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Morning Briefing

Summaries of health policy coverage from major news organizations

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Friday, Feb 2 2018

吃瓜不打烊 Original Stories 1

  • Indiana Medicaid Drops 25K From Coverage For Failing To Pay Premiums

Capitol Watch 1

  • Few Republicans Have Appetite To Risk Another Repeal Failure In Election Year

Administration News 1

  • 'Palpable Relief' Sweeps CDC With Announcement Of Acting Director

Veterans' Health Care 1

  • Oregon VA Clinic Director Accused Of Trying To Game Ratings System Being Replaced

Marketplace 1

  • Bickering In Congress Created Vacuum That Tech Billionaires Decided To Fill With Health Initiative

Public Health 3

  • Effectiveness Of Flu Vaccine Looks Like It Will Be Even Lower Than CDC Experts Expected
  • Judge Overseeing 200 Suits Against Painkiller Makers Holds Summit To Get To Root Of Crisis
  • 'It鈥檚 Just So Scary': Brett Favre Cringes Over Physical Toll Football Takes On Little Kids

State Watch 2

  • Texas Lawmakers Aim To Reduce Maternity Mortality; Nurse Practitioner Bill Makes Headway In Va.
  • State Highlights: Calif. Struggles To Expand Care For Mentally Ill Inmates; New Ore. State Hospital Chief Pledges To Raise Level Of Care

Health Policy Research 1

  • Research Roundup: Microcephaly; Insurance Coverage; And Child Mortality

Editorials And Opinions 1

  • Perspectives: 5 Questions for Trump About The Opioid Crisis; Pros And Cons Of Amazon's Health Care Plan

From 吃瓜不打烊 - Latest Stories:

吃瓜不打烊 Original Stories

Indiana Medicaid Drops 25K From Coverage For Failing To Pay Premiums

The state branded its Medicaid expansion with some key conservative policies, and officials and advocates across the country are keenly watching the results. ( Phil Galewitz , 2/1 )

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Summaries Of The News:

Capitol Watch

Few Republicans Have Appetite To Risk Another Repeal Failure In Election Year

鈥淲e sort of tested the limits of what we can do in the Senate last year. And we鈥檙e one vote down from where we were then," said Sen. John Thune (R-S.D.), the No. 3 GOP leader.

Republicans are giving up on their years-long dream of repealing Obamacare. Though the GOP still controls both chambers of Congress and maintains the ability to jam through a repeal-and-replace bill via a simple majority, there are no discussions of doing so here at House and Senate Republicans鈥 joint retreat at The Greenbrier resort. Republicans doubt they can even pass a budget providing for the powerful party-line 鈥渞econciliation鈥 procedure used to pass tax reform last year, much less take on the politically perilous task of rewriting health care laws in an election year. (Everett, 2/1)

In other news from Capitol Hill聽鈥

A bipartisan group of senators is calling on President Trump to boost funding for Alzheimer鈥檚 research in his fiscal 2019 budget set to be released this month. 鈥淎t a time when the United States is spending more than $200 billion a year to care for Alzheimer鈥檚 patients, we are spending less than two thirds of one percent of that amount on research,鈥 the letter 鈥 led by Sens. Susan Collins (R-Maine) and Amy Klobuchar (D-Minn.) and signed by a dozen others 鈥 states. (Roubein, 2/1)

And community health centers are struggling as Congress sits on funding聽鈥

While Washington recently passed a six-year renewal of the Children鈥檚 Health Insurance Program, the health centers are getting month-to-month allotments, waiting for a long-term fix. The centers鈥 longer-term funding expired at the end of September. (Miller, 2/1)

Despite congressional inaction, the federal agency that oversees community health centers has sent money to some centers in Connecticut and committed this week to send funding to more, giving them a temporary reprieve from potential layoffs and cuts to services. Like the Children鈥檚 Health Insurance Program (CHIP), despite bipartisan support, Congress missed its Sept. 30 deadline to reauthorize money for the Community Health Center Fund, which represents the largest chunk of federal grant money going to the centers. (Rigg, 2/2)

Administration News

'Palpable Relief' Sweeps CDC With Announcement Of Acting Director

Anne Schuchat, who has nearly three decades of experience at the Centers for Disease Control and Prevention, will be taking on the role again.

It took several hours Wednesday before employees at the Centers for Disease Control and Prevention heard who was going to run the nation鈥檚 leading public health agency. Brenda Fitzgerald had just resigned after barely six months in the job because of conflicts over financial interests. When the notice finally went out on the CDC鈥檚 internal announcement board that the principal deputy director, Anne Schuchat, 58, with nearly three decades of CDC experience, would be taking over (again) as acting director, employees were very happy to hear the news. (Sun, 2/1)

In other news from the CDC聽鈥

Four years after the United States pledged to help the world fight infectious-disease epidemics聽such as Ebola, the Centers for Disease Control and Prevention is dramatically downsizing its epidemic prevention activities in 39 out of 49 countries because money is running out, U.S. government officials said. The CDC programs, part of a聽global health security聽initiative, train front-line workers in outbreak detection and work to strengthen laboratory and emergency response systems in countries where disease risks are greatest. The goal is to stop future outbreaks at their source. (Sun, 2/1)

Veterans' Health Care

Oregon VA Clinic Director Accused Of Trying To Game Ratings System Being Replaced

The Roseburg Veterans Administration Medical Center saw its ratings dramatically improve under Douglas Paxton. But doctors said that was driven largely by strategic tweaks to health care practices to boost performance measures, even when they left veterans worse off. Meanwhile, Wisconsin is setting up an alert system to locate at-risk, missing veterans.

The Department of Veterans Affairs announced on Thursday it would replace the director of its medical center in Roseburg, Ore., Douglas Paxton. He had come under fire in recent weeks for limiting the number of patients the center admitted in an effort to improve its dismal performance rating, according to doctors at the hospital. 鈥淭here are times that facility leadership needs to change in order to usher in a new approach that will demonstrate we are committed to delivering results for veterans,鈥 Dr. Carolyn Clancy, executive in charge of the Veterans Health Administration, said in a statement. (Philipps, 2/1)

Wisconsin is expected to become the first state to聽set up聽a 鈥淕reen Alert鈥 system to help families and law enforcement officials locate missing at-risk veterans. Advocates say they hope other states soon adopt Green Alerts, which are similar to the Amber and Silver alerts for missing children and older adults. The legislation unanimously passed the Wisconsin state Senate and is likely to pass the state聽Assembly in February, as first聽reported by The Milwaukee Journal Sentinel. (Wax-Thibodeaux, 2/1)

Gwen Adams called the next day and was told the officer who took their missing person's report was off for two days and they would have to wait until she returned. They did. They told police their son suffered from PTSD, they told police the medications he was taking and that he had missed an appointment at the VA. But because he was an adult, the family was told he didn't meet the criteria for a critical missing person. (Jones, 1/30)

And in other news聽鈥

The veterans' families聽鈥 and others who have spent time at the Murfreesboro VA hospital聽鈥 paint a bleak picture about how some are treated, leveling accusations that patients are force-fed medications, treated like jail inmates and given dozens of prescriptions when discharged. ... The surviving family members say their loved ones were not the same when they left treatment,聽overly medicated and with the underlying conditions they developed serving the country in combat the same or worse.聽In multiple cases reviewed by the USA TODAY NETWORK - Tennessee, they relapsed and were found dead within days or weeks after their release, each by self-inflicted means. (Lowary, 2/2)

Marketplace

Bickering In Congress Created Vacuum That Tech Billionaires Decided To Fill With Health Initiative

The idea of businesses stepping in where they see government failing is nothing new. But will the initiative from Amazon, Berkshkire Hathaway and JPMorgan actually succeed with the odds stacked against it?

Can private businesses solve public policy problems better than the government? It鈥檚 a question that has persisted for decades and taken on new resonance now that a career businessman is in the White House. There has never been a clear answer. For every sign of success 鈥 a smooth privatized toll road or a gleaming charter school 鈥 there have been obstacles revealing just how difficult public works can be. But companies haven鈥檛 stopped trying. (Gelles, 2/1)

While health care analysts are skeptical of the ability of Amazon, Berkshire Hathaway and JPMorgan Chase to transform the industry, tech futurists think it could at least lead to patients shopping for insurance plans the way they compare products on Amazon鈥檚 online retail platform. The key question, they say, is whether Jeff Bezos and his partners are thinking about the middle- or longterm. (Ravindranath, 2/1)

Cigna Corp., which reported higher 2017 fourth-quarter and full-year revenue on Thursday, isn't worried about the potential threat posed by the Amazon-JPMorgan Chase-Warren Buffett mashup unveiled earlier this week, even though the announcement sent insurance stocks spiraling down. Instead, Bloomfield, Conn.-based Cigna sees the new employer coalition, built to tackle rising healthcare costs, as another opportunity to leverage its expertise in value-based funding arrangements, medical management and ability to keep cost trends low, according to CEO David Cordani. (Livingston, 2/1)

Public Health

Effectiveness Of Flu Vaccine Looks Like It Will Be Even Lower Than CDC Experts Expected

Canadian researchers offer the first study on the vaccination's effectiveness in North America this year. Their midseason estimate suggested that the H3N2 component of the vaccine is 17 percent effective at preventing infection.

As the country battles an especially fierce flu season, experts have struggled to explain why one family of virus 鈥 the influenza A virus H3N2 鈥 that has infected a lot of people in recent years is causing so much damage again this winter. Now, new data from north of the border sheds some light on the question. Canadian influenza researchers reported Thursday in the online journal Eurosurveillance that the first reckoning of how well the flu vaccine is protecting against H3N2 viruses this year in North America has a dismal answer: not very. (Branswell, 2/1)

And in the states聽鈥

New York's historic flu season is聽continuing to worsen every week, Gov.聽Andrew Cuomo (D) said Thursday. Cuomo said the聽state confirmed聽more than聽11,600 cases of influenza reported to the health department over the past week, with聽more than 2,200 people hospitalized. (Weixel, 2/1)

Kinsa, one of several companies that make thermometers that connect to smartphones, has produced data on flu-like symptoms for the last two years that has been similar to the information from the Centers for Disease Control, but with less lag time. The company reported this week that Kansas had surpassed Missouri to take the nation鈥檚 top spot in percentage of people showing flu-like symptoms like fever, cough, sore throat and chills. (Marso, 2/1)

The number of confirmed flu cases in Arizona this season rivals the total seen during the H1N1 flu pandemic of 2009-10, with 19,279 cases of influenza reported this season as of last Saturday, state officials said. The number of reported cases is a sharp increase from the 2,175 total cases confirmed in the state last season. (Fish, 2/1)

Judge Overseeing 200 Suits Against Painkiller Makers Holds Summit To Get To Root Of Crisis

Taking Purdue Pharma's most powerful pill off the market was one suggestion at the gathering held by U.S. District Judge Dan Polster. Meanwhile, those on the front lines of the epidemic are struggling to deal with the crisis without extra funding from the federal government.

Local governments pressing lawsuits to hold pharmaceutical companies responsible for the opioid epidemic told a judge that taking the strongest version of Purdue Pharma Inc.鈥檚 Oxycontin painkiller off the market would have immediate results in addressing the crisis, according to people at the meeting. Purdue鈥檚 80-milligram version of Oxycontin is snorted by thousands of abusers, so removing it would be a good first step, experts for cities and counties and state attorneys general told U.S. District Judge Dan Polster, according to three people in attendance at the Wednesday meeting. They spoke on the condition of anonymity because they weren鈥檛 authorized to speak publicly about the closed-door summit. (Feeley, 2/2)

Insys Therapeutics Inc's legal woes deepened on Thursday as New York's attorney general filed a lawsuit seeking at least $75 million from the company, which he said deceptively promoted a fentanyl-based cancer pain medicine for unsafe uses. New York Attorney General Eric Schneiderman alleged that the Chandler, Arizona-based drugmaker recklessly marketed its product Subsys for wider uses than the U.S. Food and Drug Administration approved and bribed doctors to prescribe it. (2/1)

Every 25 minutes an infant is born to an opioid-addicted mother, and that's when the intense care starts. The average hospital bill to Medicaid in Missouri is about $63,000 per birth of a child with so-called neonatal abstinence syndrome. These babies may experience difficulty eating and breathing, rapid weight loss and sometimes seizures; on average, they stay in the hospital for three weeks after birth. From 2009 to 2012, hospital billing for care of these infants soared from $732 million to $1.5 billion, according to the last comprehensive analysis by Journal of Perinatology. Since that study, addiction rates have only climbed but there has been no more recent estimate of the costs incurred. (Luthi, 2/1)

And in California聽鈥

Orange County's first and only needle exchange program has shut down after Santa Ana city officials denied its permit application, a move some local advocacy groups and the state's leading public health agency say could negatively affect public welfare. However, the city contends the move was necessary because of an increased number of discarded syringes in the Santa Ana Civic Center, for which it says the needle exchange was at fault. (Brazil, 2/1)

'It鈥檚 Just So Scary': Brett Favre Cringes Over Physical Toll Football Takes On Little Kids

The veteran National Football League star says that with all the new information out about brain damage and concussions that can result from the sport, it's hard to watch kids play it. In other public health news: gut microbes, seizures, tainted baby formula, Alzheimer's and heart failure.

Sometime on Saturday morning, Brett Favre will do a small favor for an old friend and former backup, stepping up to deliver a pep talk to Doug Pederson鈥檚 Eagles before Super Bowl LII. But it鈥檚 the聽dangerous side of football that聽preoccupies Favre the most these days. 鈥淚 cringe,鈥 he said, 鈥渨hen I see video, or I鈥檓 driving and I see little kids out playing, and they鈥檙e all decked out in their football gear and the helmet looks like it鈥檚 three times bigger than they are. It鈥檚 kind of funny, but it鈥檚 not as funny now as it was years ago, because of what we know now.聽I just cringe seeing a fragile little boy get tackled and the people ooh and ahh and they just don鈥檛 know. Or they don鈥檛 care. It鈥檚 just so scary.鈥 (Boren, 2/1)

Two types of bacteria commonly found in the gut work together to fuel the growth of colon tumors, researchers reported on Thursday. Their study, published in the journal Science, describes what may be a hidden cause of colon cancer, the third most common cancer in the United States. The research also adds to growing evidence that gut bacteria modify the body鈥檚 immune system in unexpected and sometimes deadly ways. (Kolata, 2/1)

When Sarah Jay had her first seizure, she was in her mid-20s and working a high-stress job at a call center in Springfield, Mo. "I was going to go on break," she says. "I was heading towards the bathroom and then I fell and passed out." An ambulance took Jay to the hospital but doctors there couldn't find anything wrong. Jay figured it was a one-time thing. Then a week later, she had another seizure. And that kept happening once or twice a week. "So I was put on short-term disability for my work to try to figure out what was going on," says Jay, who's now 29. (Hamilton, 2/1)

When the French dairy giant Lactalis began recalling baby formula, S茅gol猫ne Noviant thought she was safe. The milk she had been feeding her 5-month-old son wasn鈥檛 on the list. Then her son, Noan, was rushed to the emergency room with a fever, diarrhea and internal bleeding. His formula was tainted with salmonella 鈥 and a broad range of other Lactalis powdered milk products still on the shelves were at risk, too. (Alderman, 2/1)

[Reisa] Sperling is director of the Center for Alzheimer Research and Treatment at Brigham and Women's Hospital. She's forging ahead studying the treatment of amyloid plaques and is urging people at risk of Alzheimer's to enroll in clinical trials, because she believes the key may lie in catching the disease much earlier. (Mullins and Joliocoeur, 2/1)

Shirline Burbanks is one of the 6.5 million Americans suffering from congestive heart failure (CHF). Recently, she checked herself in to the Tulane Medical Center in New Orleans, complaining of shortness of breath. But unlike most other CHF patients in the U.S., within hours of her admittance, Burbanks was met at her bedside with an offer: to sign up for cooking classes. (Nargi, 2/1)

State Watch

Texas Lawmakers Aim To Reduce Maternity Mortality; Nurse Practitioner Bill Makes Headway In Va.

State legislatures also focus on telemedicine practices and medical marijuana.

It's no secret that Texas has a serious health crisis on its hands with the alarming number of women dying due to issues related to pregnancy within a year after giving birth, and state leaders haven't yet come to a consensus on finding the best policy path forward.聽But some women's health experts and state legislators agree one of the first steps is making sure Texas mothers have continuous access to health care before, during and after childbirth. (Milburn, 2/1)

A bill that would provide an avenue for nurse practitioners to practice independently without the supervision of a physician edged through its first committee hearing Thursday after being saddled with an amendment requiring them to receive far more training. The House Health, Welfare and Institutions Subcommittee was standing-room-only as nurse practitioners and physicians 鈥 many wearing white medical coats 鈥 showed their support or opposition for House Bill 793, sponsored by Del. Roxann Robinson, R-Chesterfield. (O'Connor, 2/1)

A telemedicine bill aimed at improving health care access for Kansans, particularly in rural areas, may get bogged down in abortion politics. The legislation would mean insurance companies can鈥檛 refuse to pay for services provided long-distance that they would cover at an in-person office visit. More controversially, the bill would not allow drug-induced abortion or other abortion procedures through telemedicine. (Fox, 2/1)

A bill that would allow physicians to broadly prescribe a form of medical marijuana received preliminary approval in the Virginia House of Delegates on Thursday and seems likely to become law, its sponsors say, after years of failed attempts. The legislation, HB 1251, would permit the use of non-hallucinogenic marijuana or cannabis extracts known as cannabidiol oil or THC-A oil to treat any diagnosed condition or disease. Scientific studies indicate that the oils can reduce nausea and alleviate pain, and also may slow the growth of and kill some cancer cells. (Sullivan, 2/1)

State Highlights: Calif. Struggles To Expand Care For Mentally Ill Inmates; New Ore. State Hospital Chief Pledges To Raise Level Of Care

Media outlets report on news from California, Oregon, Colorado, Pennsylvania, Washington, Illinois, Texas, Maryland and Florida.

Gov. Jerry Brown has earmarked $117 million in his new state budget to expand the number of treatment beds and mental health programs for more than 800 mentally ill inmates found incompetent to stand trial. State officials said they have struggled to keep up with the needs of a population that has jumped in size by 33% over the last three years, as judges are increasingly referring defendants to treatment. But one state lawmaker says additional funds are not enough. (Ulloa, 2/2)

Officials with the Oregon Health Authority announced Thursday that Dolly Matteucci has been hired to lead the Oregon State Hospital, filling a void atop the state psychiatric institution that has gone without a permanent superintendent for a year. Matteucci, who will take the helm in mid-March, will arrive from California, where she has served as executive director of Napa State Hospital since 2010. That hospital serves more than 1,200 patients with an annual budget of $305 million, compared to Oregon's 600-some patients and $250 million annual budget. (Friedman, 2/1)

Sixty-nine Colorado patients were prescribed aid-in-dying medication during 2017, the first year of the law approved by voters, and 50 of those patients filled the prescription, according to a report by the Colorado Department of Public Health and Environment released Thursday. Although 56 of those 69 patients died, the data don鈥檛 reveal which ones died as a result of the drugs, or even if the deceased had filled their prescription. (Simpson and Brown, 2/1)

The federal government has withdrawn its appeal and agreed to pay $42 million to the parents of a young Pennsylvania boy left disabled from brain injuries apparently caused by the use of forceps during his birth, the parents' lawyers and the government announced Thursday. "The government recognized that their issues on appeal were without merit and that the verdict was just and appropriate," said Regan Safier, of Kline & Specter, a Philadelphia law firm. "The judge recognized the catastrophic injuries suffered by this child and awarded the money necessary to care for him over his lifetime." (2/1)

Roughly 622,000 Washington state residents received low-value services over one year, which collectively cost about $282 million, a new report found. The not-for-profit Washington Health Alliance's study found that 45.7% of the 1.5 million total services it analyzed from July 2015 to June 2016 were unnecessary and wasteful according to recommendations from the Choosing Wisely campaign. (Castellucci, 2/1)

When 86-year-old Carol Wittwer took a taxi to the emergency room, she expected to be admitted to the hospital. She didn't anticipate being asked if she cooks for herself. If she has friends in her high-rise. Or if she could spell lunch backward. "H-C-N-U-L," she said, ruling out a type of confusion called delirium for the geriatrics-trained nurse who was posing the questions in a special wing of Northwestern Memorial Hospital's emergency department. Wittwer's care is part of a new approach to older patients as U.S. emergency rooms adapt to serve the complex needs of a graying population. (2/2)

The regional office of Planned Parenthood has selected a new president and CEO. Brandon Hill, formerly executive director of the Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health at the University of Chicago, assumed the role on Thursday. Hill says he's eager to move from reproductive research to advocacy. (Smith, 2/2)

The Texas Health and Human Services Commission won鈥檛 fight an auditor coming through their doors 鈥 in fact, they welcome it. That鈥檚 what Charles Smith, executive commissioner for the state health agency, said just one day after his staff was blasted by state leadership for mishandling state contracts. (Evans, 2/1)

The United Arab Emirates says it鈥檚 making a $50 million gift to Johns Hopkins University for a new institute for stroke research in Baltimore and in Abu Dhabi. The UAE ambassador to the U.S., Yousef Al Otaiba, released a statement in partnership with Johns Hopkins on Thursday ahead of a planned announcement in New York. The statement says the Sheikh Khalifa Stroke Institute in Baltimore and Abu Dhabi will focus efforts by Johns Hopkins鈥 to develop new tools for stroke diagnosis, treatment and patient recovery. (2/1)

The United Arab Emirates has donated $50 million to Johns Hopkins Medicine to create an institute to transform treatment for stroke patients across the globe. Officials from the Baltimore health system and the Middle Eastern nation gathered in New York City Thursday, at the United Arab Emirates鈥 permanent mission to the United Nations, to announce plans for the Sheikh Khalifa Stroke Institute. (McDaniels, 2/1)

Among findings in the 2018 California Children鈥檚 Report Card, only half of California鈥檚 3- and 4-year-olds attend preschool 鈥 now considered a critical launchpad for a child鈥檚 learning 鈥 and just one-quarter of infants and toddlers have access to licensed child care. Only 14 percent of low-income children are in publicly funded child care. (Noguchi, 2/1)

Before year鈥檚 end, Central Floridians who are at high risk of HIV infection will be able to get the preventive drug Truvada at no coast at their local health department. The state health department rolled out the program last October as part of its efforts to reduce new HIV infections. (Miller, 2/1)

Some of the poorest people in the city spend their days in the shadow of Los Angeles City Hall, napping on flattened cardboard boxes. On any given day, as many as 20 people take to the City Hall lawn, across the street from LAPD headquarters. They're there to "escape the madness" in downtown streets, a 53-year-old homeless man named Lazarus said last week. At night, they fan out to doorways or deserted plazas to wait for daybreak. (Holland, 2/1)

When California voters legalized recreational weed in 2016, they made the law retroactive, allowing residents to petition to overturn or reduce old convictions for possession, cultivation and distribution of marijuana. But it is a difficult and expensive legal procedure, advocates say, and many people are not even aware they are now eligible to clean up their records. (Koseff, 2/2)

Health Policy Research

Research Roundup: Microcephaly; Insurance Coverage; And Child Mortality

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

According to the International Fetal and Newborn Growth Consortium for the 21st Century definition, the prevalence of microcephaly (>2 SDs below the mean for gestational age and sex) was higher in SL (3.5%) than in RP (2.5%). The prevalence of severe microcephaly (>3 SDs below the mean) was higher in SL (0.7%) than in RP (0.5%). Low maternal schooling, living in consensual union or without a companion, maternal smoking during pregnancy, primiparity, vaginal delivery, and intrauterine growth restriction were consistently associated with microcephaly. The number of cases of microcephaly is grossly underestimated, with an underreporting rate of 鈭90%. (Silva et al., 2/1)

Using the 2016 American Community Survey (ACS), this brief updates a previous analysis that examined health insurance coverage among children ages 3 and younger and their parents in 2015. High rates of coverage through Medicaid and the Children鈥檚 Health Insurance Program (CHIP) continued among young children and their parents in 2016, the third year after implementation of the major coverage provisions of the Affordable Care Act. Uninsurance among both young children and their parents continued to decline, and coverage levels varied across states and metropolitan areas. Estimates for children ages 2 and younger nationally and across states are also presented. (Haley et al., 1/30)

Models that predict risk of maltreatment as defined by child protective services substantiation also identify children who are at heightened risk of injury and mortality outcomes. If deployed at birth, these models could help medical providers identify children in families who would benefit from more intensive supports. (Vaithianathan, Rouland, Putnam-Hornstein, 2/1)

In a randomized clinical trial of 1467 Danish participants receiving at least 5 medications, a statistically significant reduced rate of readmissions within 30 and 180 days after inclusion was observed in patients randomized to receive an extended pharmacist intervention compared with those who received usual care or a basic pharmacist intervention. (Ravn-Nielsen, Duckert and Lund, 1/29)

As concerns about retirement savings have intensified, many older adults have begun working beyond traditional retirement age. By working longer, they can improve their retirement security by increasing their future monthly Social Security payments and shortening the time they must rely on their savings. But does delaying retirement deepen income inequality for older adults by leaving those with health problems behind? (Johnson, 2/1)

Mortality and morbidity are higher among patients with atrial fibrillation and heart failure than among those with heart failure alone. Catheter ablation for atrial fibrillation has been proposed as a means of improving outcomes among patients with heart failure who are otherwise receiving appropriate treatment. ...聽Catheter ablation for atrial fibrillation in patients with heart failure was associated with a significantly lower rate of a composite end point of death from any cause or hospitalization for worsening heart failure than was medical therapy. (Marrouche, et al., 2/1)

Findings: In this study of patients with 1 of 5 common surgical conditions, Medicaid expansion was associated with a 7.5鈥損ercentage point increase in insurance coverage at the time of hospital admission. The policy was also associated with patients obtaining care earlier in their disease course and with an increased probability of receiving optimal care for those conditions. Meaning: The Patient Protection and Affordable Care Act鈥檚 Medicaid expansion was associated with increased coverage of patients, earlier presentation with common diagnoses, and improved surgical care. (Loehrer et al., 1/24)

Editorials And Opinions

Perspectives: 5 Questions for Trump About The Opioid Crisis; Pros And Cons Of Amazon's Health Care Plan

Editorial pages highlight these important health care issues.

President Trump鈥檚 State of the Union address was 80 minutes long. He spent just 49 seconds on the opioid epidemic, something he has declared to be a public health emergency. The brevity of his remarks on opioids is indicative of the lack of action taken by the federal government in the three months since the emergency declaration. For us on the front lines of the epidemic in Baltimore, as elsewhere around the country, the declaration has had no impact at all. The federal government continues to delay committing new funding to treating addiction as the disease that it is, while hundreds of people die every day from overdoses. (Leana S. Wen, 2/1)

Here鈥檚 the good news about the announcement this week that Amazon, Berkshire Hathaway and JPMorgan Chase are forming a new company to cover health care for their employees: If you鈥檙e one of the million-plus people who work at these companies, or a family member of one, you鈥檙e likely to get cheaper, better health care pretty soon. Here鈥檚 the bad news: If you鈥檙e one of the approximately 300 million other Americans, you might not see savings for a long time, if ever. And in the short term at least, you could be hit by bigger medical bills. (Elisabeth Rosenthal, 2/1)

Amazon.com Inc., Berkshire Hathaway Inc. and JPMorgan Chase & Co. are publicly traded, profit-oriented corporations. So it聽is interesting that when they聽announced their new joint health-care venture聽this week they made a point of saying it would be "an聽independent company that is free from profit-making incentives and constraints."Interesting but maybe not all that surprising:聽Around the world, health, life and property聽insurance, as well as various other financial services, have long been provided by聽nonprofit organizations, mostly in the form of聽customer-owned mutuals. (Justin Fox, 2/1)

"The ballooning costs of healthcare act as a hungry tapeworm on the American economy," said Berkshire Hathaway's Warren Buffett. ... Are the nearly 16 million people laboring in healthcare parasites? Of course not. The healthcare system is a vital cog in our society and a healthy workforce is crucial to its economy. That's why cancer is the better comparison for the system's unsustainable costs. The system is growing too quickly, like a tumor. To restore health, you have to eliminate the cancer, not the vital organ on which the tumor grows. (Merrill Goozner, 1/31)

President Trump told some whoppers in this week's State of the Union speech: His tax cuts were the biggest ever (they weren't), he has added 2.4 million new jobs (only if you count former President Obama's last few months in office), wages are finally rising (they've been slowly but steadily climbing for years). But the one that really got my attention was Trump's declaration that he's committed to addressing "the injustice of high drug prices." (David Lazarus, 2/1)

Two years ago, the Long-Term Care Financing Collaborative proposed a public catastrophic long-term care insurance program. In effect, people would use private insurance, savings, or home equity to pay for the first few years of their care needs, then the government would pick up costs for people with true catastrophic needs. Today, two highly-respected long-term care experts offered an important refinement to that basic structure: A plan that ties the time period before insurance benefits are available to a person鈥檚 income. As a result, lower-income people could access new benefits sooner than higher-income people. (Howard Gleckman, 1/31)

As the sports-loving part of the population looks forward to the National Football League's annual Super Bowl on Sunday, legislatures in New York and Illinois are zeroing in on a different aspect of the nation's most popular sport: brain injuries among young players. Lawmakers in both states have introduced measures that would ban tackle football for children under age 12. Making kids wait longer to don pads and helmets is not a bad idea, nor would it be a bad choice to extend such limits to other sports, such as hockey, lacrosse and boxing, where children as young as 8 strap on gloves and protective gear and punch each other in the head. (2/2)

Besides damage resulting from football-related concussions, my husband has never had a diagnosed brain injury. He鈥檚 never been in a car accident or fallen off a roof. He never did steroids and, after struggling with alcohol abuse for about six years, off and on, after retirement, hasn鈥檛 had a drink in eight years. And he鈥檚 only 43. (Emily Kelly, 2/2)

It鈥檚 surprising how easy it is to brush off dire existential threats. We remain, for example, unprepared for the next pandemic flu, though experts warn it鈥檚 only a matter of time before a new strain capable of killing millions will emerge. ...One problem is that we citizens of the 21st century have also been warned about our 鈥渨oeful鈥 lack of preparedness for Ebola and similar disease outbreaks, a major earthquake, sea level rise, nuclear war, and a massive asteroid striking the earth. And if that isn鈥檛 enough, experts at MIT and Cambridge University are discussing how unprepared we are for threats of technology run amok, such as intelligent machines taking over the world. (Faye Flam, 2/1)

Close your eyes, and conjure up an image of an autistic kid. What springs to mind? If I had to guess, I鈥檇 say it鈥檚 probably a socially awkward boy who鈥檚 obsessed with gaming.But the time has come to challenge that assumption. A new study in the Journal of Autism and Developmental Disorders, released Jan. 4, reinforces something I鈥檝e known innately for years, having myself been an undiagnosed autistic girl: It is easy to overlook us. According to the Centers for Disease Control and Prevention, autism affects one in 68 children but is four and a half times more prevalent in boys than girls. But that still means there are an awful lot of autistic girls. (Sally J. Pla, 2/1)

Put simply, under the right-to-try bill, a death caused by the use of an experimental drug could not be considered by the FDA in deciding whether to approve or reject the therapy. While this may help address pharmaceutical and biotechnology industry concerns that expanded access programs could jeopardize ongoing studies, it is simply unethical at its core. I鈥檓 also worried about the financial, legal, and medical protection afforded to patients and their families under the proposed right-to-try bill. Do patients undergoing right-to-try therapies lose their coverage for hospice? Would insurers be absolved of any responsibility for covering further medical expenses once a patient starts a drug under right-to-try? What if the experimental drug causes hospitalization or leads to additional treatments 鈥 who would pay for that? (Michael D. Becker, 2/1)

Bureaucrats botch the rollout of big changes to health care coverage that affect hundreds of thousands of state employees and could have resulted in layoffs at a local insurer. Yet the governor manages to escape much of the blame, as if the agency making the decision went rogue, as if he didn鈥檛 appoint half of the board overseeing the agency, as if he doesn鈥檛 know how health care works. (Shirley Leung, 1/31)

On Monday, a Kansas legislative committee on corrections got answers to questions they should have been asking all along. Rep. J. Russell Jennings, Chairman of the Committee on Corrections and Juvenile Justice Oversight, called the hearing after The Star detailed the nearly $2 billion Missouri and Kansas will pay to Corizon Health over a decade to provide health care to inmates. Despite the cost to taxpayers, legislative oversight has been lax, particularly in Missouri. That needs to change. (2/1)

Women are strong and empowered, capable of achieving our goals without abortion. Our Legislature prides itself on caring about women, but SB 320 does nothing to address the real needs of pregnant students, such as housing, child care, lactation stations, diaper changing tables, flexible exam schedules, counseling and pre-natal care. (Wynette Sills, 2/1)

According to the American Medical Association鈥檚 2018 economic impact study, California鈥檚 90,000 physicians generate $232 billion in direct and indirect economic activity, an average of $2.6 million each. U.S. physicians produced $2.3 trillion in economic activity, more than the total economic output for the entire country of Brazil. (Theodore Mazer, 2/1)

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