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Morning Briefing

Summaries of health policy coverage from major news organizations

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Tuesday, Jun 26 2018

Full Issue

Viewpoints: Wrecking Ball Hitting Health Law Might Just Swing Back, Harm GOP; Give Veterans Safe Options For PTSD

Opinion pages focus on these and other health issues.

President Trump鈥檚 administration was not shy about its health-care scheme: If it couldn鈥檛 repeal the Affordable Care Act outright, it would sabotage it, meaning the White House would create uncertainty and move to end the聽cost-sharing reduction payments that helped keep premium costs down and keep insurers in the market. Republicans repealed the individual mandate, and the administration cut down on ACA advertising intended to remind the public about open enrollment. Trump鈥檚 theory, which he never hid, was that the public would blame President Barack Obama and Democrats would have to agree to one of the GOP plans they unsuccessfully tried to implement in 2017. Let Obamacare 鈥渋mplode,鈥 he declared. As child separation was to immigration (the intentional infliction of pain on innocents to get his way), Trump鈥檚 approach of strangling Obamacare (make it more expensive, the exchanges more unstable for consumers) was to health care. (Jennifer Rubin, 6/25)

Polls continue to show that the health care issue, despite being crowded out of the news by immigration, tariffs, North Korea and Trump administration scandals, remains near the top of voters鈥 concerns. Republican candidates would be wise not to underestimate the power of this issue to sway votes this fall. Among major items of concern:鈥 Two weeks ago, the Trump administration鈥檚 Justice Department told a federal court that it would no longer enforce key parts of the Affordable Care Act that require insurance companies selling plans on the Healthcare.gov marketplace to cover consumers with pre-existing conditions. This decision also could affect the 160 million Americans covered by employer-sponsored health care plans, who could be free to resume charging higher premiums or imposing waiting periods for coverage of pre-existing conditions. The administration is rolling out new 鈥漚ssociation health plans鈥 for individuals and small businesses. These policies would be cheaper and offer less comprehensive than current plans and might eliminate coverage for things like maternity services, emergency care or mental health treatment. (6/25)

When Sens. Cory Gardner (R-Colo.) and Elizabeth Warren (D-Mass.) introduced legislation this month to restrain the federal government from interfering with state-legal cannabis consumption and commerce, they galvanized an all-too-rare level of bipartisan, bicameral support. Notably missing from the voices of support for their bill are America鈥檚 veterans. While the States Act would provide vital protection from federal criminal prosecution under the Controlled Substances Act, it would do nothing to provide legal protection or access to medical cannabis for the nine million veterans who rely on the Veterans Health Administration (VHA). (Nick Etten, 6/26)

Pharmaceutical giants forming venture capital groups is an interesting twist in drug development. We need innovative approaches like that to help create new medications. But they shouldn鈥檛 come just from the pharma industry. Personal sacrifice, political will, and a shared commitment to the public good must also play roles. (Allan Hugh Cole Jr., 6/26)

June is Pride Month, a ripe time to reflect on one of the most startling facts about our sexual culture today: Condom use is all but disappearing among large numbers of gay men. Many rightly attribute the condom鈥檚 decline to the rise of PrEP 鈥 an acronym for pre-exposure prophylaxis, a two-drug cocktail that inoculates a person from contracting H.I.V. But another crucial component is the fading memory of the AIDS crisis that once defined what it meant to be gay. After tracking the sexual practices of 17,000 gay and bisexual Australian men from 2014 to 2017, a team of researchers this month unveiled the most convincing evidence to date. While the number of H.I.V.-negative men who are on PrEP increased to 24 percent from 2 percent, the rate of condom use decreased to 31 percent from 46 percent. More troubling, condom use among non-gay men is also down significantly. (Patrick William Kelly, 6/26)

In my more exasperated moments of residency, I must admit I was envious not only of what my supervising doctors knew, but also who they treated. Residents in our clinic, doctors in training just out of medical school, generally picked up patients they cared for in the hospital 鈥 with lots of medical problems, little medical care and often without a place to stay. The attending physicians who supervised us, it seemed, built their patient panels handing out business cards in luxury suites at Patriots games. Over time, as we transferred patients from one graduating resident to the next, our panels came to embody the city鈥檚 deepest and most recalcitrant social challenges. (Dhruv Khullar, 6/26)

The FDA鈥檚 approval of Epidiolex, a medication derived from cannabis, could be life changing for Americans suffering from certain types of epilepsy. It may also have far-reaching implications for U.S. marijuana policy. Epidiolex, made by GW Pharmaceuticals, is the first medication derived from the cannabis plant ever approved by the FDA. It has in the past approved synthetic formulations of tetrahydrocannabinol (THC) the active ingredient in marijuana. The FDA鈥檚 decision directly contradicts the decision by the Drug Enforcement Administration (DEA) to keep the newly approved compound, cannabidiol, under the umbrella of marijuana as a Schedule I substance, since by definition drugs in that class have no medicinal benefit. (John Cooper, 6/26)

As research-validated, evidence-based treatments for addiction disorders continue to emerge, the pendulum has begun to swing from the traditional emphasis on a 30-day inpatient treatment model to a primarily outpatient chronic disease management approach. This shift has many advantages for patients, but it also poses some challenges. Outpatient treatment allows individuals to live their lives and fulfill family and work obligations while receiving the medical care and behavioral therapy necessary for a successful recovery. However, patient retention, compliance, and long-term, consistent follow up with treating clinicians may be more of a concern for outpatient treatment models than for inpatient approaches. It seems now is the perfect time for the emergence of digital technology as a potential solution for some of these challenges.聽(Brent Boyett and Stephen Taylor, 6/26)

The bigger issue here is whether the city will use the construction of a modest number of housing units as an excuse to start rousting homeless people off streets across Los Angeles at night. That鈥檚 the last thing the city should be doing right now. Whether the city has reached what amounts to an arbitrary number of housing units set 11 years ago, there are still 鈥 and this should not come as a news flash to city officials 鈥 thousands more homeless people than there are available housing units or beds in decent shelters. And until we can solve that problem, police should not be breaking up homeless encampments wholesale at night. (6/26)

Rather than look for innovative, people-first solutions that could include working with local, public hospitals and universities, ADC chooses more of the same: providing inadequate care to some of our state鈥檚 most vulnerable. Judge Duncan鈥檚 sanctions are themselves an urgent call for change, but apathy is proving to be ADC鈥檚 only response. (Tiera Rainey, 6/25)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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