Note To Readers

THE DRUG INDUSTRY SPENDS BIG ON LOBBYING AND POLITICS: Tune in to KHN’s next Facebook Live as senior correspondent Jay Hancock details what he uncovered in his examination of  PhRMA’s recent financial disclosure forms to the Internal Revenue Service. The discussion will be Wednesday, Jan. 10, at 3 p.m. ET. You can send questions here and watch here.

In This Edition:

From Kaiser Health News:

Kaiser Health News Original Stories

7. Political Cartoon: 'Nerves Of Steel?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Nerves Of Steel?'" by Dave Coverly, Speed Bump.

Here's today's health policy haiku:

Pot Churches Proliferate As States Ease Access To Marijuana

Left coast religion
Is that incense burning there?
Stone(d)-cold acolytes.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Summaries Of The News:

Health Law

8. Under Trump's Proposed Rules, Small Businesses Could Band Together To Buy Health Plans

Republicans say that relaxing restrictions on association health plans will make coverage more affordable, but critics cite a history of fraud and abuse that has left employers and employees with hundreds of millions of dollars in unpaid medical bills.

The New York Times: Trump Proposes New Health Plan Options For Small Businesses
The Trump administration on Thursday proposed sweeping new rules that could make it easier for small businesses to band together and create health insurance plans that would be exempt from many of the consumer protections mandated by the Affordable Care Act. As many as 11 million Americans “could find coverage under this proposal,” the Labor Department said in issuing the proposed rules, which carry out an executive order signed by President Trump on Oct. 12. The public will have 60 days to comment on the proposal before the Trump administration adopts final rules with the force of law. (Pear, 1/4)

The Washington Post: Trump Administration Proposes Rules For Health Plans Without Certain ACA Protections
The proposal, issued by the Labor Department, would carry out the most significant part of an executive order that President Trump signed in October, directing the government to foster alternative types of insurance. Proponents say the association health plans would be less expensive and enhance consumer choice, while critics — including the insurance industry — fear they would promote substandard coverage and weaken the ACA’s already fragile insurance marketplaces. Specifically, the rules would allow such health plans to be reclassified so they no longer would have to include a set of 10 essential health benefits — including maternity care, prescription drugs and mental health services — that the ACA requires of insurance sold to individuals and small companies. (Goldstein, 1/4)

The Wall Street Journal: Trump Administration Proposal Would Exempt Small Businesses From Some ACA Rules
[A] senior official said there are nondiscrimination provisions in the rule, a draft of which was released on Thursday, that would prevent an association from cherry-picking employers with healthy workforces or charging higher premiums to less-healthy people. An association couldn’t charge different premiums to different small employers based on health factors, the official said. But allowing the plans not to cover the mandatory ACA benefits could enable associations to essentially exclude people by not offering coverage for specific treatments, such as chemotherapy, said Timothy Jost, an emeritus law professor at Washington and Lee University in Lexington, Va. “There are plenty of opportunities for discrimination,” he said. (Armour, 1/4)

Modern Healthcare: Trump Administration Proposes Rule To Expand Association Health Plans 
Current criteria make it difficult for an association health plan to be regarded as a large employer under ERISA. So, many existing association plans are subject to the rules and standards that govern the small group and individual insurance markets. Those standards include protections for people with pre-existing medical conditions, and the requirement that insurers cover 10 essential health benefits. Members must be part of the same industry to form an association health plan under the current rules. The proposed rule would change that, allowing workers in unrelated professions to band together to obtain coverage through an association health plan so long as they are in the same geographic region, explained Chris Condeluci, a health policy consultant who was a Senate GOP staffer during passage of the ACA. (Livingston, 1/4)

Bloomberg: Trump’s Obamacare Rule Would Let Small Firms Act Like Big Ones 
Other Obamacare rules do apply though, including caps on how much an individual has to pay out of pocket in a year, and bans on lifetime or annual limits for services that are covered by the plan. All plans are also required to cover a list of preventive services with no out-of-pocket costs to the beneficiary. (Tracer and Eidelson, 1/4)

Los Angeles Times: Trump's Move To Make Skimpier Health Plans More Available Threatens To Undermine Obamacare
[M]any patient groups and consumer advocates — who are already alarmed by Trump administration efforts to undermine the 2010 health law — fear that less comprehensive health plans will leave Americans without vital protections. "The rule proposed today will almost certainly result in more people facing financial distress when an unexpected health crisis happens and they discover their association health plan coverage is inadequate," said Chris Hansen, president of the advocacy arm of the American Cancer Society. By allowing healthier Americans to buy plans that don't cover expensive medications or other medical benefits, these plans also risk driving up costs for sick patients who need the more extensive coverage. (Levey, 1/4)

The Associated Press: In New Rule, Trump Tries To Deliver A Health Care Promise
Don't look for revolutionary changes, said analyst Elizabeth Carpenter of the health industry consultancy Avalere Health. "The impact on the markets and on consumers really may depend on whether it is easy enough for the groups potentially affected to take advantage of the rule," she said. No sweeping consequences are seen for the more than 170 million Americans with employer-sponsored coverage, or the nearly 30 million still uninsured. (Alonso-Zaldivar, 1/4)

The Hill: Trump Offers New Rule Going After ObamaCare
Republicans argue the proposal would give employers more flexibility to choose the insurance plan that works best. “If made final, this rule should help up to 11 million hard working Americans who don’t have access to employer sponsored coverage and in addition provide new, more affordable options to Americans in the individual market who are getting hammered by skyrocketing premiums,” Sen. Lamar Alexander (R-Tenn.), chairman of the Senate Health Committee, said in a statement. (Weixel, 1/4)

Kaiser Health News: Trump Administration Rule Paves Way For Association Health Plans
Critics, though, are wary about whether the plans will provide consumers adequate protection. “This approach allows associations to offer coverage that doesn’t have to come into compliance with all the critical consumer protections that would otherwise apply to small employers and individuals. It might not be as comprehensive,” said Kevin Lucia, project director at Georgetown University’s Health Policy Institute. (Appleby, 1/4)

Kaiser Health News: Podcast: ‘What The Health?’ While You Were Celebrating …
The year in health policy has already begun: The Trump administration Thursday released a long-awaited regulation aimed at making it easier for small businesses and others to form “association health plans.” Now advocates and opponents will be able to weigh in with more specific recommendations. Meanwhile, in December, the health policy focus was on the tax bill and its repeal of the Affordable Care Act’s “individual mandate” penalty for most people who don’t have health insurance. But some recent key court decisions could reshape the benefits millions of people receive as part of their health coverage. (1/4)

Administration News

9. 'Preparing For The Unthinkable': CDC To Teach Health Professionals What To Do In Case Of Nuclear War

The agency is holding a teaching session for doctors, nurses, epidemiologists, pharmacists, veterinarians, certified health education specialists, laboratory scientists, and others to prepare them for how to act in case of a nuclear detonation.

The Hill: CDC Schedules Briefing On Preparing For Nuclear Detonation 
The Centers for Disease Control and Prevention (CDC) has scheduled a briefing for later this month on how to plan and prepare for a nuclear detonation. The briefing, for CDC employees, is part of a monthly series at the agency meant to "further strengthen CDC's common scientific culture and foster discussion and debate on major public health issues." (Hellmann, 1/4)

Politico: CDC Briefing To Focus On Preparing For Nuclear War
The Centers for Disease Control and Prevention has posted a notice touting a Jan. 16 briefing about the work that federal, state and local governments are doing in case of a possible nuclear strike. “While a nuclear detonation is unlikely, it would have devastating results and there would be limited time to take critical protection steps,” the notice states. “Despite the fear surrounding such an event, planning and preparation can lessen deaths and illness.” (Ehley, 1/4)

Stat: CDC Plans Session On 'Preparing For The Unthinkable': A Nuclear Detonation
A spokesperson for the agency said planning for the event has been underway for months — in fact, since CDC officials took part in a “radiation/nuclear incident exercise” led by the Federal Emergency Management Agency last April, Kathy Harben said in an email. ... Still, the timing of the announcement was eerie, coming on the heels of back-to-back threats exchanged between North Korean leader Kim Jong Un and President Donald Trump. (Branswell, 1/4)

10. Justice Department Announces It's No Longer Taking Hands-Off Approach To Legalized Marijuana

Attorney General Jeff Sessions says he is revoking an Obama-era policy that was deferential to states’ permissive marijuana laws, but it's not clear exactly what that means. However, the industry, which was riding a high from California legalizing recreational marijuana use, is worried.

The New York Times: Trump Administration Takes Step That Could Threaten Marijuana Legalization Movement
The viability of the multibillion-dollar marijuana legalization movement was thrown into new doubt on Thursday when the Trump administration freed prosecutors to more aggressively enforce federal laws against the drug in states that have decriminalized its production and sale, most recently California. Attorney General Jeff Sessions, long a vocal opponent of the legalization of marijuana, rescinded an Obama-era policy that discouraged federal prosecutors in most cases from bringing charges wherever the drug is legal under state laws. (Savage and Healy, 1/4)

The Associated Press: Federal Pot Policy Change Sparks Confusion, Crackdown Fears
Officials wouldn't say if federal prosecutors would target pot shops and legal growers, nor would they speculate on whether pot prosecutions would increase. The action by Attorney General Jeff Sessions was not unexpected given his longtime opposition to pot, but comes at a heady time for the industry as retail pot sales rolled out New Year's Day in California. (1/5)

The New York Times: California Defiant In Face Of Federal Move To Get Tough On Marijuana
The sale of recreational cannabis became legal in California on New Year’s Day. Four days later, the Trump administration acted in effect to undermine that state law by allowing federal prosecutors to be more aggressive in prosecuting marijuana cases. A memo by Attorney General Jeff Sessions on Thursday was widely interpreted in the nation’s most populous state as the latest example of Trump vs. California, a multifront battle of issues ranging from immigration to taxes to the environment. (Fuller, 1/4)

Sacramento Bee: California Moves To Protect Legal Cannabis From Sessions
California signaled its intent Thursday to defend the state’s voter-approved law legalizing recreational marijuana, hours after U.S. Attorney General Jeff Sessions issued a memo clearing the way for a federal crackdown on weed. Two state leaders – Attorney General Xavier Becerra and Bureau of Cannabis Control Chief Executive Lori Ajax – issued statements saying they’ll defend Proposition 64, the 2016 initiative that led to the opening of the state’s first retail cannabis stores this week. (Hart and Irby, 1/4)

11. Administration Decision On Medicaid Work Requirements Expected Soon

Nine states are applying for federal waivers to impose the requirements for able-bodied adults enrolled in Medicaid. The Obama administration had refused such requests. Elsewhere, tensions are growing in Maine as the governor seeks to stop the Medicaid expansion approved by voters, frustrations with Iowa's managed care program are raising concerns among lawmakers and budget requests for Medicaid programs in Arkansas and Alabama come in lower than expected.

The Hill: Trump Poised To Take Action On Medicaid Work Requirements
The Trump administration is preparing to release guidelines soon for requiring Medicaid recipients to work, according to sources familiar with the plans, a major shift in the 50-year-old program. The guidelines will set the conditions for allowing states to add work requirements to their Medicaid programs for the first time, putting a conservative twist on the health insurance program for the poor. (Sullivan, 1/5)

Kaiser Health News: Maine Voters Chose Medicaid Expansion. Why Is Their Governor Resisting?
At least 70,000 low-income Maine residents like Donna Wall should gain Medicaid health insurance because of the ballot measure that passed last fall. Advocates collected signatures to put the question to voters, and, in November, Maine became the first state to get approval at the ballot box to expand Medicaid, passing with 59 percent approval. But even though voters here in Maine decided to expand Medicaid, the law’s fate is unclear. Republican Gov. Paul LePage has said that opening up the program to more poor adults threatens the state’s financial stability and that lawmakers shouldn’t raise taxes to pay for it. (Varney, 1/5)

Bangor (Maine) Daily News: LePage Can Expect A Lawsuit If He Blocks Medicaid Expansion
[Gov. Paul] LePage and some Republicans — including most of the party’s gubernatorial candidates — have made it clear that they want to find a way to block Medicaid expansion. ... [Assistant House Majority Leader Jared] Golden said expansion proponents’ strategy is to watch for signs that the LePage administration is not moving forward with expansion and, if not, to sue him. “The organizations that banded together to support Question 2 feel like they have a bullet-proof legal argument,” he said. (Cousins, 1/4)

Des Moines Register: Iowa's Medicaid Woes Eroding Patience Of GOP Legislators, Upmeyer Warns
Gov. Kim Reynolds acknowledged Thursday that Iowa's decision to hire private companies to manage the state's $5 billion Medicaid program has had a rocky start, but she insisted steps are underway to fix troubles that have generated widespread complaints from patients and health care providers. The Republican governor also indicated that while input from the Iowa Legislature is welcome, she doesn’t necessarily believe the problems will require the passage of special bills targeted at the issue. However, Iowa House Speaker Linda Upmeyer, R-Clear Lake, bluntly warned that lawmakers’ patience is waning with Medicaid managed care, which serves 600,000 low-income and disabled Iowans. (Petroski, 1/4)

Northwest Arkansas Democrat-Gazette: Budget Request Falls $478M For Medicaid
Thanks to efforts to reduce Arkansas' Medicaid spending and enrollment, Gov. Asa Hutchinson said, his request for federal and state funding for the program during the fiscal year that starts July 1 will be about $478 million lower than what he had first planned. The reduction would bring the budget for the state Medicaid program in fiscal 2019 to about $7.5 billion -- about $55 million less than the state budgeted this fiscal year. (Davis, 1/5)

The Associated Press: Arkansas Governor: Medicaid Rolls Dropped By 117K Last Year
Arkansas' governor on Thursday touted an 11 percent drop in the state's Medicaid rolls over the past year as he prepared for another potential fight in the Legislature to keep the state's hybrid Medicaid expansion alive. Gov. Asa Hutchinson and Department of Human Services officials said that enrollment in the state's Medicaid program dropped by more than 117,000 people from 2017 to 2018. Nearly 59,000 of that came from the state's hybrid expansion, which uses Medicaid funds to purchase private insurance for low-income residents. (Demillo, 1/4)

AL.com: Alabama Medicaid Agency Delivers Good News, At Least For Now
Medicaid, the biggest consumer of dollars in the state's General Fund, expects to carry forward $53 million into next year, offsetting the need for an increase in state funding for 2019. Medicaid Commissioner Stephanie Azar made a presentation today at a legislative budget hearing in Montgomery. Lawmakers are preparing for their annual session, which starts Tuesday. A key task will be to pass a state budget for 2019. (Cason, 1/4)

The CT Mirror: Medicare Program Fix Adds Red Ink To CT’s Finances
To reverse new eligibility restrictions for the Medicare Savings Program, which uses Medicaid funds to pay medical expenses that Medicare doesn’t cover for poor seniors and the disabled, legislators needed to find about $54 million this fiscal year. Estimates are those restrictions, if not reversed, could eliminate or reduce benefits for as many as 113,000 residents. (Phaneuf, 1/4)

Medicaid

12. Picking Name Out Of Bowl Might Determine Fate Of Medicaid Expansion In Virginia

A House of Delegates race in Virginia is drawing national attention because the seat determines if Republicans retain power of the state chamber. The outcome will affect how hot-button issues such as Medicaid expansion play out in the state. The winner for the seat -- the Republican candidate -- was selected on Thursday, but the loser will have an option to request a recount.

The New York Times: Virginia Official Pulls Republican’s Name From Bowl To Pick Winner Of Tied Race
An official of the Virginia State Board of Elections pulled the name of David Yancey from a blue and white stoneware bowl on Thursday, breaking a tied race that is pivotal to control of the state House of Delegates. The outcome in favor of Mr. Yancey, the Republican incumbent, means that the House remains narrowly in his party’s hands, 51 seats to 49, after a Democratic wave in November propelled by anger at President Trump. ...Virginia Democrats had hoped that under Ralph Northam, the governor-elect and a Democrat, thwarted liberal priorities would break through a logjam of Republican control of both houses of the General Assembly. Expanding Medicaid in the state was high on that list. (Gabriel, 1/4)

Politico: Medicaid Expansion Fight Looms After Virginia Statehouse Drawing
A showdown over Obamacare's Medicaid expansion pitting Republican lawmakers against Virginia's newly elected governor is almost certain following the GOP victory in a drawing to decide control of the state's House of Delegates. The expected fight in a purple state demonstrates the law's staying power even as a Republican president and Congress work to undo it. (Pradhan, 1/4)

Health Care Personnel

13. Secret Settlements Can Keep Sexual Misconduct Allegations Against Doctors Hushed Up

Two cases at the renowned Cleveland Clinic are examples of how confidential settlements cover up misconduct in the health industry.

USA Today: Confidential Deals Can Obscure Sexual Misconduct Allegations Against Doctors As Cleveland Clinic Case Shows
The Cleveland Clinic, one of the nation's largest and most renowned hospitals, knew of at least two cases in which one of its surgeons was accused of raping patients but kept him on the staff while reaching a confidential settlement, a USA TODAY investigation has found. Ryan Williams, a colorectal surgeon accused in police reports by two women of anally raping them in 2008 and 2009, left Cleveland Clinic last summer for another hospital, which placed him on leave after learning of the complaints against him. (O'Donnell, 1/5)

In other news on health care personnel —

Modern Healthcare: ACP Launches Initiative To Target Physician Burnout
The American College of Physicians is launching an initiative to improve doctor job satisfaction, hoping that will help curb the tide of clinicians leaving the field due to burnout. The organization's new "Physician Well-being and Professional Satisfaction" initiative aims to promote wellness by providing clinicians with educational tools to help reduce the impact of several job-related stressors, such as the burden of administrative tasks, poor work-life balance, patient overload and pressures to reduce health costs. (Johnson, 1/4)

Marketplace

14. Large Health Systems Asking Medicare For Relief From Some MACRA Requirements

The Centers for Medicare & Medicaid Services has already announced that physician practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients per year did not have to comply with the Medicare Access and CHIP Reauthorization Act (MACRA) that set up a new payment formula for doctors. Larger health systems are complaining that they need relief from the burden as well, though.

Modern Healthcare: Large Health Systems Say They Need MACRA Relief Just As Much As Small Providers 
Large health systems say the CMS's efforts to make MACRA less burdensome on small providers leaves them behind and they're suggesting the agency overhaul how the new payment model tracks physician performance to make it easier. Providers expressed the concern in comments to the CMS. The agency asked for that feedback on the interim final rule for the second year of the Medicare Access and CHIP Reauthorization Act. (Dickson 1/4)

In other news from the health industry —

Modern Healthcare: Hospital Profits Continued Their Rise In 2016 
Profits at the more than 4,800 U.S. community hospitals rose 3.8% in 2016, climbing to $76.1 billion, from $73.3 billion a year earlier. The trend follows years of steadily increasing profits. Total net revenue reached $979 billion in 2016—including nursing home results—and expenses were $903 billion, according to the 2018 edition of the American Hospital Association's Hospital Statistics report aggregating hospital financial and utilization trends, which was released Thursday. The annual report includes data on all 4,840 registered community hospitals in the U.S.—159 fewer than in 2012. (Bannow, 1/4)

Modern Healthcare: Insurers Paid $447 Million In Medical Loss Ratio Rebates For 2016
Health insurers paid nearly $447 million in customer rebates for 2016 under a federal rule requiring payers to spend a minimum percentage of their premium dollars on medical care and quality improvement, the CMS said last week. Those rebates issued under the medical loss ratio provision of the Affordable Care Act went to 3.9 million consumers enrolled in individual and employer-based health insurance coverage for 2016. (Livingston, 1/4)

Bloomberg: Government, Health Services At Risk From Intel Chip Weakness 
Highly regulated sectors, such as government offices and public health institutions, are most at risk of compromise as a result of the security flaw present in modern microprocessors from Intel Corp., Advanced Micro Devices Inc. and other manufacturers, according to security experts. Widespread use of old computers and legacy components means software-based fixes being developed by companies like Microsoft Corp. may slow down already-aging systems. (Lanxon and Kahn, 1/4)

Bloomberg: Aetna And CVS Were Talking To Others During Takeover Process
CVS Health Corp. and Aetna Inc. were both talking to other potential partners during early discussions that led to their $68 billion merger, according to a regulatory filing Thursday. As late as August, Aetna was in discussions with a “Party X” about a “strategic partnership, business combination or other opportunities.” The mystery company, which isn’t named in the document, told Aetna in October that it wasn’t planning to make a takeover offer. (Tracer and Langreth, 1/4)

Medicare

15. Medicare Agrees To Cover Abbott's Glucose Monitor For Diabetes Patients

The monitor allows patients to avoid pricking their fingers to get blood-sugar readings. Analysts suggest the decision by Medicare will give Abbott a leg up over another device made by DexCom.

CNBC: Medicare To Cover New Glucose Monitor, Giving Abbott An Edge Over Rival Dexcom
Abbott won big and early this new year. Its FreeStyle Libre continuous glucose monitor received Medicare coverage, one month after it was launched, the company said Thursday. The decision comes ... between 9 and 12 months ahead of Wall Street's expectations, J.P. Morgan analyst Michael Weinstein wrote in a note following the announcement. The product is the first continuous glucose monitor on the market that doesn't require patients to prick their finger to draw blood. (LaVito, 1/4)

Chicago Tribune: Medicare Patients With Diabetes Gain Coverage For Abbott's Prick-Free Glucose Monitor
The system reads glucose levels through a sensor the size of two stacked quarters that patients place on the back of their upper arm. It can be worn for 10 days. Patients capture real-time glucose readings by placing a hand-held reader over the sensor and give themselves insulin dosages based on the results. Users still may have to prick their fingers to confirm the results if their symptoms don’t match the system reading or if they get particularly low or high readings. The list price in the U.S. is $36 per sensor and $70 for the reader, though prices vary at the retail pharmacy and based on insurance coverage, a company spokeswoman said. (Elejalde-Ruiz, 1/4)

Reuters: CMS To Cover Abbott's Glucose Monitoring Device
Abbott’s device is the second continuous glucose monitoring system after DexCom Inc’s G5 Mobile to be covered by the federal agency. DexCom’s device is similar to Abbott‘s, but requires fingertip testing about two to four times a day for optimal accuracy. (1/4)

Pharmaceuticals

16. Pipeline Of Generics Into Drug Marketplace Contributing To Lower Prices, CVS And Walgreens Say

But the influx of the medications might help the companies' bottom lines because generics generally have a higher margin than name-brand drugs. Meanwhile, the industry is primed for another wave of mega-mergers in the coming year.

The Wall Street Journal: CVS, Walgreens Say Drug Prices Are Easing After Years Of Ballooning
After years of surging U.S. drug prices, the two largest drugstore companies said some pricey prescription medicines are becoming more affordable. CVS Health Corp. and Walgreens Boots Alliance Inc. said Thursday that their pharmacy revenues are taking a hit from an increase in generic alternatives, particularly for some expensive specialty drugs, along with slowing price inflation for name-brand medications. (Terlep, 1/4)

The Wall Street Journal: Drug Industry Is Ripe For A Wave Of Deals
Nearly a decade ago, a wave of megamergers gripped the pharmaceutical industry. In 2018, conditions are right for a sequel. Back then, concerns about growth and tougher regulations spurred deals like Pfizer ’s $68 billion acquisition of Wyeth and Merck & Co.’s $41 billion acquisition of Schering-Plough. Today, growth concerns are rising again, and several other factors, including consolidation in other parts of health care, are setting the stage for another wave of deals. (Grant, 1/5)

In other pharmaceutical news —

Stat: Sage Therapeutics's Frenzied CEO Pushes For Depression Drug Approvals
Sage has already completed an encouraging mid-stage trial for a drug to treat major depressive disorder and positive late-stage trials for an infusion to treat postpartum depression. Though some questions about the drugs remain, their potential has built up hope that much-needed new treatments for depression could be on the horizon. The company’s successes have come at a time when much of the biopharma industry has retrenched from trying to develop such psychiatric drugs because the conditions have proven so difficult to treat. (Joseph, 1/4)

The New York Times: New Shingles Vaccine Is Cost Effective
The new shingles vaccine is expensive, but worth it, according to a new analysis in JAMA Internal Medicine. Shingles is a painful and sometimes debilitating nerve inflammation and blistering skin rash caused by the same virus that causes chickenpox. Anyone who has had chickenpox is susceptible to it many years later. (Bakalar, 1/4)

Public Health And Education

17. Less Than One In Three Americans Think Opioid Crisis Is A National Emergency

A "surprising" study finds that while many think it's a problem, only a small number of Americans think the opioid epidemic rises to the level of an emergency.

The Hill: More Than Half Think Painkillers A Major Problem, But Not A National Emergency: Report 
A little over half the country considers prescription painkiller addiction a major problem for the nation, but say it doesn't rise to the level of national emergency, a new report in the New England Journal of Medicine notes. In late October, President Trump declared the epidemic a national public health emergency; declaring some type of national emergency was the “first and most urgent” recommendation from the president’s commission to address the opioid epidemic. (Roubein, 1/4)

Meanwhile, in California —

Los Angeles Times: California Bills Aim To Tackle Opioid Addiction By Curbing Excessive Prescriptions
Looking to combat the opioid abuse epidemic, a Silicon Valley legislator has introduced a slate of bills meant to clamp down on access to highly addictive prescription drugs. Assemblyman Evan Low (D-Campbell) authored three measures meant to provide a better understanding of patients’ access to these medications, building on an existing state database tracking prescriptions in California. “I don’t think there’s enough attention at the issue at hand, which is the system is not working,” Low said. (Mason, 1/4)

18. Risky Behavior Decreased 'Markedly' Among Younger Students

The proportion of high school students having sex continues to decrease, a new government study finds, and other students are waiting longer.

The Washington Post: Fewer Teens, Several Ethnic Groups Are Less Sexually Active
The number of high-school-aged teens who are having sex dropped markedly over a decade, a trend that includes substantial declines among younger students, African Americans and Hispanics, according to a new government report released Thursday. The survey by the Centers for Disease Control and Prevention showed especially steep declines in the past two years. It adds to evidence about ongoing progress in reducing risky behavior by teenagers, who are becoming pregnant, smoking cigarettes, drinking alcohol and using marijuana at lower rates than younger people before them, according to public health surveys. (Bernstein, 1/4)

The Hill: More Students Are Putting Off Having Sex
The most significant declines occurred among 9th and 10th grade students. Just under a quarter of 9th graders reported having sex, down 10 percentage points from a decade ago, while the number of 10th graders with sexual experience declined by 7 points. “The decreases in sexual intercourse by grade suggest that fewer students are having sexual intercourse during the earlier years of high school,” authors Kathleen Ethier, Laura Kann and Timothy McManus wrote. They called those findings “especially encouraging.” (Wilson, 1/4)

19. While Cancer Deaths Are Decreasing, U.S.'s No. 2 Killer Still Remains Formidable Foe

Experts credit a decline in tobacco use for the improved rates, along with breakthrough drugs that have improved the chance of surviving a diagnosis. In other public health news: the IV bag shortage linked to the hurricane in Puerto Rico may be over soon; a study finds that antioxidants don't ease muscles after exercise; and more.

The Washington Post: The Cancer Death Rate Has Dropped Again. Here's Why.
The nation's overall cancer death rate declined 1.7 percent in 2015, the latest indication of steady, long-term progress against the disease, according to a new report by the American Cancer Society. Over nearly a quarter-century, the mortality rate has fallen 26 percent, resulting in almost 2.4 million fewer deaths than if peak rates had continued. But the report, released Thursday, shows that Americans' No. 2 killer remains a formidable, sometimes implacable, foe. An estimated 609,000 people are expected to die of the ailment this year, while 1.74 million will be diagnosed with it. (McGinley, 1/4)

Bloomberg: Cancer Deaths Fall To Lowest Rate In Decades 
While a number of breakthrough, high-cost drugs have improved the outlook for people with some deadly cancers, the biggest cause of the decrease in deaths is that Americans are smoking less. “It’s the low-hanging fruit,” said Ahmedin Jemal, the cancer group’s vice president of surveillance and health services research. “We’re going to continue to see this decline because of prevention, primarily reduction in smoking prevalence.” (Levingston, 1/4)

The Hill: Shortage Of IV Fluids Caused By Hurricane Expected To Improve 
The Food and Drug Administration (FDA) is confident the shortage of saline IV fluids and bags caused by the hurricane that hit Puerto Rico last year will soon subside. The hurricane crippled a leading manufacturer — Baxter International — in Puerto Rico. But Baxter has announced all of their facilities on the island have returned to the commercial power grid, FDA Commissioner Scott Gottlieb said Thursday. (Hellmann, 1/4)

The New York Times: Antioxidants Don’t Ease Muscle Soreness After Exercise
Many people take antioxidants before or after exercise in the belief that this prevents muscle soreness. A thorough review of the scientific literature has found no solid evidence that it works. Researchers pooled data from 50 randomized placebo-controlled trials involving 1,089 participants. Some studies looked at antioxidant supplements taken before exercise, some after. The type of antioxidant studied varied — cherry juice, pomegranate juice, vitamins C and E, black tea extract and others in various doses. The studies used supplements as powders, tablets and concentrates. (Bakalar, 1/4)

Kaiser Health News: From Retirement To The Front Lines Of Hepatitis C Treatment
When a hepatitis C treatment called Harvoni was released in 2014, Dr. Ronald Cirillo knew it was a big deal. “It’s the reason that dragged me out of retirement!” he said. Cirillo specialized in treating hepatitis C for more than 30 years in Stamford, Conn., before retiring to Bradenton, Fla. During his time in Connecticut, the only available treatment for hepatitis C had terrible side effects and didn’t work well. It cured the viral infection less than half the time. But the newer drugs, Harvoni and Sovaldi, cure almost everybody, with few adverse reactions. (Ochoa, 1/5)

Miami Herald: Claire’s Says Its Makeup Is Asbestos-Free, But Law Firm Says Otherwise
Two weeks after a Rhode Island law firm said lab tests found cancer-causing asbestos in girls’ fashion chain Claire’s makeup, Claire’s declared Thursday the lab tests it funded proves the makeup is asbestos-free. Claire’s, based in Pembroke Pines, Fla., said it’ll still honor returns from customers feeling uneasy about any of the nine products it pulled off shelves in reaction to a Dec. 22 news report by Providence's NBC10. (Neal, 1/4)

State Watch

20. State Highlights: Flu Activity Takes Toll In Calif., Fla.; Breaking Down Infant And Maternal Death Rates In Texas, Conn.

Media outlets report on news from California, Florida, Texas, Connecticut, Maryland, Washington and Georgia.

San Jose Mercury News: Vicious Influenza Strain Sweeps Bay Area, Deaths Up In State
The flu got off to an early start this season and has been on a vicious tear throughout the Bay Area and California. State health officials have confirmed 17 deaths of people younger than 65 statewide, though news reports from counties around the state indicate the death toll is in the dozens. There have been four reported deaths in Santa Clara County as of Dec. 30, and one in Monterey County as of Dec. 28. (Drummond, 1/4)

Orlando Sentinel: Flu Activity Widespread And Increasing In Florida
Flu activity is increasing sharply across the state, averaging above the last two years’ peak levels at this time, according to the latest flu report from the state health department. ...With nearly 600 flu cases last week, Central Florida’s Centra Care centers reported a 200-percent increase compared with the same time last year and a 400-percent increase compared to 2015. (Miller, 1/4)

ProPublica: Maternal Deaths Are Increasing In Texas, But Probably Not
According to vital statistics records, Texas’ maternal mortality rate — defined as deaths per 100,000 live births — jumped 87 percent, from 18.3 for the five years from 2006 to 2010 to 34.2 for 2011 to 2015. But researchers say it’s likely that some of the deaths classified as maternal in the second five-year period were mistakenly linked to pregnancy or childbirth. (Fields, 1/4)

Los Angeles Times: L.A. County Officials Confirm First Case Of Sexually Transmitted Zika Virus
L.A. County officials said Thursday that a woman had been infected with the Zika virus by her partner in the first case of sexually transmitted Zika virus in the county. A man who lives in L.A. County traveled to Mexico and became infected with the Zika virus in early November, and shortly afterward his female partner, who didn't travel to Mexico, also developed the infection, officials said. (Karlamangla, 1/4)

The Baltimore Sun: Baltimore VA Doctors Try Acupuncture To Treat Veterans' Pain 
Seeking ways to curb the use of opioid painkillers, doctors at Baltimore’s VA Medical Center started offering a version of acupuncture to treat some veterans’ chronic pain. Two years later, the U.S. Department of Veterans Affairs has embraced the therapy based on the traditional Chinese practice of inserting needles into the body to treat maladies. The VA is using acupuncture at clinics across the country. (Cohn, 1/5)

Seattle Times: Washington State Birth Certificates Will Soon Have Nonbinary Option
People born in Washington will now have a third choice — X — when defining their sex on a birth certificate. Anyone born here can change the designation on their birth record from male or female to a single mark of “X,” a nonbinary designation, starting Jan. 27. The steps are simple, can be done multiple times, and there is no fee. A person completes the request, signs it, has it notarized and submits it to the Department of Health. (Willmsen, 1/4)

Dallas Morning News: Hospitals In Frisco, Sunnyvale And Rowlett To Face New Ownership Structure In Baylor, Tenet Deal
A deal finalized just two years ago between nonprofit Baylor Scott & White Health and Tenet Healthcare, one of the nation’s largest for-profit hospital chains,  to jointly operate five area hospitals has come to an end. The two will no longer share ownership of the Frisco-based Centennial and Rowlett-based Lake Pointe medical centers. A third center in Sunnyvale will continue in a partnership, but will now be partly owned by United Surgical Partners International, an Addison company acquired by Tenet in 2015. (Rice, 1/4)

Houston Chronicle: Central Care Funding Won By Houston Area Community Services' Avenue 360 
Federal grant money lost by Central Care clinics that leaders say will shut down its six locations has been awarded to Houston Area Community Services, a well-known local health provider to the underserved that has rebranded as Avenue 360 Health & Wellness. Central Care Integrated Health Services, which serves about 10,000 patients in Third Ward, Acres Homes and Sunnyside among other areas, has sued the U.S. Department of Health and Human Services to continue receiving the grant money. A temporary restraining order issued by a federal judge in December extended the funding until Monday. (George, 1/4)

Georgia Health News: Health Care To Get Attention In Legislature, Ralston Says
Certificate of need. Rural access to health care. Medical marijuana. Hands-free cellphone use. Medicaid “waivers.’’At a Capitol press conference on the upcoming General Assembly, [David] Ralston indicated that health care and the recommendations of the House Rural Development Council are among his top legislative priorities for the session, which begins Jan. 8. (Miller, 1/4)

Health Policy Research

21. Research Roundup: Opioid Use; Medicaid Work Requirements; And Individual Marketplace Performance

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Pediatrics: Persistent Opioid Use Among Pediatric Patients After Surgery
Persistent opioid use after surgery is a concern among adolescents and young adults and may represent an important pathway to prescription opioid misuse. Identifying safe, evidence-based practices for pain management is a top priority, particularly among at-risk patients. (Harbaugh et al., 1/1)

JAMA Internal Medicine: Household Opioid Availability And Prescription Opioid Initiation
In a study comparing 12 695 280 commercial insurance beneficiaries with a household member who started a new prescription of opioids, to 6 359 639 beneficiaries with a household member who started a new prescription of nonopioid pain relievers, the 1-year risk of subsequent opioid use was 0.71% higher among individuals exposed to opioids through a household member’s prescription. (Seamans, Carey and Westreich, 1/1)

Urban Institute: Work Requirements In Social Safety Net Programs: A Status Report Of Work Requirements In TANF, SNAP, Housing Assistance, And Medicaid
This report presents information on the work requirements currently in use in TANF, SNAP, and federal housing assistance programs and discusses the available evidence on implementation experiences and impacts. It also describes Medicaid waiver requests currently under consideration at CMS that would include work requirements and closes by highlighting key questions for consideration when assessing the use of work requirements in safety net programs. For example, given the evidence that employment among families who are subject to current work requirements rarely pays high enough wages to move a family off assistance and out of poverty, what are the expected benefits of implementing new work requirements? (Hahn et al., 12/22)

The Henry J. Kaiser Family Foundation: Individual Insurance Market Performance In Late 2017
Concerns about the stability of the individual insurance market under the Affordable Care Act (ACA) have been raised in the past year following exits of several insurers from the exchange markets, and again with renewed intensity in recent months during the debate over repeal of the health law. Our earlier analysis of first quarter financial data from 2011-2017 found that insurer financial performance indeed worsened in 2014 and 2015 with the opening of the exchange markets, but showed signs of improving in 2016 and stabilizing in 2017 as insurers began to regain profitability. (Cox, Semanskee and Levitt, 1/4)

Pediatrics: Exemptions From Mandatory Immunization After Legally Mandated Parental Counseling
Exemption rates for mandated immunizations are associated with ease of the administrative procedures to obtain exemptions. Several states, in recent years, have implemented the addition of health care provider counseling/signature as a requirement to obtain a nonmedical exemption. ... States in the United States and jurisdictions in other countries should consider adding parental counseling by health care provider as a requirement for obtaining exemptions to vaccination requirements. (Omer et al., 1/1)

Editorials And Opinions

22. Parsing The Policies: Trump And Association Health Plans; What About Out-Of-Pocket Health Care Costs?

Opinion writers examine a range of health policy issues, including the Trump administration's proposed rule to pave the way for the creation of more association health plans and a push for Congress to restore funding for the Children's Health Insurance Program.

The New York Times: Remember Trump’s Pitch On Health Care Associations? Now We Know What He Meant
When President Trump claimed last week that “I know the details of health care better than most, better than most,” it now appears he had a point in at least one area. His meandering comments about health care and “associations” were confusing, and not totally accurate. But, in his remarks to Michael Schmidt of The New York Times, Mr. Trump previewed several tenets of a major regulation that was proposed by his Department of Labor on Thursday. And he articulated how the rule could interact with other health policy changes — and the consequences that could follow. (Margot Sanger-Katz, 1/5)

Bloomberg: Out-Of-Pocket Health Costs Rising, But Not That Much
“Dad, I got a bill for $1,113.” One of our daughters was incensed. “I went to my doctor with a simple question. She sent me downstairs where they drew a few tubes of blood for tests. It took two minutes. How do I owe over $1,000?” She's not the only one outraged by out-of-pocket health costs in the U.S. Many of us feel we are paying more for less and less insurance coverage. We blame high-deductible plans, rising co-pays and other policies that seem to shift more costs onto patients.  But health-care costs overall increased 4.3 percent, so as a percentage of total health-care spending, out-of-pocket costs actually fell. And this has been the case for several years.  ( Orszag and Ezekial J. Emanuel 1/4)

Cleveland Plain Dealer: Restore Long-Term Funding For Children's Health Programs
Last month's congressional funding Band-Aid to keep the federal government in business included $2.85 billion in stopgap money for the Children's Health Insurance Program. That's far short of the five-year $8 billion CHIP extension advocates had sought. Even more worrying, after partisan squabbles allowed the program to lapse Sept. 30, is that "it's unclear how long [that funding] will actually allow all states to continue operating their CHIP programs," warns the National Academy for State Health Policy. (1/5)

The New England Journal Of Medicine: Removing ERISA’s Impediment To State Health Reform
States are assuming an increasingly important role in driving U.S. health care policy. Hyperpartisanship has made it difficult for Congress to enact reform — and what action is possible is likely to reduce federal involvement in health care. Despite the growing importance of states in this arena, however, many state-led health care reforms have been thwarted by the Employee Retirement Income Security Act (ERISA), a 1974 federal law that established minimum standards for private employer-sponsored benefit plans known as ERISA plans. (Erin C. Fuse Brown and Ameet Sarpatwari, 1/4)

23. Viewpoints: Decline In Life Expectancy An 'Indictment' Of U.S. Health System; The Toll Alzheimer's Takes

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

Stat: Drop In Life Expectancy An 'Indictment Of The American Health Care System'
We are the wealthiest nation on earth, but far from the healthiest, and things are getting worse, not better. The CDC report is yet another call to action for fundamental health system change that should include, among other things, reforming our pharmaceutical markets and making good health insurance available to all Americans. These need to be urgent priorities in 2018 for a government that should care as much about the health of Americans as their wealth. (David Blumenthal, 1/4)

The Des Moines Register: I've Always Been A 'Doer,' But Alzheimer's Is Taking A Toll
So what do I mean by this made-up word “doerness?” I mean one who is a doer, one who gets things done on or before they need to be done. I have been the doer in the family, but my Alzheimer’s is slowly but surely eroding my “doerness” ability. Examples: my ability to arrive ahead of time has eroded because I’m not the driver and many times we arrive on time or a little late. That drives me crazy because I always arrived early. (Dick Goodson, 1/3)

The New England Journal Of Medicine: Chasing Seasonal Influenza — The Need For A Universal Influenza Vaccine
As clinicians in the United States prepare for the start of another influenza season, experts have been watching the Southern Hemisphere winter for hints of what might be in store for us in the North. Reports from Australia have caused mounting concern, with record-high numbers of laboratory-confirmed influenza notifications and outbreaks and higher-than-average numbers of hospitalizations and deaths. ... it is of note that the vaccine for this upcoming season has the same composition as that used in the Southern Hemisphere. As we prepare for a potentially severe influenza season, we must consider whether our current vaccines can be improved and whether longer-term, transformative vaccine approaches are needed to minimize influenza-related morbidity and mortality. (Catharine I. Paules, Sheena G. Sullivan, Kanta Subbarao and Anthony S. Fauci, 1/4)

The New England Journal Of Medicine: The Public And The Opioid-Abuse Epidemic
Over the past year, the U.S. opioid-abuse epidemic has gained enormous visibility. President Donald Trump has identified it as a “public health emergency,” and a national commission and a commission of state governors have issued recommendations for action. This concern stems from the fact that in 2016 more than 11 million Americans misused prescription opioids, and opioid-related deaths have more than quadrupled since 1999. To determine what the public believes should be done to address the epidemic, we examined data from seven national polls conducted in 2016 and 2017. Many of the findings may surprise people who have been following this issue in professional journals and the media. (Robert J. Blendon and John M. Benson, 1/3)

Stat: When A Child Needs Trauma Care, Parents' Presence Is An Asset
I once subscribed to the school of thought that having parents in the trauma bay with their children is an unwanted distraction for physicians. Many hospitals still practice that way, establishing designated areas near, but apart from, the trauma unit where parents can wait — out of sight and out of mind — while their child receives care. ... Parents generally have a calming, comforting effect on their children. When a child is scared about a procedure, parents are able to relay vital information to their children in a clear, comforting way, allowing our medical team to focus on what we do best — caring for children in the most critical times. (Donald Plumley, 1/4)

Bloomberg: Is It Legal To Delay Lead-Paint Regulations?
In its first year, the Trump administration has had only modest success in eliminating existing regulations. But it has dramatically slowed the issuance of new regulations, including in the areas of safety, health and the environment. For 2018, and the remainder of Donald Trump’s presidency, that raises an urgent question: Will courts ever intervene and require agencies to act? (Cass R. Sunstein, 1/4)

The New England Journal Of Medicine: Toward Competency-Based Medical Education
Competency-based medical education (CBME) reconceives medical training by recognizing that not all students or trainees master all necessary skills at the same pace. Rather than insisting that a medical school or residency class proceed through medical education en masse, CBME focuses on all trainees demonstrating the competencies required for caring for a population by means of time-variable transitions from training to practice. (Deborah E. Powell and Carol Carraccio, 1/4)

Bloomberg: Food Science Is Caught Between The Head And The Heart
A few weeks ago, a scientific claim linking canola oil to Alzheimer’s disease risk raised an intriguing question: When it comes to healthy eating, do we have to choose between the head and the heart? In other words, is it possible that foods promoted as good for cardiovascular health, such as canola oil, are bad for the brain? There’s surprisingly little information out there on what to eat for brain health. The vast majority of nutrition research is aimed at the heart. Why wouldn’t scientists want to focus on maintaining the seat of consciousness, memory, creativity, love, learning and joy, as opposed to a glorified pump? (Faye Flam, 1/4)