rise But Overall Enrollment Set To Fall
The number of consumers who signed up for 2018 Obamacare health insurance surpassed the 1 million mark in the second-to-last week of enrollment, the government said on Wednesday, but it did not appear to be enough to grow the program. The Trump administration has worked to undercut former President Barack Obama's national healthcare law by decreasing advertising and discussing ending the mandate that Americans have health insurance, which has weighed on 2018 enrollment. (Humer, 12/13)

The Washington Post: Enrollment In ACA Health Plans Up From Same Time Last Year, But Sign-Up Chance Dwindling
With three days remaining in most of the country to buy Affordable Care Act coverage for 2018, enrollment is ahead of the same time last year but is almost sure to fall short in the end because of a compressed enrollment season. During each of the six weeks of this sign-up period, the number of consumers choosing plans through the federal website has outmatched that of 2017, according to a federal enrollment snapshot released Wednesday. The overall sign-ups of nearly 4.7 million Americans through last Saturday was about 650,000 higher than through the parallel week a year ago. (Goldstein and Shaban, 12/13)

NPR: HealthCare.Gov's Sign-Up For 2018 Health Insurance Ends Friday For Most
Friday is the last day to enroll in a health insurance plan through the federal government's insurance exchange, And in a little office park in Northern Virginia, Brima Bob Deen is dealing with the rush. He is the president of a church-sponsored job training center called Salvation Academy. But this time of year, he acts mostly as an enrollment counselor for Affordable Care Act health plans. And this week, his calendar is full. (Kodjak, 12/13)

The Hill: 4.7M Have Signed Up For ObamaCare Plans
The strong numbers so far come despite cuts the Trump administration made to ObamaCare's advertising and outreach budget. The initial surge has also put the administration, which has long claimed the health-care law is failing, in a difficult spot. But if the final enrollment numbers are significantly lower than in the past, which many analysts expect, it could bolster the GOP's argument that ObamaCare is failing and needs to be repealed. (Hellmann, 12/13)

The Hill: Maryland Extends ObamaCare Enrollment Deadline
Maryland is extending the deadline by one week for people to enroll in ObamaCare through its state exchange. The new deadline is Dec. 22. The previous deadline would have been Friday, the same date for states that use the federal exchange. (Weixel, 12/13)

The Philadelphia Inquirer/ Obamacare Signups Surge Across Nation As Friday Deadline Looms; Here's How To Get Help In Philly Area
Enrollment in Affordable Care Act health insurance coverage sped up last week, the Trump administration said Wednesday, ahead of a Friday deadline that could catch some people by surprise. More than one million consumers chose plans on the ACA (or Obamacare) exchanges during the week that ended Saturday in the 39 states that use That brought the total since enrollment started Nov. 1 close to 4.7 million, including 206,000 Pennsylvanians and 139,000 New Jersey residents. (Sapatkin, 12/13)

NPR: Health Insurance Bargains Still Available For Many, But Deadline Looms
Gene Kern, 63, retired early from Fujifilm, where he sold professional videotape. "When the product became obsolete, so did I," he says, "and that's why I retired." Kern lives in Frederick, Md., and has been an enthusiastic enrollee in Maryland's health exchange since it began in 2014. But this fall he received a letter from his insurer explaining that the cost of his policy's premium would jump from $800 a month to $1,300 in 2018. (Simmons-Duffin and Farmer, 12/14)

Meanwhile, a new report touts the benefits of the Affordable Care Act —

Los Angeles Times: Obamacare Is Helping Patients Get To The Doctor And Pay Their Medical Bills, New Report Finds
Fewer Americans are putting off doctor visits or struggling with medical bills, according to a new report examining the effect of the Affordable Care Act. The report – based on a state-by-state survey of data collected by the federal government – provides powerful new evidence that insurance gains made through the 2010 healthcare law are helping millions of patients get needed medical care. (Levey, 12/13)

6. Insurer Subsidies Likely To Be In Spending Bill, Collins Vows

The Trump administration earlier in the year stopped payment on the cost-sharing subsidies that are designed to help offset insurers’ costs for reducing out-of-pocket costs such as deductibles and co-pays for lower-income individuals. Meanwhile, House Freedom Caucus Chairman Mark Meadows (R-N.C.) says that Speaker Paul Ryan (R-Wis.) never made a promise either way on the subsidies.

The Hill: Collins Confident Health Subsidies Will Be In Spending Bill
Funding for key ObamaCare insurer subsidies is likely to be included in the upcoming government funding bill, Sen. Susan Collins (R-Maine) said Wednesday. Collins said she had received reassurances Tuesday from Vice President Pence that the subsidies, opposed by House conservatives, would be in the funding bill. (Weixel, 12/13)

Roll Call: Those That Shall Not Be Named: Cost Sharing Reductions
In Congress, where most lawmakers are hesitant to spill secrets about ongoing negotiations, answers are often found in what lawmakers are not saying. And House Republican leaders are not saying much about subsidies for health care insurers lately. GOP leaders’ continued refusal in recent weeks to rule out funding the cost-sharing reduction subsidies, or CSRs, which President Donald Trump’s administration has stopped paying, is not a guarantee that Congress will do so. But it’s certainly a green light for negotiations to continue. (McPherson, 12/14)

Politico Pro: Freedom Caucus Chairman Says Ryan Never Vowed To Block Obamacare Stabilization
House Freedom Caucus Chairman Mark Meadows said on Wednesday morning that GOP leaders never vowed to keep funding for key Obamacare insurance subsidies out of a year-end spending agreement. That contradicts claims made last week by the head of another group of conservative House members, Republican Study Chairman Mark Walker, who said that Speaker Paul Ryan had promised not to restore the cost-sharing payments that President Donald Trump halted earlier in October. (Cancryn, 12/13)

In other news —

The Hill: Alabama Result Deals Heavy Blow To ObamaCare Repeal
The surprise election of a Democrat in Alabama has dealt a major blow to Republican hopes of reviving ObamaCare repeal next year. Republicans already failed multiple times this year to pass an ObamaCare replacement through the Senate with a 52-48 majority. Next year, thanks to the election of Democrat Doug Jones in Alabama, their margin for error will be even slimmer, at 51-49. (Sullivan, 12/14)


7. Fate Of 340B Drug Discount Program In Spending Bill Pits Hospitals, Pharma

The 340B program requires drugmakers to offer discounts on medicines sold to safety-net hospitals. Earlier this year, the Trump administration slashed funding for the program, and hospitals want it restored in Congress' year-end spending bill. Meanwhile, lawmakers are turning their attention to pharmacy benefit managers in their efforts to bring down high drug costs.

Stat: Hospital And Pharma Lobbyists Spar Over Drug-Discount Program Before Time Runs Out
Hospital and pharmaceutical industry lobbyists are facing off as lawmakers scramble to finalize a year-end spending deal that could include changes to the controversial 340B program. Hospitals want Congress to use the package to reverse a $1.6 billion cut to the program that the Trump administration finalized this fall, and which is set to take effect Jan. 1. Drugmakers don’t. And if the package does end or delay the cut, they want hospitals to disclose far more information about the discounts they get under the program, according to a half dozen lobbyists from both industries and several congressional staffers. (Mershon, 12/14)

The Hill: Lawmakers Battle Trump, PhRMA On Discount Drug Rule
Lawmakers in both parties are seeking to block the Trump administration’s changes to a Medicare drug discount program, arguing it would have a negative impact on hospitals that serve low-income people. A rule from the Centers for Medicare and Medicaid Services (CMS) slated to go into effect on Jan. 1 would result in $1.6 billion in cuts to “safety net” hospitals that serve a significant number of low-income patients under the so-called 340B drug discount program. (Hellmann, 12/14)

Modern Healthcare: California, North Carolina And New York Hit Hardest By 340B Cuts
The CMS' planned $1.6 billion in Medicare cuts to 340B hospitals across the nation will disproportionately impact providers in California, North Carolina and New York, according to a new study. Slashing the 340B drug discount program, which is intended to lower operating costs for hospitals to give its low-income patients access to drugs, would result in large funding cuts across California, North Carolina and New York hospitals, ranging from $62 million to $126 million, researchers for consultancy Avalere found. Overall, six states will see drug payment cuts of more than $50 million next year. (Kacik, 12/13)

Stat: ‘Big Black Box Called PBMs’ Draws Attention From Lawmakers Trying To Solve Drug Prices
As lawmakers are puzzling over the question of why so many patients are paying so much money for prescription drugs — and what to do about it — Republicans are focusing increasing scrutiny on the middlemen: pharmacy benefit managers. “What I’m seeing, and what the public sees, is that we’ve got this big black box called PBMs,” said Rep. Morgan Griffith, a Virginia Republican, at a Wednesday House subcommittee hearing. (Swetlitz, 12/13)

And in other pharmaceutical news —

KCUR: Missouri And Other States Face Potentially Costly Dilemma Over Treating Inmates With Hep C
According to the Centers for Disease Control and Prevention, the most common way inmates get Hep C is by sharing equipment used for injecting drugs, tattooing and piercing with other people who are already infected. Civil liberties groups in Missouri and at least seven other states are now suing to get more inmates treated with new-generation Hep C drugs that are highly effective but also very costly. ... In 2016, around 5,000 Missouri inmates had Hep C. The data show that no more than 14 received the drugs. (Smith, 12/13)

California Healthline: Pharmacy Costs Continue To Soar For California’s Public Employee Health System
Spending on prescription drugs by the California Public Employees’ Retirement System (CalPERS) continues to climb, putting pressure on administrators to deploy more cost-cutting measures at the nation’s largest public pension system. The agency’s health benefits committee will discuss the challenge of rising drug costs at its regular meeting on Tuesday, and it will convene a special panel in January to discuss ways to address the problem. (Bartolone, 12/14)


8. Uncertainty Over Funding For Medicare Programs Has Rural Hospitals On Edge

Congress has lagged in renewing extenders for programs that the hospitals rely on. "It's very devastating," said Maggie Elehwany of the National Rural Health Association.

Modern Healthcare: Rural Hospitals Feel The Squeeze As Medicare Extender Funding In Flux
As Congress considers waiting until January to fund expired Medicare programs, the continued uncertainty already roils rural hospitals. The Medicare dependent hospital program and the low-volume adjustment are among the Medicare provisions that must be regularly renewed by Congress, but expired on Sept. 30, known as extenders. These are mandatory appropriations, but Congress has to agree to make them through legislation and the hope was that they would ride along with the Children's Health Insurance Program in the last spending bill of the year. (Luthi, 12/13)

In other Medicare news —

Modern Healthcare: 60% Of Medical Practices' Medicare Revenue Expected To Be Risk-Based By 2019
By 2019, nearly 60% of medical practices' Medicare revenue will come from pay models that require the providers to take downside risk, according to a new survey of AMGA members released Wednesday. Overall, if Medicare Advantage, bundled payments and Medicare accountable care organizations are factored together, alternatives to Medicare fee-for-service, or FFS, are predicted to account for 59% of AMGA member's revenue by 2019, compared to 53% in 2017. (Dickson, 12/13)


9. Maine Officials Wrestle Over Options For Funding Medicaid Expansion

The referendum authorizing the state to move ahead on expanding the program for low-income residents did not include a provision for funding. News outlets also report on Medicaid developments in Montana, Louisiana, Mississippi and the District of Columbia.

Bangor (Maine) Daily News: Attempt To Nail Down Maine Medicaid Expansion Costs Makes No Progress
Questions about how much expanding the state’s Medicaid program would cost took center stage Wednesday during the Legislature’s first discussion of last month’s referendum. But the budget committee meeting ended with no answers. ... At issue is the fact the voter-approved bill mandates expansion but includes no language about how to fund it. Proponents of the measure considered proposing raising the income tax to pay for expansion but opted to omit any funding mechanism from the signature drive that put the question on the ballot. (Cousins, 12/13)

The Associated Press: Lawmakers Figuring Out How To Pay For Medicaid Expansion
Maine faces a July deadline for expanding Medicaid as lawmakers scramble to figure out exactly how much it will cost and how the state will pay for it. The Legislature’s appropriations committee met Wednesday to start coming up with an official estimate of the costs and savings of Medicaid expansion. So far, lawmakers have offered no ideas about how to pay for the expansion. (12/13)

Portland (Maine) Press Herald: Lawmakers Begin Looking For Ways To Fund Maine’s Share Of Medicaid Expansion
[T]he state’s share of expanding the health insurance program for low-income residents is an estimated $60 million, and the budget surplus is expected to be only about $12.5 million at the end of the coming two-year budget cycle in June 2019. Lawmakers will get a revised budget forecast in April. ... Expansion would provide coverage to about 80,000 low-income residents – those earning less than 138 percent of the federal poverty level, or about $17,000 a year for a single adult and $22,412 for a two-person household. [Gov. Paul] LePage, a staunch opponent of Medicaid expansion, is unlikely to cooperate by quickly providing data needed to figure out how to fund the state’s share. (Thistle, 12/13)

MTN News: Medicaid Expansion: The Big Impact Of Big Part Of Obamacare Going Strong In Montana
The Trump administration and Republicans in Congress have begun chipping away at other elements of the ACA, but Medicaid expansion remains largely intact in the 31 states that chose to accept it, including Montana. The government-funded coverage is available to childless adults who earn up to 138 percent of the federal poverty level – about $16,600 a year for a single person or $22,400 for a couple. However, state data show that nearly three-fourths of the people signing up for Medicaid coverage are earning less than 51 percent of the federal poverty level – a mere $6,000 a year. (Dennison, 12/13)

MTN News: Native Americans, Low-Income Clinics Are Big Beneficiaries Of Medicaid Expansion
In the past 18 months, tribal health services on the Flathead Indian Reservation have added a physical therapist and more dental care, and will soon add a new clinic and new speech therapist. Anna Whiting Sorrell, a top health official for the Confederated Salish and Kootenai Tribes, says the changes are largely linked to Montana’s 2016 expansion of Medicaid. Expanded Medicaid – a key part of the Affordable Care Act, or “Obamacare” – has extended government-funded coverage to some 13,000 Native American adults statewide. More than 1,000 of them are in Lake County, enabling them to get the medical care they previously couldn’t afford, Whiting Sorrell says. (Dennison, 12/13)

New Orleans Times-Picayune: Louisiana Lawmakers To Consider Medicaid Contracts For 4th Time
Louisiana's Joint Legislative Committee on the Budget will have another chance Thursday (Dec. 14) to approve $15.4 billion worth of Medicaid contracts that oversee health care for 1.6 million people in Louisiana. The agreements would span 23 months and start Feb. 1. ... Gov. John Bel Edwards' administration has tried and failed three times to get the contracts approved. They are worth a quarter of the state's operating budget and govern health care for 90 percent of the people who receive Medicaid in Louisiana. (O'Donoghue, 12/13)

Jackson (Miss.) Clarion-Ledger: Medicaid, Costs And Quality Of Care, Big Issue Of 2018 Legislative Session
Mississippi lawmakers are gearing up to address the sunset this legislative session of the state's heavily debated Medicaid program, which provides health insurance to more than 760,000 Mississippians. This tasks the Legislature with reauthorizing the Division of Medicaid through what's called the "Medicaid technical amendments bill." It's an opportunity for lawmakers to reexamine the program and make significant changes. (Wolfe, 12/13)

The Washington Post: Judge Blasts District’s Handling Of Medicaid Contracts, Orders Reevaluation
The District government mishandled how it awarded lucrative contracts to manage care for Medicaid beneficiaries and must revaluate proposals by the end of January, an administrative law judge has determined. The ruling, written Nov. 30 but released Wednesday, comes in response to a protest filed with the Contract Appeals Board by MedStar, one of the region’s largest employers and operator of the city’s biggest hospital. It has implications for tens of thousands of Medicaid patients who were transitioning to a new company with a different network of doctors and specialists. (Nirappil, 12/13)

Administration News

10. Nominee For EPA Chemical Safety Position Bows Out After Criticism Over Ties To Industry

Michael Dourson's consultant group produced research for chemical companies that consistently showed little or no human health risks from their products. Critics were worried that if he was confirmed, he would be in the position to oversee the review of chemicals produced by companies he once represented.

The Washington Post: Facing Senate Rejection, Controversial Pick To Head EPA Chemical Office Bows Out
Michael Dourson, whose nomination to become the Environmental Protection Agency’s top chemical safety official drew widespread criticism, withdrew from consideration Wednesday after it became clear the Senate probably would not confirm him. Dourson’s decision, which was confirmed by two senior administration officials who spoke on the condition of anonymity to discuss personnel matters, prevents him from likely becoming the first Trump nominee rejected by the Senate. (Dennis and Eilperin, 12/13)

The Associated Press: EPA Chemical Safety Nominee Drops Out Amid Strong Opposition
North Carolina’s two Republican senators, Richard Burr and Thom Tillis, said last month they would vote against Dourson’s nomination after The Associated Press and other media outlets detailed his past work as a toxicologist hired to defend major chemical companies. The Senate’s 48 Democrats were united in opposition, meaning only one more GOP defection would be needed to defeat Dourson’s nomination. In his letter asking the president to withdraw his name from consideration, which was obtained by the AP, Dourson said his stepping aside “avoids unnecessarily politicizing the important environmental protection goals of Administrator Pruitt.” (Biesecker and Colvin, 12/13)

Public Health And Education

11. Biden Comforts McCain's Daughter Over Her Father's Brain Cancer Diagnosis

Sen. John McCain's cancer is the same type that affected former Vice President Joe Biden's son. The Arizona Republican has been hospitalized at Walter Reed Medical Centers for side effects of his disease treatment.

The New York Times: Joe Biden Comforts Meghan McCain In Heartfelt Exchange On ‘The View'
It lasted only a short time, and it hardly eclipsed the bitterness of partisan politics that has consumed the country. But for nearly five minutes on Wednesday morning, Joe Biden and Meghan McCain shared an emotional exchange about the aggressive form of brain cancer that has affected both of their families. The clip from “The View,” on which Mr. Biden, the former United States vice president, was a guest, drew a powerful and heartfelt outpouring online from viewers. Ms. McCain, a Republican who co-hosts the morning talk show, told Mr. Biden, a Democrat, that she “couldn’t get through” his new book, “Promise Me, Dad,” about his son Beau’s battle with the disease. (Salam, 12/13)

The Associated Press: Biden Consoles Daughter Of Ailing Arizona Sen. John McCain
“I think about Beau almost every day and I was told that this doesn’t get easier but that you cultivate the tools to work with this and live with this,” Meghan McCain said, her voice breaking. “I know you and your family have been through tragedy I couldn’t conceive of.” Biden, who served with John McCain in the Senate, stood up and moved from his seat on the set to sit next to her and hold her hand. He told Meghan McCain not to lose hope and that a medical breakthrough is possible. “And it can happen tomorrow,” Biden said, adding that if anyone can beat brain cancer, it’s John McCain. (Lardner, 12/13)

Politico: Biden Consoles An Emotional Meghan McCain Over Father's Cancer
Biden added that while the glioblastoma diagnosis was "about as bad as it gets," medical advancements were ongoing in the battle against cancer. And that McCain, a renowned-war veteran and congressional leader, would persevere. "If anybody can make it, [it's] your dad," Biden said. "Her dad is one of my best friends." (Lima, 12/13)

12. To Buy Time After Overdose Patient Is Released From Hospital; Some States Mull Involuntary Rehab As An Answer

“Often people leave the emergency room, right back onto the street to find their next fix,” said Marylou Sudders, the Massachusetts secretary for Health and Human Services. States have been working to bridge this gap between hospitalization and getting a patient into a program, but Massachusetts has pitched a more aggressive approach.

The Wall Street Journal: In Opioid Fight, Should States Consider Involuntary Rehab?
When Julia Raposa overdosed on opioids last year, she was rushed to a hospital in Leominster, Mass., where her aunt says she was treated and released within 90 minutes. Days later, Ms. Raposa’s next overdose killed her. A big challenge in the opioid crisis is getting overdose patients from emergency rooms into treatment. Failed opportunities can be fatal. In an aggressive, new proposal, Massachusetts authorities want to allow hospital staff to send overdose patients to treatment centers against their will for up to three days. The goal is to buy more time for addicts facing imminent risks to accept longer-term treatment. (Kamp, 12/13)

Boston Globe: Researchers Say Mass. Effort To Influence Opioid Prescribing Failed
Last March, the state Department of Public Health sent a confidential letter to every health care provider who prescribes opioids and other controlled substances, showing how each practitioner’s prescribing practices compared with those of his or her peers. ...But an article in Thursday’s New England Journal of Medicine concludes that the letter probably didn’t work. (Freyer, 12/13)

In other news on the opioid crisis —

Stat: Kellyanne Conway, Top White House Aide, Is Leading An 'Opioids Cabinet'
Kellyanne Conway, counselor to President Trump, has been leading weekly meetings at the White House with officials across a dozen federal departments to develop a plan to respond to the opioid crisis and to implement recommendations from a presidentially appointed commission, she and other officials told STAT. The “opioids cabinet,” as the group is known, is intended to help streamline efforts across the government and includes staffers from the Department of Health and Human Services and the Office of National Drug Control Policy, among other executive branch offices. (Facher, 12/14)

The Baltimore Sun: CareFirst Plans To Help Curb Opioid Addiction Through Grants, Programs
After noticing a large uptick in claims for addiction treatment services, including expensive emergency room visits, CareFirst BlueCross BlueShield administrators said Wednesday that the insurer was developing a comprehensive method of caring for its customers. The effort was announced by the state’s largest health insurer during an event at Baltimore City Hall, along with a plan to provide$1.5 million to nonprofit groups in the region to curb an opioid epidemic that has ravaged the city in particular. (Cohn, 12/13)

Kaiser Health News: Telemedicine For Addiction Treatment? Picture Remains Fuzzy
When President Donald Trump declared the opioid epidemic a public health emergency, it came with a regulatory change intended to make it easier for people to get care. The declaration allows for doctors to prescribe addiction medicine virtually, without ever seeing the patient in person. In Indiana, this kind of virtual visit has been legal since early 2017. But among a dozen addiction specialists in Indiana contacted by a reporter, just one had heard of doctors using telemedicine for opioid addiction treatment: Dr. Jay Joshi. (Forman, 12/14)

13. Mother's Close Proximity To Fracking Sites Linked To Risk For Having Underweight Baby

The study found negative health consequences up to a two-mile radius around the hydraulic fracturing site. The method for extracting natural gas from the ground relies on chemical-laced water.

The Washington Post: Fracking Sites May Raise The Risk Of Underweight Babies, New Study Says
Living within half a mile of a hydraulic fracturing site carries a serious risk for pregnant women, a new study has found. The drilling technique, also known as fracking, injects high-pressure water laced with chemicals into underground rock to release natural gas. Women who lived within that distance to fracking operations in Pennsylvania were 25 percent more likely to give birth to low-weight infants than were mothers who lived more than two miles beyond the sites. (Fears, 12/13)

The Wall Street Journal: Study Links Lower Birth Weights To Living Near Fracking Sites
That research underscores a problem that has bedeviled the industry and regulators: While the benefits of hydraulic fracturing are widespread, the costs are very localized. The drilling and completion technologies commonly known as fracking have turned the U.S. into an energy superpower while lowering both energy prices and carbon dioxide emissions. To accommodate the industry’s rapid growth over the past decade, several regions of the country—including parts of Pennsylvania, Colorado, Texas and North Dakota—have been turned into industrialized zones, sometimes overlapping with communities. (Gold, 12/13)

Los Angeles Times: Babies Born To Moms Who Lived Near Fracking Wells Faced Host Of Health Risks, Study Suggests
Many of the toxic chemicals used in the hydraulic fracturing process are known carcinogens. Toxic gases, including benzene, are released from the rock by fracking. And the high-pressure pumping of a slurry of chemicals into the ground is widely thought to release toxins and irritants into nearby air and water. The noise and pollution emitted by trucks and heavy machinery also may affect the health of people living nearby. (Healy, 12/13)

14. Teenagers' Smoking, Drug Abuse And Drinking At Lowest Levels Seen In Decades

A notable exception to this trend is marijuana use: the proportion of teens who said they had tried it has remained steady over the last decade.

The New York Times: Marijuana And Vaping Are More Popular Than Cigarettes Among Teenagers
Cigarette smoking has dropped so sharply among American teenagers that vaping and marijuana use are now more common, according to a national survey of adolescent drug use released Thursday. The report, sponsored by the federal government’s National Institute on Drug Abuse and administered by the University of Michigan, found that 22.9 percent of high school seniors said they had used marijuana within the previous 30 days and 16.6 percent had used a vaping device. Only 9.7 percent had smoked cigarettes. (Hoffman, 12/14)

Los Angeles Times: Smoking, Drinking And Drug Abuse Decline Among U.S. Teens, Who Prefer Pot And Vaping, Study Finds
About 1 in 3 middle and high school students surveyed in 2017 said they had used some kind of illicit drug sometime in their life. Two decades ago, that figure was 43%. Likewise, 17% of students surveyed in 2017 said they smoked cigarettes at least once, and 26% said they had been drunk. In the 1990s, those figures reached highs of 58% and 46%, respectively. “The rates of drug use among teenagers in our country are the lowest they’ve ever been for some drugs,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. (Kaplan, 12/13)

15. Could Success Of Personalized Medicine Lend Itself To Precision Public Health Care?

The idea would be to pinpoint populations with genetic vulnerabilities and try to prevent health issues such as cancer and obesity that way. Although roadblocks remain, some advocates are hopeful. In other public health news: the flu, irregular heart rhythms, Parkinson's disease, ADHD, and more.

Stat: Precision Medicine Is Rapidly Advancing. Precision Public Health Could Be Next
Rapid advances in personalized medicine have sparked interest in another new idea: precision public health. Essentially, it’s the thought that if doctors could pinpoint populations with genetic vulnerabilities — like those prone to obesity, depression, or cancer — they might be able to treat those diseases sooner, slow their progression, or even prevent them altogether. It could be a more effective preventive medicine tactic than the blanket approaches used right now (Thielking, 12/13)

The New York Times: A ‘Game Changer’ For Patients With Irregular Heart Rhythm
The patients were gravely ill, their hearts scarred by infections or heart attacks. In each, the electrical system that maintains a regular heartbeat had been short-circuited. They suffered frequent bursts of rapid heartbeats, which can end in sudden death. The condition kills an estimated 325,000 Americans each year, the most common cause of death in this country. And these people had exhausted all conventional treatments. (Kolata, 12/13)

The New York Times: Exercise May Aid Parkinson’s Disease, But Make It Intense
Intense treadmill exercise can be safe for people who have recently been given diagnoses of Parkinson’s disease and may substantially slow the progression of their condition, according to an important new study of adults in the early stages of the disease. But the same study’s results also indicate that gentler exercise, while safe for people with Parkinson’s, does not seem to delay the disease’s advance. (Reynolds, 12/13)

The New York Times: Can The Weather Make Bones And Joints Ache?
Fact or old wives’ tale? A change in the weather can make bones and joints ache. A new study has an answer: old wives’ tale. Other studies have looked at whether an increase in humidity, rainfall or barometric pressure can bring on pain, but never with as much data as in this newest study, in BMJ. Researchers looked at medical records of 11,673,392 Medicare outpatient visits. Matching the dates of the visits to local weather reports, they found that 2,095,761 of them occurred on rainy days. (Bakalar, 12/13)

The Washington Post: A Baby Was Born With Her Heart Outside Her Body — And Survived
Immediately after Vanellope Hope Wilkins was born, she was put in sterile plastic to protect her heart — which was beating outside her tiny chest. It was a moment that her parents, Dean Wilkins and Naomi Findlay, had hoped for but were not certain would actually come — a moment in which their baby girl would come into the world, and live. The newborn, who was born Nov. 22 at Glenfield Hospital in Leicester, England, was delivered by Caesarean section several weeks premature with a rare and often fatal congenital condition called ectopia cordis, in which the heart is growing either completely or partially outside the chest cavity. (Bever, 12/13)

Sacramento Bee: Being Stubborn Might Just Be The Key To A Longer Life, Study Finds
Stubborn people might have another reason to be headstrong — it could keep them alive longer. That’s according to a new study published Tuesday in the journal International Psychogeriatrics, which found that traits like stubbornness, optimism, a love for family and country and a willingness to work hard are common among some Italians aged 90 to 101. (Magness, 12/13)

Kaiser Health News: Good Friends Might Be Your Best Brain Booster As You Age
Ask Edith Smith, a proud 103-year-old, about her friends, and she’ll give you an earful. There’s Johnetta, 101, whom she’s known for 70 years and who has Alzheimer’s disease. “I call her every day and just say ‘Hi, how are you doing?’ She never knows, but she says hi back, and I tease her,” Smith said. There’s Katie, 93, whom Smith met during a long teaching career with the Chicago Public Schools. “Every day we have a good conversation. She’s still driving and lives in her own house, and she tells me what’s going on.” (Graham, 12/14)

Kaiser Health News: Fear Compromises The Health, Well-Being Of Immigrant Families, Report Finds
Luis Ramirez has lived in the U.S. without immigration papers for two decades, but he is more worried about deportation now than ever before. Ramirez said he and his wife, Luz Cadeo, who is also here illegally, have already made plans in case they are arrested by immigration police: The couple, who live in Lakewood, Calif., would try to find work in their native Mexico while their youngest U.S.-born children, ages 15 and 18, stayed in the U.S. with a relative. (Gorman, 12/13)

State Watch

16. Ohio Governor Likely To Sign Bill Banning Down Syndrome Abortions Following Passage In Legislature

A similar measure in Indiana has been blocked by a federal judge, who ruled the state has no authority to limit a woman's reasons for ending a pregnancy. Outlets report on abortion news from Pennsylvania and Arkansas, as well.

The Associated Press: Bill Banning Down Syndrome Abortions Heads To Ohio Governor
In one of their last acts of the year, Ohio lawmakers moved Wednesday to ban abortions based on a diagnosis of Down syndrome and sent the measure to Republican Gov. John Kasich, who is likely to sign it. Two states, Indiana and North Dakota, already have passed laws like the one that Ohio is advancing, touching off an emotional debate over women's rights, parental love and the relationship between doctor and patient. (12/13)

Cleveland Plain Dealer: Ohio Senate Sends Down Syndrome Abortion Ban To Gov. John Kasich
The Ohio Senate on Wednesday gave final approval to House Bill 214 in a 20-12 vote. The bill was passed by the House in November. Three Republicans, including Gayle Manning of North Ridgeville and Matt Dolan of Chagrin Falls, voted with Democrats against the bill. Kasich, who has signed 18 abortion restrictions into law since 2011, told last month he generally supported the idea but wanted to see the legislation before deciding how to act. (Borchardt, 12/13)

The Hill: Pa. Gov Says He'll Veto 20-Week Abortion Ban Passed By Legislature
Pennsylvania Gov. Tom Wolf (D) vowed to veto a bill passed by the state's legislature that would ban abortions after 20 weeks of pregnancy. "This bill is an attack on women, and it should never have reached my desk," Wolf tweeted Wednesday. "I will veto it, because all Pennsylvania women deserve to make their own health care decisions." (Hellmann, 12/13)

The Associated Press: Arkansas Abortion Facilities Threatened With Suspension
Two Arkansas abortion facilities were threatened with suspension — one for not listing the Red Cross on its emergency number list and another for using cloth booties on an exam table — under a new law that the abortion providers are challenging in federal court, according to documents released Wednesday. The state Department of Health issued notices of suspension to Planned Parenthood’s Fayetteville facility and to Little Rock Family Planning Services last week following their annual inspections, according to documents filed by the providers in federal court. The providers are challenging a law enacted this year requiring Arkansas to suspend or revoke abortion clinics’ licenses for violating any rule or law. (Demillo, 12/13)

17. State Highlights: D.C. Public Hospital To Permanently Shutter Nursery And Delivery Rooms; Fla. Hospitals Seek More Funding To Combat Doctor Shortage

Media outlets report on news from Washington, D.C., Florida, Connecticut, California, Indiana, Tennessee, New Hampshire, Minnesota, Georgia, Maryland and Pennsylvania.

The Washington Post: Nursery And Delivery Rooms At D.C.’s Public Hospital Will Not Reopen
The board of D.C.’s public hospital voted Wednesday to permanently close the facility’s nursery and delivery rooms, leaving a broad section of the nation’s capital east of the Anacostia River without a hospital where women can give birth and seek prenatal care. The obstetrics ward at United Medical Center has been closed since Aug. 7, when regulators shut it down after uncovering what they said were serious medical errors in the treatment of pregnant women and newborns. However, elected officials, maternal-health advocates and residents of Southeast Washington had expressed hope that it would reopen. (Jamison, 12/13)

Tampa Bay Times: Florida Hospitals Call For More Funding In Effort To Address Looming Doctor Shortage
The number of doctors practicing in Florida has not kept up with the state’s surging population growth, and more money is needed to recruit and keep them here, hospital leaders said Wednesday. The shortage is particularly acute in four speciality areas: urology, thoracic surgery, nephrology and ophthalmology, according to a second annual report by the Safety Net Hospital Alliance of Florida and the Teaching Hospital Council of Florida. (Griffin, 12/13)

San Jose Mercury News: Uber Reduces Ambulance Usage Across The Country, Study Says
In what is believed to be the first study to measure the impact of Uber and other ride-booking services on the U.S. ambulance business, two researchers have concluded that ambulance usage is dropping across the country. A research paper released Wednesday examined ambulance usage rates in 766 U.S. cities in 43 states as Uber entered their markets from 2013 to 2015. (Seipel, 12/13)

The Associated Press: Fertility Doctor Faces Judge For Lying About Using Own Sperm
A retired Indianapolis fertility doctor accused of inseminating patients with his own sperm is set to plead guilty to charges that he lied to investigators. Dr. Donald Cline is scheduled to appear in a Marion County court Thursday, when a judge is expected to sentence him on two counts of obstruction of justice. Prosecutors say the 79-year-old Cline initially wrote to investigators denying he used his own sperm. (12/14)

Nashville Tennessean: Mayor Barry Slammed Over Handling Of Nashville General Hospital Plans
Less than 48 hours after the Metro Council last week signed off on Nashville Mayor Megan Barry’s $275 million Major League Soccer stadium, many African-American council members say they were blindsided by the next big proposal. With no warning, Barry announced plans to end inpatient care at Nashville General Hospital, a longtime symbol in the city’s black community, which has fought for years to keep the safety-net hospital in operation. The mayor cited the facility’s long-standing fiscal instability. (Garrison, 12/13)

APM: The Minneapolis Police Department Used To Give New Recruits Five Psychological Tests. Now It Just Uses One
Starting in 2012, the city eliminated four of the five psychological tests used to screen applicants for its police academy. Those tests — at least one of which the department had used since at least the mid-1990s — were dropped even though a federally funded study conducted in the Minneapolis Police Department showed some were effective at identifying problem officers. (Gilbert, 12/14)

Georgia Health News: Brookhaven OKs Big Children’s Healthcare Development
The Brookhaven City Council on Tuesday night approved several steps that will enable Children’s Healthcare of Atlanta to move forward with its planned $1 billion North Druid Hills campus. The 72-acre campus will serve as a catalyst for more than $40 million of transportation improvements in the surrounding area, officials said. (Miller, 12/13)

The Baltimore Sun: Hopkins Favored Out-Of-State Patients Over Locals To Increase Revenue, Lawsuit Claims
A former supervisor in the patient appointments department at the Johns Hopkins Health System Corp. has accused the medical system in a lawsuit of prioritizing out-of-state patients over Maryland residents to boost revenue. Anthony C. Campos said in the lawsuit filed Wednesday in U.S. District Court that his department was directed with the task of “filling the plane” with patients from outside Maryland. The directive to bring in more of these patients came from the highest ranks at the medical system, the lawsuit contends. (McDaniels, 12/13)

The Philadelphia Inquirer/ Suburban Woods And Elkins Crest Nursing Homes, Facing Big Fines, Will Have New Operators
A group of 20 Pennsylvania nursing homes, including three facing $1.2 million in federal fines for deficient care, will have new operators after less than three years in the hands of a nonprofit formed to run them. The nonprofit, Oak Health & Rehabilitation Centers Inc, headed by Bala Cynwyd lawyer Howard Jaffe, was put into receivership by its landlord in September after failing to make at least three rent payments totaling $10.5 million and missing financial targets. (Brubaker, 12/14)

Weekend Reading

18. Longer Looks: The Future Of Pharma; Jimmy Kimmel On CHIP; And Presidential Health

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

Politico: Politico's Agenda: The Pharma Issue
The pharmaceutical industry has scored some big successes in the past century. Antibiotics allowed surgery to become routine instead of life-threatening. Drugs to lower cholesterol and blood pressure have cut the death rates from cardiovascular disease. Chemotherapy drugs have turned some cancers into more of a chronic disease than a death sentence.But when we look to the future, it’s not at all clear that we’re going to have the drugs we need for the health challenges we can already predict. (12/13)

Jimmy Kimmel Live: Jimmy Kimmel Returns With Baby Billy After Heart Surgery
The fight is not over for millions of children whose health is threatened right now because a program called CHIP (Children’s Health Insurance Program), that is there to protect them, is in serious need of funding because Congress recently failed to approve funding for it. This is not a partisan issue. Democrats and Republicans have always overwhelmingly supported it – until now. Video. (12/11)

The Atlantic: How Much Will We Find Out About Trump's Health?
President Trump’s detractors have raised concerns that he doesn’t quite fit that first category. There are already some publicly available reasons to worry about Trump’s health: Besides being the oldest president ever elected, he’s overweight, appears to subsist on a junk-food-heavy diet, and avoids exercise. (Olga Khazan, 12/8)

Vox: We’re Barely Using The Best Tool We Have To Fight Obesity
The medical case for bariatric surgery has grown much stronger in recent years. High-quality studies on the long-term health outcomes of people with obesity who got surgery show, on average, that they’re able to lose dramatic amounts of weight, and even reverse or prevent their obesity-related health conditions, like diabetes and high cholesterol. ... Yet out of the 20 million people who are eligible in the US, fewer than 1 percent get bariatric surgery for weight loss, according to the Obesity Society. (Julia Belluz, 12/8)

The New Yorker: Ophelia Dahl’s National Health Service 
[Partners in Health] first came to West Africa in 2014, at the invitation of the governments of Liberia and Sierra Leone, during the height of the Ebola epidemic. Emergency intervention is distinctly not P.I.H.’s project; in contrast with organizations like Médecins Sans Frontières, which specialize in addressing intense crises, P.I.H. works to remake entire health-care systems, by collaborating with local governments. Its commitments are long-term and large in scale. (Ariel Levy, 12/11)

Editorials And Opinions

19. Viewpoints: Handicapping The Health Law's Future; 'Tis The Season... For The Flu'

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

The Des Moines Register: After Tax 'Reform,' GOP Finds New Target: Health Care
The GOP-crafted tax changes are about as popular as a root canal with Americans. A recent poll found the vast majority of voters do not believe their own taxes would be reduced. But Congress can’t move fast enough to deliver more “reform” to the people. Next on the agenda: health insurance programs covering 100 million Americans. (12/13)

Modern Healthcare: Democratic Senate Win In Alabama Dims Odds Of New ACA Repeal Effort
You could almost hear healthcare industry stakeholders sigh with relief when Democrat Doug Jones was projected the winner of the special Senate election in Alabama Tuesday night. That's because Jones' narrow victory over Republican Roy Moore dims GOP hopes of successfully reviving their drive to repeal and replace the Affordable Care Act and cutting and block-granting Medicaid in 2018. Providers, insurers, and consumer advocacy groups almost universally opposed the GOP effort, fearing massive insurance coverage losses and healthcare spending cuts. (Harris Meyer, 12/13)

The Columbus Dispatch: Feel Horrible? It’s Flu Season
It’s not just sleigh bells ringing we hear this time of year, it’s snuffle, moan and cough. And here’s the bad news: Even if you got your flu jab, your chances of avoiding the misery-inducing bug aren’t so good this year; the dominant strain of influenza that is here is less vulnerable to vaccines. (12/13)

Stat: As A Doctor, I Was Opposed To Supervised Injection Facilities. Now I’m Ready To Give Them A Try
[T]he opioid crisis and the frightening rate at which it has accelerated doesn’t allow for the outright dismissal of this idea — or any others — that could have prevented even one of the more than 60,000 deaths caused by drug overdoses in the United States last year. As a health care professional, I can’t stand idly by with the knowledge that a better way exists for reaching and caring for those suffering from the disease of addiction. We can’t allow individuals to die cruel deaths alone in alleyways or under the cover of darkness in public parks. (Henry L. Dorkin, 12/13)

JAMA: A Fair Interpretation
A patient who doesn't speak English lies in bed, looking up at doctors who don't speak Spanish, who point their fingers at the patient’s body, chest, belly, and ask the only question they can: “¿tienes dolor?” We’ve all seen this, more or less. Yes or no—that's the entire story this patient is allowed to tell. No, lo siento, I’m not here to argue for the use of medical interpreters—hopefully your moral compass argues for that on its own. I'm arguing for something else. (Anna DeForest,12/12)

Stat: A Health Care Paradox: Measuring And Reporting Quality Has Become A Barrier To Improving It
How should we measure quality in meaningful and efficient ways? The answer could either smooth the transformation to a value-based delivery and payment system or continue to allow performance measurement to impose a significant roadblock to this transition to value. I say “we” because physicians and other health care providers share ownership of this issue with patients, payers, and purchasers. (Jerry Penso, 12/13)

The Washington Post: Sandy Hook Was Five Years Ago. Congress Has Still Done Nothing.
Josephine "Joey" Gay should have celebrated her 12th birthday this week. She should have been surrounded by friends and family in a place festooned with purple, her favorite color. Chase Kowalski should have been working toward a Boy Scout merit badge and training for a triathlon. Avielle Richman should have been where her parents said she was happiest, on a horse. (12/13)

Los Angeles Times: Five Years On, We're Still Waiting For Sandy Hook To Change The Gun Debate
Five years ago today, Adam Lanza shot and killed his mother in Newtown, Conn., then took two semiautomatic handguns and a semiautomatic rifle from her cache of firearms to massacre 20 children and six staff members at Sandy Hook Elementary School. Of course, people declared at the time, such a tragic, senseless event would be a turning point. Surely a slaughter of innocent children would be too much even for the National Rifle Assn. and its adherents, and finally Congress would act to ban civilian possession of the guns of war. Nope. (12/14)

RealClear Health: Keeping Affordable Contact Lenses And Patient Rights In Focus
While most of Congress and K Street is preoccupied with tax reform, keeping the government funded and deciding which holiday parties to attend, other issues in Congress are moving ahead under the radar. If the American people are not vigilant, Congress is going to get away with supporting some fairly anti-free market policies that will have real, negative effects on millions of people. (Easton Randall, 12/13)