In This Edition:

From Kaiser Health News:

Kaiser Health News Original Stories

5. Facebook Live: It’s 2018, Can Big Pharma Hold The Line Against Pricing Controls?

In this chat, KHN senior correspondent Jay Hancock discusses how drug-pricing battles could play out this year in D.C., state legislatures and beyond. What do we know about the drug industry’s agenda to quiet the drumbeat of cost control and transparency proposals? How will they officials target their efforts? Will the battles take place at the state level? Senior editor Stephanie Stapleton moderates. (1/10)

6. Political Cartoon: 'Mixed Bag?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Mixed Bag?'" by Steve Kelley.

Here's today's health policy haiku:


Treating the person
as well as their addiction
will solve this crisis.

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:

Administration News

7. In Monumental Policy Shift, Administration Paves Way For States To Impose Medicaid Work Requirements

Adding a work requirement to Medicaid would mark one of the biggest changes to the program since its inception in 1966, and is likely to prompt a lawsuit from patient advocacy groups.

The Wall Street Journal: Trump Administration Sends Mixed Messages On Welfare Work Rules
The Trump administration issued guidelines Thursday to help states impose the first-ever work requirements on Medicaid beneficiaries, one of the biggest changes in the program’s 50-year history. That approach contrasts with a move the administration made with less fanfare earlier in the week to extend waivers that allow food-stamp recipients in 33 states to avoid work requirements. The different approaches reflect the complex political forces that surround safety-net programs. (Radnofsky and Armour, 1/11)

Kaiser Health News: Trump Administration Clears Way To Require Work For Some Medicaid Enrollees
The announcement came in a 10-page memo with detailed directions about how states can reshape the federal-state health program for low-income people. The document says who should be excluded from the new work requirements — including children and people being treated for opioid abuse — and offers suggestions as to what counts as “work.” Besides employment, it can include job training, volunteering or caring for a close relative. (Galewitz, 1/11)

Reuters: Trump Administration Will Allow States To Test Medicaid Work Requirements
Certain Medicaid populations would be exempt from the rules, including those with disabilities, the elderly, children and pregnant women. Verma also said states would have to make "reasonable modifications" for those battling opioid addiction and other substance use disorders. "This gives us a pathway to start approving waivers," Verma said on a call with reporters on Wednesday. "This is about helping those individuals rise out of poverty." (Abutaleb, 1/11)

The Washington Post: Trump Administration Opens Door To Let States Impose Medicaid Work Requirements
To qualify for a waiver, a state must provide a convincing justification that its experiment would “further the objectives” of Medicaid. Unlike the 1996 rewrite of welfare law, which explicitly mentions work as a goal, Medicaid’s law contains no such element, and critics contend rules that could deny people coverage contradict its objectives. To get around this, the 10-page letter argues that working promotes good health. (Goldstein, 1/11)

CNN: Trump Administration Allows States To Make Medicaid Recipients Work
Ten states -- Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin -- have submitted waivers that include work or community engagement requirements, according to the agency. South Dakota's governor said in his State of the State address Tuesday that he would also look to require certain recipients to work. (Luhby, 1/11)

CQ: Proposed Medicaid Changes Could Spur Lawsuits
A national health advocacy group says it is seriously considering taking legal action against the Trump administration if it approves state proposals that would make key changes to Medicaid programs including requiring tens of thousands of poor Americans to join jobs programs or lose access to health care. Federal health officials are expected to begin announcing decisions on the state Medicaid proposals soon. The plans include a variety of conservative concepts, such as requiring premiums and co-payments, eliminating retroactive coverage and locking people out of coverage for failure to make payments or other issues. (Williams, 1/11)

Health Law

8. Trump's Elaborate, Secret Blueprint To Chip Away At Health Law Reveals Strategy Behind The Scenes

Sen. Bob Casey (D-Pa.) is calling the road map a list of options for “sabotage.” In other health law news, Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) continue to work on bipartisan legislation to stabilize the marketplaces, insurers renew the risk-corridor fight, the Trump administration releases estimates on how many insurers are still in the exchanges, and more.

Politico: Trump’s Secret Plan To Scrap Obamacare
Early last year as an Obamacare repeal bill was flailing in the House, top Trump administration officials showed select House conservatives a secret road map of how they planned to gut the health law using executive authority. The March 23 document, which had not been public until now, reveals that while the effort to scrap Obamacare often looked chaotic, top officials had actually developed an elaborate plan to undermine the law — regardless of whether Congress repealed it. (Haberkorn, 1/10)

The Hill: Internal Document Reveals Trump's Strategy On ObamaCare Changes 
An internal Trump administration document shared with Republican lawmakers last year shows officials' plans to change ObamaCare through administrative actions, in what Democrats say is evidence of “sabotage” of the health law. The one-page document lists 10 actions the administration planned to take to make conservative-leaning changes to how the law is implemented. It was shared at a meeting with House GOP lawmakers on March 23, in the heat of the effort to win votes for the House’s ObamaCare repeal measure, which was pulled the next day. (Sullivan, 1/10)

The Hill: Bipartisan Senators Discuss Path Forward On ObamaCare Fix 
Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) met Wednesday to discuss the path forward for their bipartisan legislation aimed at stabilizing ObamaCare, aides in both parties said. The legislation’s future has been thrown into question after it was punted at the end of last month. Alexander is now pushing for the legislation to be included in a government funding package when a long-term deal on that measure is reached. (Sullivan, 1/10)

CQ: States Prepare Reinsurance Requests As Congress Weighs Funding
The lesser known of two bipartisan Senate bills aimed at stabilizing the individual health insurance market is the one policy experts say would have a greater influence on lowering premium costs at this point. But supporters worry the bill may continue to stall in Congress while states are looking for guidance. The measure from Sens. Susan Collins, R-Maine, and Bill Nelson, D-Fla., would provide funding for states to set up reinsurance programs or high risk pools, which policy experts say could help drive down premiums. But while lawmakers are focused on issues like funding the government and immigration, experts say now would be the time for Congress to take up that legislation before states and health insurers begin preparing for the 2019 plan year. (McIntire, 1/10)

Modern Healthcare: Insurers Wait On Federal Circuit To Determine Fate Of Risk-Corridor Payments
Insurers on Wednesday renewed their fight to claw back billions of dollars in unpaid risk corridor payments, telling a federal appeals panel that the government legally can't default on its obligation when Congress takes away the money stream. Three judges from the U.S. Court of Appeals for the Federal Circuit homed in on the government's argument that Congress essentially redefined the intent of the Affordable Care Act's risk corridor provision by limiting what funds could go towards the payments. (Luthi, 1/10)

Modern Healthcare: Estimated Number Of Health Plans On Federal Exchange Plummets By Two-Thirds 
The Trump administration is estimating there are now only 700 issuers in the individual and small group markets, which is down from 2,400 in an earlier estimate. The CMS posted the updated figure in an information collection notice posted Jan. 8. The agency is seeking permission from the White House's OMB to continue an annual data collection from exchange plans about the risk profile of their enrollees. (Dickson, 1/10)

The Star Tribune: Medical Device Companies Brace For Return Of Affordable Care Act Tax 
During the three years that the government collected a tax on sales of medical devices, Maple Grove's Inspire Medical Systems never turned a profit on its sleep apnea treatments. CEO Tim Herbert says the company could have had 12 to 15 more employees if that tax money, which helped pay for the Affordable Care Act, had stayed in-house. (Spencer and Carlson, 1/10)

Nashville Tennessean: After Individual Mandate Repeal, Here Are Three Things To Expect
Republicans successfully repealed the Affordable Care Act’s individual mandate through their tax reform legislation, which has created many questions for consumers. How will this decision affect insurance markets and consumers’ ability to get coverage? Without additional legislative action, there are three things we can expect. With the individual mandate repealed, many healthy people will drop their coverage. This will likely lead insurers to expect to lose money, and they will either exit the individual market or raise premiums. As a result, there will be increased pressure on Congress to come up with a solution before consumers’ access to coverage is reduced.(Tolbert, 1/10)

The Star Tribune: Health Plan Shoppers Now In Buying Mode As MNsure Closes In On Deadline
Enrollment activity is picking up at the state’s MNsure health insurance exchange in advance of Sunday’s deadline for individuals to buy 2018 coverage. On Monday, the number of online shopping sessions at the MNsure website hit its highest point since last month’s deadline for coverage that started Jan. 1, said Allison O’Toole, the MNsure chief executive. People who sign up for coverage between now and Sunday would have health plan coverage as of Feb. 1. (Snowbeck, 1/10)

Capitol Hill Watch

9. CHIP Funding Could Pass As Early As Next Week, Lawmakers Say

Progress toward renewing money for the popular program, which provides health care for children of low-income families, has been at a standstill because Democrats and Republicans haven't been able to agree on how to pay for it. Lawmakers say it is likely the deal will be resolved as part of the overall spending plan.

The Hill: Lawmakers Say They're Close To Deal On CHIP Funding 
Lawmakers in both parties say that a long-running disagreement over children’s health funding has almost been resolved and that funding could be passed as soon as next week. The reauthorization of the Children’s Health Insurance Program (CHIP) could be attached to a short-term government funding bill that must pass before Jan. 19, lawmakers say. Whether the reauthorization is ultimately tied to the bill, however, will depend on broader leadership negotiations. (Sullivan, 1/10)

The Oregonian: Greg Walden Pledges Congress Will Fund Children's Health Care, ‘Hopefully Next Week’ 
Greg Walden, the Oregon Republican who chairs the powerful House Energy and Commerce Committee, pledged Wednesday that Congress will vote to extend funding for children's health insurance, "hopefully next week." Walden, in a lengthy interview with host Todd Zwillich on public radio show The Takeaway, said his committee has already identified and voted to spend the $800 million needed to keep the program funded beyond Jan. 19. That's when the money Congress has provided so far is expected to run out. (Borrud, 1/10)

Houston Chronicle: Texas Sen. John Cornyn Confident Congress Will Pass CHIP Funding 
U.S. Sen. John Cornyn, R-Texas, is confident Congress will reauthorize the Children's Health Insurance Program (CHIP) by the end of next week. In a conference call Wednesday with reporters, Cornyn called CHIP funding a "must-pass piece of legislation." More than 400,000 Texas children get their health insurance through CHIP, but funding for the decades-long program expired in September. Texas has enough funding to cover its costs until the end of March, but the looming deadline has many families worried about their long-term health care needs. (Matos, 1/10)

Meanwhile —

The Wall Street Journal: States In Limbo As Lawmakers Disagree On How To Pay For Children’s Health Program
Some states risk running out of money for a children’s health program in a countdown that is pressuring Congress to approve new money quickly, part of a continuing funding delay that has turned a little-known insurance program into an unwelcome embarrassment for Congress. Democrats and Republicans agree on the need to preserve funding for the Children’s Health Insurance Program, or CHIP, which covers about 9 million low-income children. Its formal funding ended Sept. 30. (Armour, 1/10)

The New York Times: What If CHIP Funds Run Out? Here’s What 6 Families Would Do
The Children’s Health Insurance Program, better known as CHIP, covers nearly nine million children whose parents earn too much for Medicaid, but not enough to afford other coverage. But the program, which ran out of funding in September, is at a crisis point. Congress passed a stopgap spending bill late last month that was expected to keep CHIP running through March, but the Centers for Medicare and Medicaid Services said some states could run out of money as early as next week. We asked readers to tell us how they would be affected if their children lost CHIP coverage. Their stories have been condensed and edited for clarity. (Haque, 1/10)


10. Lawmakers May Reverse 'Devastating' Cuts To 340B Drug Program, But There Will Likely Be A Trade-Off

House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) said his panel is going to be looking at changes Congress can make to the program, which has sparked a furor between the pharmaceutical industry and hospitals. "I think, that we need to bring transparency and accountability to this program for it to survive long term,” Walden said.

Stat: Overhaul Of 340B Program Could Happen This Spring, Key Republican Says
Republicans on the House Energy and Commerce Committee are gearing up to overhaul a controversial Medicare drug discount program as soon as this quarter, a key Republican tells STAT. That’s a win for drug makers who have long pushed to narrow the scope of the so-called 340B drug discount program. At the same time, however, the committee will also examine whether to restore a recent $1.6 billion cut to the program, which came under a Trump administration rule that took effect Jan. 1, according to committee Chairman Greg Walden of Oregon. Hospital groups have called the cut “devastating” and have lobbied Congress to reverse it. (Mershon, 1/11)

The Hill: Lawmakers Look To Step Up Oversight On Discount Drug Program 
Following a two-year review by the House Energy and Commerce Committee, Chairman Greg Walden (R-Ore.) told reporters Tuesday that Republicans will push for substantial changes to bring what they argue is much-needed transparency and oversight to 340B, namely by expanding the federal government’s authority over the program. “We understand this is a very important program in many of our communities. It does amazing work and helps a vulnerable population,” Walden said. (Hellmann, 1/10)

In other pharmaceutical news —

Stat: Drug Makers Signal Interest In Exiting Vaccine Development During Crises
Every few years an alarming disease launches a furious, out-of-the-blue attack on people, triggering a high-level emergency response. SARS. The H1N1 flu pandemic. West Nile and Zika. The nightmarish West African Ebola epidemic. In nearly each case, major vaccine producers have risen to the challenge, setting aside their day-to-day profit-making activities to try to meet a pressing societal need. With each successive crisis, they have done so despite mounting concerns that the threat will dissipate and with it the demand for the vaccine they are racing to develop. (Branswell, 1/11)

Kansas City Star: Step Therapy Bill In Kansas Would Restrict Insurers' Prescription Drug Denials
Insurers use step therapy to try to steer clients toward less expensive, older treatments to see if that works for them before they “step” up to something newer and usually more expensive. ... But patient advocacy groups say unregulated step therapy allows insurance companies to impose an unrealistic, one-size-fits-all approach to medicine that prevents doctors from using their best clinical judgment to tailor treatments to individuals. (Marso, 1/10)


11. It's Official: Humana Becomes Third Insurer To Leave AHIP

While some insiders predict that the termination, following departures by Aetna and UnitedHealth, will weaken the largest trade group's influence on Capitol Hill, AHIP pushed back on the idea, citing its growing membership and profits.

The Hill: Humana Leaves Insurers Group
Humana has ended its membership with the health insurance industry’s largest trade group, America’s Health Insurance Plans (AHIP). According to a Humana spokesman, the formal termination happened Dec. 31, but he said the company “has not actively participated in AHIP since early 2017.” (Weixel, 1/10)

Modern Healthcare: Humana Officially Leaves AHIP
Kristine Grow of AHIP said while Humana scaled back its "engagement with our activities" in 2017, the association understands Humana's move was a "business decision" rather than based on policy disagreements. Insurers trod cautiously in their public statements and lobbying efforts last year as the GOP-led Congress repeatedly tried to overhaul the Affordable Care Act. Grow said despite the uncertainty, AHIP grew by 12 members over the last year and saw its $2.3 million in revenue losses following the exits of Aetna and UnitedHealthcare in early 2016 turn to $1.2 million in profit. (Luthi, 1/10)

12. Medical Credit Cards Can Add To Big Bills For Patients

They may seem like a solution for consumers struggling to pay for medical procedures not covered by insurance, but consumer advocates warn that they can lead to unexpected penalties and sky-high interest rates.

The Associated Press: Medical Credit Cards Can Mean Aches And Pains For Patients
Few people look forward to a trip to the doctor or dentist, especially if they're not sure how they will pay for it. Some choose to use a special kind of credit card offered by medical professionals to pay for care at certain locations or networks. Often pitched by office assistants, they can seem like a quick fix for pricey procedures not covered by insurance including dental work, cosmetic surgery or laser vision correction. (1/10)

Also in the news health care costs, a look at the wide variation in the prices charged by Minnesota hospitals for a variety of common procedures —


13. Trump Administration Takes Another Look At Medicare Bundled Payments

After canceling a similar Obama-era plan, the Department of Health and Human Services now says it will try out a program that provides a single “bundled payment” for nearly all the services provided in a 90-day period to certain Medicare patients.

The New York Times: Trump Officials, After Rejecting Obama Medicare Model, Adopt One Like It
In a notable back flip, the Trump administration has decided that maybe the Obama administration was right in its efforts to change the way doctors and hospitals are paid under Medicare. The Trump administration said late Tuesday that it was starting a Medicare payment model very similar to the ones it canceled and curtailed last year. The Obama administration devised the earlier projects using authority in the Affordable Care Act. In the new program, as described by Trump appointees, Medicare will make a single “bundled payment” for nearly all the services provided in a 90-day period to certain Medicare patients who are admitted to a hospital or have certain outpatient medical procedures. (Pear, 1/10)

Women’s Health

14. Critics Accuse Administration Of 'Playing Politics With Women’s Health' Over Family Planning Funding

An announcement about the federal funding was expected last November, and states whose grants end March 31 could be in a bind if a decision isn't made soon.

CQ: States Frustrated By Delay In HHS Family Planning Money
State officials are dismayed that the Trump administration stalled the process for applying for new family planning money the states are counting on. Abortion advocacy groups worry that the delay may mean that the administration is planning to target abortion providers or rewrite family planning policies. The funding announcement was expected to be out by November, with states' applications for 2018-19 due Jan. 3. But the announcement still isn't out. The funding is provided by the Title X program, the only federal grants focused on family planning. (Raman, 1/11)

In other news —

Sacramento Bee: CA Bill Requires Abortion Pills At College Campuses
A controversial bill that would require student health centers at the University of California and California State University to offer “non-surgical abortion services” faces a crucial vote today to keep advancing this session. ... Sen. Connie Leyva, a Chino Democrat who is carrying the measure, said she believes the more than 400,000 female students attending UC and CSU deserve affordable and safe abortion procedures on campus. (Kobin and Koseff, 1/10)

The Hill: Paul Ryan To Speak At Anti-Abortion March In DC
Speaker Paul Ryan (R-Wis.) will address this year's March for Life, an annual anti-abortion rally in Washington, D.C. March for Life President Jeanne Mancini called it an "honor" to have Ryan speak at the Jan. 19 event.  ... Ryan is currently the highest-ranking government official scheduled to speak at the event. Last year Mike Pence became the first sitting vice president to address the marchers. (Hellmann, 1/10)

Public Health And Education

15. Trump Promised To 'Liberate' Americans From Opioid Crisis. But States Say Little Has Been Done.

The public health emergency President Donald Trump declared is set to expire later this month, and public health officials in the states are frustrated that there were more "thoughts and prayers" and than money to back it up. Meanwhile, Trump signs legislation aimed at tackling the epidemic, the Cherokee Nation's lawsuit against opioid makers is dealt a blow, Ohio issues new guidelines on painkillers and work-related back injuries, and more.

Politico: 'Nothing Is Actually Being Done': Trump's Opioid Emergency Order Disappoints
President Donald Trump in October promised to "liberate" Americans from the "scourge of addiction," officially declaring a 90-day public health emergency that would urgently mobilize the federal government to tackle the opioid epidemic. That declaration runs out on Jan. 23, and beyond drawing more attention to the crisis, virtually nothing of consequence has been done. (Ehley, 1/11)

The Associated Press: Trump Signs Bill To Improve Opioid Screening Technology
President Donald Trump signed legislation Wednesday aimed at giving Customs and Border Protection agents additional screening devices and other tools to stop the flow of illicit drugs. Speaking at a surprise bill signing ceremony flanked by members of Congress from both parties in the Oval Office, Trump described the bill as a "significant step forward" in the fight against powerful opioids such as fentanyl, which he called "our new big scourge." (1/10)

The Hill: Trump Signs Bipartisan Bill To Combat Synthetic Opioids 
President Trump signed a bipartisan bill Wednesday aimed at stopping powerful synthetic opioids from coming into the country illegally. A group of Republican and Democratic lawmakers attended the bill signing, a rare showing of bipartisanship with members of both parties seeking to show their support for tackling the issue. (Roubein, 1/10)

Reuters: Judge Deals Setback To Cherokee Nation Lawsuit Over Opioids
A federal judge in Oklahoma has dealt a blow to a Cherokee Nation lawsuit seeking to stop the flow of addictive opioid painkillers in its territory by issuing a preliminary injunction to prevent the case from being heard in tribal court. In a decision late Tuesday, U.S. District Judge Terence Kern ruled the tribal court lacked jurisdiction because the lawsuit involving six wholesale drug distributors and pharmacy operators does not directly concern tribal self-government. (Krehbiel-Burton, 1/10)

The Associated Press: Ohio Imposes Strict Rule On Workers' Back Surgery, Opioids
Ohio residents with work-related back injuries in most cases must try remedies like rest, physical therapy and chiropractic care before turning to spinal fusion surgery and prescription painkillers under a groundbreaking new guideline that is partly meant to reduce the overprescribing of opioids but isn't sitting well with everyone. (Carr Smyth, 1/10)

Orlando Sentinel: Opioid Epidemic Could Be Stressing Foster-Care System, Study Says
A new study shows that the increase in opioid prescription rates in Florida may have had a role in the higher rate of kids being removed from their homes, putting more stress on the state’s foster care system and highlighting the shortage of foster parents. ...The study doesn’t directly link the rate of opioid prescriptions and kids’ removal to foster care, but its authors think it is the first to use data to show a potential correlation. (Miller, 1/10)

16. Federal Registry To Help Find Effective Treatments For Behavioral Health Problems Suspended

The registry offers a database of hundreds of mental health and substance abuse programs that have been assessed and deemed scientifically sound. Officials confirmed that a new entity will take over the program’s duties, but no staff other than a new director is in place to run it.

The Washington Post: Trump Administration Freezes Database Of Addiction And Mental Health Programs
Federal health officials have suspended a program that helps thousands of professionals and community groups across the country find effective interventions for preventing and treating mental illness and substance use disorders. The National Registry of Evidence-based Programs and Practices is housed within the Health and Human Services Department’s Substance Abuse and Mental Health Services Administration. (Sun and Eilperin, 1/10)

Stat: 'Evidence-Based' Program That Evaluates Behavioral Health Therapies Halted
The program, called the National Registry of Evidence-Based Programs and Practices, was launched in 1997 and is run by the Substance Abuse and Mental Health Services Administration. Its website lists 453 programs in behavioral health — aimed at everything from addiction and parenting to HIV prevention, teen depression, and suicide-hotline training — that have been shown, by rigorous outcomes measures, to be effective and not quackery. The most recent were added last September. (Begley, 1/10)

The Hill: Trump Administration Ends Registry For Substance Abuse, Mental Health Programs
[T]he Substance Abuse and Mental Health Services Administration (SAMHSA), the department under HHS that manages the program, wrote on its website that the contract for the database had been discontinued. SAMHSA is still "very focused on the development and implementation of evidence-based programs in communities across the nation," the notice says. (Hellmann, 1/10)

17. Flu Death Warning: A Healthy Young Man Thought He Could Fight The Virus

Most of this year's deaths are among older people, but everyone regardless of their age needs to get a flu shot, know the symptoms of influenza, cover their mouths when they cough and seek help if symptoms worsen, emergency room doctors say.

The Washington Post: He Was 21 And Fit. He Tried To Push Through The Flu — And It Killed Him.
Kyler Baughman seemed to be the face of fitness. The 21-year-old aspiring personal trainer filled his Facebook page with photos of himself riding motorbikes and lifting weights. He once posted an image of a kettlebell with a skeleton, reading: “CrossFit, hard to kill.” So when he came down with the flu last month, his mother said, he possibly assumed he simply needed some rest. (Bever, 1/10)

San Jose Mercury News: Two More Flu Deaths Reported In Greater Bay Area
In what California public health officials say could be the state’s worst flu season in a decade, two more flu-related deaths have been reported in the Greater Bay Area, increasing the region’s total to seven, and the state’s unofficial tally to 29. ...Since the state only records victims younger than 65, the number is likely to be even higher, state public health officials said during a news conference Wednesday. (Seipel, 1/10)

Dallas Morning News: Dallas County Reports 5 More Flu-Related Deaths After Tarrant County Records Its First 3 This Season
Three adults in Tarrant County have died from the flu, according to reports given to Tarrant County Public Health late Tuesday. Five more deaths were reported in Dallas County on Wednesday, bringing the county's total to 23. All the deaths in Tarrant County involved people 55 and older with previous medical conditions. Their names and ages were not released. (Branham, 1/10)

Los Angeles Times: Experts Help Public Combat Flu In First Installment Of USC VHH ‘Doc Talk’ Series
With one of the nastiest flu seasons in recent history gaining steam, USC Verdugo Hills Hospital experts shared some free tips Wednesday on how to recognize the symptoms of influenza and what to do if you think you’ve been hit. In the first of a series of free lunchtime “Doc Talks” being held at the Crescenta-Cañada YMCA every second Wednesday through November, Mary Virgallito, director of patient safety for the local hospital, discussed the different strains of influenza and how the virus can be spread from up to 6 feet away. (Cardine, 1/10)

Meanwhile —

18. Men Report Less Pain In Studies When Researcher Is Female, And Other Ways Gender Influences Experiments

Researchers are looking into the ways gender can change the results of medical experiments in drastic ways. In other public health news: Americans are rushing out to buy anti-radiation pills, more on the president's mental health, former Vice President Joe Biden talks about toxins associated with burning waste at military institutions, alcohol-related ER visits are on the rise, and more.

NPR: A Scientist's Gender Can Skew Research Results
The results of an IQ test can depend on the gender of the person who's conducting the test. Likewise, studies of pain medication can be completely thrown off by the gender of the experimenter. This underappreciated problem is one reason that some scientific findings don't stand the test of time. Colin Chapman found out about this problem the hard way. He had traveled to Sweden on a Fulbright scholarship to launch his career in neuroscience. And he decided to study whether a nasal spray containing a hormone called oxytocin would help control obesity. The hormone influences appetite and impulsive behavior in obese men. (Harris, 1/10)

Kaiser Health News: Fallout From ‘Nuclear Button’ Tweets: Sales Of Anti-Radiation Drug Skyrocket
A Twitter battle over the size of each “nuclear button” possessed by President Donald Trump and North Korea’s Kim Jong-un has spiked sales of a drug that protects against radiation poisoning. Troy Jones, who runs the website, said demand for potassium iodide soared last week, after Trump tweeted that he had a “much bigger & more powerful” button than Kim — a statement that raised new fears about an escalating threat of nuclear war. (Aleccia, 1/11)

The CT Mirror: Forensic Psychiatrist Aims To Publicize Trump’s ‘Dangerousness'
Bandy X. Lee, a forensic psychiatrist who teaches at Yale and spent much of her career on the study of violence and ways to prevent it, says she was flooded with emails and phone calls the day after President Donald Trump was elected. People from all over the country – and around the world – but especially in the Northeast United States told her they were concerned about Trump’s mental state and his ability to serve in office. (Radelat, 1/11)

PBS NewsHour: Biden Addresses Possible Link Between Son’s Fatal Brain Cancer And Toxic Military Burn Pits
Former Vice President Joe Biden said he thinks toxins found in smoke from burning waste at U.S. military installations in Iraq and at other facilities abroad could “play a significant role” in causing veterans’ cancer. ...Biden’s comments shed light on a debate that has roiled physicians, former service members and the Department of Veteran Affairs about whether the health of some U.S. military personnel was compromised by garbage disposal methods used by contractors and the military at overseas bases in Iraq and Afghanistan. (Sagalyn, 1/10)

NPR: ER Visits Linked To Alcohol Are Rapidly Rising
Most Americans drink safely and in moderation. But a steady annual increase in trips made to emergency rooms as a result of drinking alcohol added up to 61 percent more visits in 2014 compared with 2006, according to a study published this month in the journal Alcoholism: Clinical and Experimental Research. Visits to hospital emergency rooms for alcohol-related issues rose rapidly over a nine-year period, though it's unclear why. (Lloyd, 1/11)

Los Angeles Times: Distrusting China’s Medical System, Patients Turn To U.S. Doctors Online
The doctor told Renee Gao's parents that the tumor in their teenager's chest wasn't disappearing. The girl would need a costly operation that could leave her sterile — if she survived. Then he ushered them out.Gao Jiang and Yu Wenmei had dragged their ailing daughter across this capital city of southern Yunnan province, then north to the best cancer hospitals in Sichuan and Beijing. The family stood in hours-long lines and called in favors from colleagues at Gao's life insurance company to speed up the wait. But no one would tell them why the cure for their 16-year-old's lymphoma might threaten her life. (Meyers, 1/11)

The New York Times: Antacids During Pregnancy Tied To Asthma In Children
Using antacids during pregnancy is linked to asthma in offspring, a systematic review of research has found. Researchers pooled data from eight observational studies and concluded that the risk of asthma in childhood increased by 34 percent when the mother used proton pump inhibitors and by 57 percent with the use of histamine-2 receptor antagonists. The study is in Pediatrics. (1/11)

Cincinnati Enquirer: Lead Poisoning: FDA, CDC Warn About Recall
As many as 7 million tests performed on children over the course of the three years could have been wrong, according to the Centers for Disease Control and Prevention. The manufacturer of the tests in question, however, is confident the number is millions lower. (Blackmore Smith and Sparling, 1/10)

The New York Times: Fresh Embryos As Good As Frozen Ones For In Vitro Fertilization
For most women undergoing in vitro fertilization, fresh embryos work just as well as frozen ones. Previous trials have suggested that using only frozen embryos might improve pregnancy rates in women with polycystic ovary syndrome, or PCOS, a hormonal disorder that affects about 10 percent of women. (Women with this condition ovulate irregularly and typically have a poorer response to IVF treatment.) But in two large randomized trials published in the New England Journal of Medicine, researchers found using fresh or frozen embryos makes no difference for the majority of women who do not have PCOS. (Bakalar, 1/10)

Boston Globe: Baby Boomers’ Failing Ears Drive Search For A Cure For Hearing Loss
Millions of boomers are now grappling with hearing loss — some of it caused by turning the volume to 11 — prompting companies to develop treatments that improve upon the expensive and often limited-value hearing aids and surgical implants that have been around for decades. At least half a dozen biotechs, including two well-funded local startups, are working on potential breakthroughs in the way hearing loss is treated. (Weisman, 1/10)

Kaiser Health News: For Elder Health, Trips To The ER Are Often A Tipping Point
Twice a day, the 86-year-old man went for long walks and visited with neighbors along the way. Then, one afternoon he fell while mowing his lawn. In the emergency room, doctors diagnosed a break in his upper arm and put him in a sling. Back at home, this former World War II Navy pilot found it hard to manage on his own but stubbornly declined help. Soon overwhelmed, he didn’t go out often, his congestive heart failure worsened, and he ended up in a nursing home a year later, where he eventually passed away. (Graham, 1/11)


19. After Management Shake-Up, Molina Loses N.M. Medicaid Contract

The board of directors ousted the CEO and chief financial officer -- both sons of the founder -- last year. In other Medicaid news, Florida lawmakers question plans to move some children into a managed care program and Capitol Hill looks at fixes for Puerto Rico's problems.

Modern Healthcare: Molina Loses New Mexico Medicaid Contract
Molina Healthcare has lost a contract to manage New Mexico's Medicaid recipients starting in 2019. The loss is a blow to the company, which is in the midst of an overhaul after ousting CEO Dr. Mario Molina and his brother, who was chief financial officer, in 2017. Long Beach, Calif.-based Molina is the largest Medicaid managed-care plan in New Mexico, serving 225,000 people and bringing in $893 million in premium revenue for the first nine months of 2017, or about 6.3% of Molina's total premium revenue, the company said early Wednesday in an Securities and Exchange Commission document. (Livingston, 1/10)

The Hill: Senators Eye Puerto Rico Medicaid Funding For Disaster Bill 
Senators are floating a temporary fix for Puerto Rico’s dwindling Medicaid funds as part of the chamber’s disaster aid package for the island. According to sources familiar with the discussions, the legislation would include a provision to temporarily lift restrictions on how much money the federal government can spend on Puerto Rico’s Medicaid program. (Weixel, 1/10)

State Watch

20. State Highlights: Md. Hospital Launches Probe After Video Of Incapacitated Women Goes Viral; N.H. Officials Say Curbing Arsenic Levels In Water Isn't Easy

Media outlets report on news from Tennessee, Ohio, Minnesota, Iowa, Virginia, Texas, New Hampshire, California, Kansas and Georgia.

The Washington Post: Video Shows Apparently Incapacitated, Half-Naked Woman Put Out In Cold By Baltimore Hospital
A Baltimore hospital said it was investigating Wednesday after video posted online showed an apparently incapacitated woman put out in the cold wearing nothing but a hospital gown. On Wednesday, a man who said he was a psychotherapist and a student at the University of Maryland Medical Center Midtown Campus posted a video of the woman being hustled out of the hospital by staff and left at a bus stop, her possessions strewn on the street. The woman appeared to have a wound on her forehead, and was wearing a hospital gown that was falling off. She grunted and shouted, and appeared to say at one point: “Please help me!” (Moyer, 1/10)

The Baltimore Sun: University Of Maryland Medical System Investigating Incident After Viral Video Shows Woman Outside In Hospital Gown 
The video shows what looks like four security guards, one with a wheelchair, walking away from a bus stop outside the hospital on the outskirts of Mount Vernon. A woman is seen near the bus stop dressed in a gown and socks. Her belongings are packed in plastic bags that have also been placed at the bus stop. The video, which went viral, was posted to Facebook by Imamu Baraka, who is described in an online professional profile as a mental health counselor. (McDaniels, 1/10)

The Star Tribune: Despite Progress, Ethnic Health Disparities Persist In Minnesota 
Minnesotans of many ethnic backgrounds might have similar words for a colonoscopy — it’s colonoscopia in Spanish and koloskopi in Norwegian — but they vary dramatically in the rates at which they seek this important medical screening. The state’s fourth annual health equity report, released Thursday by Minnesota Community Measurement, showed that, overall, 73 percent of adults ages 51 to 75 were up to date with colon cancer screening last year. But that rate dropped to 60 percent of Hispanics, 55 percent of American Indians and 27 percent of Somali natives. (Olson, 1/11)

Nashville Tennessean: Nashville General Hospital: Stakeholder Group Reconvenes Behind Close Doors To Discuss Hospital's Future
A controversial group convened by Meharry Medical College to make recommendations about the future of Nashville General Hospital met Wednesday amid criticism about its secretive approach to addressing the fate of the publicly-funded safety net hospital for low-income and uninsured patients. The secrecy of the group’s meetings has come under fire from one of its original members, Metro Councilwoman Tanaka Vercher, who stepped down in protest before the panel ever convened after learning that meetings weren’t going to be public. (Wadhwani and Garrison, 1/10)

Des Moines Register: Special Clinic Could Hold The Key To Helping Iowa's Foster Kids
Now a year old, the clinic is housed in the hospital’s STAR Center, which provides child advocacy, forensic interviews, services for drug-endangered children, and health and nutrition counseling for children failing to thrive. Formerly called the Regional Child Protective Center, the STAR Center long has been a place where child-protective workers could refer abused children for physical exams after they are removed. (Rood, 1/10)

The Associated Press: Sheriff Criticizes Mental Health System As Inmate Found Dead
A Virginia sheriff says an inmate who died in jail was mentally ill, and he’s criticizing the state’s mental health system. Sheriff Ken Stolle said in a statement that 69-year-old Joseph Sisson Jr.’s mental illness was the cause of his incarceration. He called Virginia’s mental health system “broken and ill-equipped to help all those who need it.” The Virginia Beach Sheriff’s Office said in a statement that a deputy and a medical technician attempted to wake Sisson to administer medication Monday night, but he didn’t respond and resuscitation attempts were unsuccessful. (1/10)

Houston Chronicle: Free Eye Screenings Expected To Help Low-Income Students Excel 
The Houston Health Department estimates up to 20,000 area students start school each year with unresolved eye or vision issues - a problem so pervasive that, in 2011, the agency and its nonprofit wing, the Houston Health Foundation, began offering free, full eye exams to 10 school districts. Most of the roughly 50,000 students who have since been treated through the temporary, makeshift See to Succeed clinics come from low-income schools and households, where access to proper health care is fleeting and parents can't always take days off work for private eye doctor appointments, Health Department officials said. (Downen, 1/10)

Kansas City Star: Reported Gonorrhea Cases Spike In Johnson, Jackson And Douglas Counties
Reported cases of gonorrhea spiked in Kansas City-area counties in 2017 amid reports that the disease has become more difficult to treat. ...Kristin Metcalf-Wilson, the assistant vice president of health services and lead clinician at Planned Parenthood of the Great Plains, said the organization’s sexually transmitted diseases screenings have been steadily turning up more positives. (Londberg and Marso, 1/10) <div> </div>

Georgia Health News: Sex And The Georgia Teenager: Data Finally On The Way
This month, the Atlanta-based public health agency reported a surprise finding: Nationwide, the proportion of high school students who’d ever had sexual intercourse decreased, from 47 percent in 2005 to 41 percent in 2015. The overall drop was driven by declines among ninth- and 10th-graders. (Miller, 1/10)

Weekend Reading

21. Longer Looks: Crowdfunding Health Care; Rural Hospitals; And Life Expectancy

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

Financial Times: Why Are So Many Americans Crowdfunding Their Healthcare?
Isabella Masucci strode into hospital after a sleepless night. She carried a paper bag of prized possessions and bore two meandering scars on her hairless head. Instead of the princess dress she had wanted to wear, she was dressed in a T-shirt and pink leggings. They enabled easier access to the tube that hung down from a catheter under the skin of her chest, allowing doctors to load the toxic drug Dactinomycin into her heart. It was close to her 50th day of chemotherapy. Isabella is two years old. (Jopson, 1/10)

The Atlantic: America's Rural Hospitals Are Dangerously Fragile
This is the story of a small-town, publicly-owned hospital that, after thriving for decades, is struggling and now in all likelihood about to be appended to a large regional health-care system. The tale of Berger Municipal Hospital is, like that of many sectors of the American economy, one defined by industrial consolidation and the costs that come with it. The story begins in 1929. That year, the city fathers of Circleville, Ohio, in the south-central part of the state, dedicated the town’s new hospital, funded partly with money willed by a local patron named Franklin Berger. (Brian Alexander, 1/9)

Vox: What The Dip In US Life Expectancy Is Really About: Inequality
What’s often lost in the conversation about the uptick in mortality here is that this trend isn’t affecting all Americans. In fact, there’s one group in the US that’s actually doing better than ever: the rich. While poor and middle-class Americans are dying earlier these days, the wealthiest among us are enjoying unprecedented longevity.So when we talk about life expectancy slipping, what we should also talk about is the growing problem of health inequality in America. (Julia Belluz, 1/9)

Politico's The Agenda: Welcome To The Upstream Issue
We need to start investing not just in medicine, but in a lot of things that have little to do with doctors and hospitals, or with drugs and procedures. So we’re ending this series with an issue on just that subject: the “Upstream” issue, an exploration of out-of-the-box ideas for getting ahead of tomorrow’s health challenges today. What else should we be focusing on if we want Americans in 20, 30 or 40 years to be healthier than they are now? Where should we focus our resources? (1/10)

WIRED: Scientists Just Solved A Major Piece Of The Opioid Puzzle
When it comes to tackling the opioid crisis, public health workers start with the drugs: fentanyl, morphine, heroin. But biochemists have a different focus: Not the opioids, but opioid receptors—the proteins the drugs latch onto within the body. (Robbie Gonzalez, 1/8)

The Atlantic: Health Care Just Became The U.S.'s Largest Employer
Due to the inexorable aging of the country—and equally unstoppable growth in medical spending—it was long obvious that health-care jobs would slowly take up more and more of the economy. But in the last quarter, for the first time in history, health care has surpassed manufacturing and retail, the most significant job engines of the 20th century, to become the largest source of jobs in the U.S. (Derek Thompson, 1/9)

Editorials And Opinions

22. Viewpoints: Exploring The Connection Between The Economy And Health Care Costs; The Need For An Opioid Czar?

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

Bloomberg: The Economy Tamed Health-Care Costs. That's Ending.
Paul Krugman tweeted about health care costs last week, suggesting excess-cost growth is ending. The point is significant. For decades, public and private health-care spending have grown significantly faster than the economy as a whole, a phenomenon known as excess-cost growth. Krugman’s tweet and a chart he attached from the Kaiser Family Foundation both suggest that growth has ended. If this is the case, then fear of a looming Medicare crisis is overblown, and Republican enthusiasm for cuts in Social Security, Medicaid and Medicare is misplaced on two counts. (Karl W. Smith, 1/11)

The New York Times: How To Fight The Opioid Crisis
Unfortunately, no one in the federal government has taken the lead to support the testing of new approaches to this epidemic. Such an effort would include new ways to prevent the illicit use of prescription drugs and to establish methods of treating addiction. The President’s Commission on Combating Opioid Drug Addiction and the Opioid Crisis has come up with nearly 60 recommendations that are thoughtful and useful, but responsibility falls across so many federal agencies that little progress is likely to result. In times of crisis, major change can happen. But this requires central leadership. The administration needs to put under one authority all of the programs and funding sources focused on drug abuse now spread among more than a dozen agencies. (David A. Kessler, 1/10)

Bloomberg: Supply, Not Despair, Caused The Opioid Epidemic
Perhaps the most important question in deciding how to respond to the U.S. opioid epidemic is whether it's primarily caused by social and economic factors, as some allege, or simply by an increased availability of drugs. Some recent U.S. research, as well as European data, shows that the latter is more likely -- that people use dangerous drugs because they can rather than because they're victims of economic ills. (Leonid Bershidsky, 1/10)

The Wall Street Journal: Children’s Health-Care Myths
By now perhaps you’ve heard that Republicans in Congress are denying health care to poor children, because what else would those robber barons do? The debate over funding the children’s health-insurance program could benefit from a fact or two, not least about political cynicism. The program known as CHIP was passed in the 1990s to offer health insurance to children in low- and middle-income families that earn too much to qualify for Medicaid. CHIP expired Sept. 30, but states have had unspent money in the interim, and Congress freed up for more in last month’s budget deal. None of the some nine million beneficiaries have lost insurance, and the program enjoys bipartisan support. This has not stopped press stories about children who will be denied care. (1/10)

Sacramento Bee: Congress, Do Your Job And Fund CHIP
Funding a bipartisan effort to secure children’s health should not be bartered in exchange for other actions, so we urge Congress to pass a clean CHIP funding bill. ... Now is not the time for lawmakers to shirk their responsibilities; now is the time to take their obligation of public service as seriously as parents and physicians take the welfare and health of our children. (Dean Blumberg and Manzo, 1/10)

The Wichita Eagle: KanCare In Need Of Solutions
Gov. Sam Brownback leaves as his legacy two experiments: massive tax cuts for businesses and the wealthy and privatized Medicaid he dubbed KanCare. Both failed. But another round of tax cuts is not coming. KanCare 2.0 is. Tim Wood, executive director of Interhab, a lobbying group for I/DD service providers, said many problems with KanCare 1.0 have yet to be solved. Despite this, Brownback still submitted version 2.0 to the federal Center for Medicare and Medicaid Services. (David P. Rundle, 1/11)

The Tennessean: Why This Medicare Assistance Program Needs Help
Since the early 1990s, Tennessee has participated in the federal government’s State Health Insurance Assistance Program, or SHIP, a program funded through the Tennessee Commission on Aging and Disability and administered locally by the Greater Nashville Regional Council. Along with the support of volunteers, professionals at GNRC are trained to understand the complexities of Medicare, know how to assess a client’s situation, and have the experience to guide them one‐on‐one through the process of signing up for benefits. ... Funding for SHIP is on unstable ground as the proposed federal budget threatens to eliminate more than $52 million in discretionary funding for this important service. This valuable program helps many across Middle Tennessee and the nation, and if you know someone who needs help with Medicare, I encourage you to contact your Congressional members to express support for SHIP. (Ken Moore, 1/8)

Los Angeles Times: Will Medicine Be The Next Field To Face A Sexual Harassment Reckoning?
While a revolution against cultures of sexual harassment and inequality has swept through Wall Street, Silicon Valley, Hollywood and other work environments, one field so far has escaped the reckoning: medicine. Could that be about to change? That's the question pondered by Reshma Jagsi, a professor of radiation oncology at the University of Michigan and director of its Center for Bioethics and Social Sciences. Jagsi was the lead author of a 2014 survey on sexual harassment and gender bias in academic medicine that is getting new attention today. (Michael Hiltzik, 1/10)

The New York Times: Why It’s Still Worth Getting A Flu Shot
This year’s flu season is shaping up to be a bad one. Much of the country endured a bitterly cold stretch, causing more people to be crowded together inside. The strain that has been most pervasive, H3N2, is nastier than most. And, we’re being told, the vaccine this year is particularly ineffective. That last fact has had many people wondering if they should still get a flu shot. If you read no further in this column, know this: The answer is yes, you should still get a flu shot. The flu season typically peaks December through February but can last until May, and it usually takes about two weeks for the shot’s immunity to kick in. (Aaron E. Carroll, 1/11)

The New York Times: You’re Sick. Whose Fault Is That?
On my pediatrics rotation in medical school, several residents told me they worked with children in part because they sometimes found themselves judging adults: Did they do drugs? Were they fat? Why did they drink so much? The idea that Americans should take personal responsibility for their health has recently received renewed attention. Vice President Mike Pence has argued for “bringing freedom and individual responsibility back to American health care.” (Dhruv Khullar, 1/10)

Des Moines Register: Let's Help Iowa Become A Health and Fitness Leader
The numbers are startling. Since 1988, the obesity rate in Iowa has increased from 14 percent to 32 percent. Harvard's T.H. Chan School of Public Health reports that by the time today's kids are 35, half will be obese. Obesity continues to be one of the costliest conditions among health-insured consumers in Iowa. These problems are not unique to Iowa. The U.S. is experiencing an unsustainable disease burden; more than 133 million Americans, or 45 percent of the population, have at least one chronic condition. Chronic diseases are the leading cause of death and disability in the U.S. Iowa’s statistics are particularly troubling – we rank No. 39 for obesity and No. 28 for inactivity. When a problem looms large, such as the state of our health, we can do two things: 1) Sit back, do nothing and wait for things to deteriorate further, or 2) We can get moving, get healthy and take back our well-being. (Chuck Long and Dr. Amy Michelle Willcockson, 1/11)

Stat: Innovative Health Insurers Must Learn To Think Like Amazon
On the spectrum of customer perception, health insurers rank closer to cable television companies than to retailers. There are plenty of reasons for that, including the fact that health insurance executives run their businesses with a deeply ingrained tendency toward conservative decision-making and incremental change. But if they are to keep pace with CVS, let alone Amazon, they’ll have to make bold investments, embrace change, and move fast. (Mark Nathan, 1/10)