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Morning Briefing

Summaries of health policy coverage from major news organizations

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Friday, Jun 15 2018

吃瓜不打烊 Original Stories 4

  • As Medicaid Costs Soar, States Try A New Approach
  • In New Hampshire, Even Mothers In Treatment For Opioids Struggle To Keep Children
  • Most Texans Want State To Expand Medicaid And Help Poor Get Health Care
  • Podcast: KHN鈥檚 鈥榃hat The Health?鈥 California Here We Come

Health Law 2

  • Court Rejects Insurers Claims That They're Owed Billions Under Health Law's Risk Corridors Provision
  • Health Care Players Present Uncommonly United Front In Texas Lawsuit Challenging Health Law

Opioid Crisis 1

  • First Generic Under-The-Tongue Film For Treating Opioid Addiction Approved

Women鈥檚 Health 1

  • Texas Abortion Clinics Challenge Dozens Of 'Restrictive' Abortion Laws, Some Created 20 Years Ago

Public Health 3

  • Feelings Of Sadness Or Hopelessness Are On The Rise In Teens, 'Deeply Disturbing' Report Finds
  • These Days It's Easy To Share Your DNA Data Online 鈥 But Erasing It Is A Whole Lot Harder
  • Vitamin D May Play Protective Role Against Colorectal Cancer

State Watch 1

  • State Highlights: Former USC Gynecologist's House Raided; Six States Warned About Potential Hep A Outbreak

Health Policy Research 1

  • Research Roundup: Medicaid; Infections; And Medicare

Editorials And Opinions 2

  • Different Takes: Lawsuit Against Pre-Existing Conditions Is Flawed; Thumbs Up For Not Defending Health Law
  • Viewpoints: During Opioid Crisis, Also Develop Treatments For Family Mental Trauma; Wrong Time To Legalize Marijuana At Federal Level

From 吃瓜不打烊 - Latest Stories:

吃瓜不打烊 Original Stories

As Medicaid Costs Soar, States Try A New Approach

New programs, known as ACOs, reward hospitals and physician groups that hold down costs by keeping enrollees healthy. The health care providers are asked to address social issues 鈥 such as homelessness, lack of transportation and poor nutrition 鈥 that can cause and exacerbate health problems. ( Phil Galewitz , 6/15 )

In New Hampshire, Even Mothers In Treatment For Opioids Struggle To Keep Children

New Hampshire parents who are trying to overcome opioid abuse face a ticking clock and limited state resources to try to keep their parental rights. ( Rachel Gotbaum , 6/15 )

Most Texans Want State To Expand Medicaid And Help Poor Get Health Care

Texans think the Legislature should expand Medicaid to more low-income people and make health care more affordable, according to a survey released today from the Kaiser Family Foundation and the Episcopal Health Foundation. ( Ashley Lopez, KUT , 6/14 )

Podcast: KHN鈥檚 鈥榃hat The Health?鈥 California Here We Come

In this episode of KHN鈥檚 鈥淲hat the Health?鈥 Julie Rovner of Kaiser Health News, Carrie Feibel of KQED San Francisco, Anna Maria Barry-Jester of FiveThirtyEight.com and Joanne Kenen of Politico report from San Francisco on the complicated health politics of the Golden State and the latest news on a lawsuit challenging parts of the Affordable Care Act. Plus, for extra credit, the panelists offer their favorite health stories of the week. ( 6/14 )

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Summaries Of The News:

Health Law

Court Rejects Insurers Claims That They're Owed Billions Under Health Law's Risk Corridors Provision

The panel said the government doesn't have to pay insurers the money because Congress had taken action 鈥 after the health law's passage 鈥 requiring the program to be budget neutral year after year. The program in contention was aimed at enticing insurers into the market with promises of covering their financial risks.

The federal government doesn鈥檛 have to pay insurers billions of dollars under an Affordable Care Act program aimed at enticing them into the markets by helping cover their financial risks, a divided federal appeals court ruled Thursday. In a case brought by Moda Health Plan Inc., the ruling is a blow to insurers hoping to recoup money they say they were owed under the 2010 health law. (Armour and Kendall, 6/14)

A divided three-judge panel rejected claims from two Obamacare insurers that the federal government was required to make good on payments from a program meant to protect insurers who attracted customers who were sicker and more expensive than anticipated. The two insurers were seeking hundreds of millions of dollars in payments from Obamacare鈥檚 risk corridor program, and at least three dozen other insurers have filed similar lawsuits. In all, insurers say they鈥檙e owed more than $12 billion from the risk corridor program, a shortfall they have partially blamed for skyrocketing premiums and dwindling competition in the Affordable Care Act marketplaces. (Demko, 6/14)

鈥淐ongress clearly indicated its intent here,鈥 the court ruled. 鈥淚t asked GAO [the Government Accountability Office] what funding would be available to make risk corridors payments, and it cut off the sole source of funding identified beyond payments in. It did so in each of the three years of the program鈥檚 existence.鈥 The insurers are likely to appeal and seek a review by the full court, rather than just a panel. If that doesn鈥檛 succeed, the next step would be an appeal to the Supreme Court. (Weixel, 6/14)

A federal appeals court on Thursday ruled that the U.S. government does not owe health insurers billions of dollars in unpaid risk-corridor funds meant to offset losses during the early years of the Affordable Care Act exchanges. Although more than three dozen insurers claimed the federal government owed them more than $12 billion in risk-corridor payments, a panel of judges from the U.S. Court of Appeals for the Federal Circuit determined the payments weren't necessary since Congress deemed the program had to be budget-neutral through appropriations riders. (Livingston, 6/14)

Health Care Players Present Uncommonly United Front In Texas Lawsuit Challenging Health Law

Hospitals, doctors, medical schools, patient-advocacy groups and insurers have filed friends of the court briefs arguing that a ruling in favor of this latest challenge to the health law's constitutionality would 鈥渉ave a devastating impact on doctors, patients, and the American health care system as a whole."

A broad swath of health-care constituencies weighed in on Thursday to oppose a lawsuit challenging the Affordable Care Act, forming an uncommonly united front against a decision by the Trump administration not to defend significant parts of the law. Hospitals, doctors, medical schools, patient-advocacy groups, the health insurance industry and others filed briefs in a federal court in Texas, disputing the argument of 20 Republican-led states and the Justice Department that all or part of the 2010 law is unconstitutional. In all, 11 friend-of-the-court briefs were filed. From various vantage points, each argues that a ruling in favor of this latest challenge to the ACA鈥檚 constitutionality would 鈥渉ave a devastating impact on doctors, patients, and the American health care system as a whole,鈥 as a brief from the American Academy of Child and Adolescent Psychiatry puts it. (Goldstein, 6/14)

In other news on the health law聽鈥

The Trump administration shook the health care world last week when the Department of Justice announced that it will no longer defend in court key protections of the Affordable Care Act, also known as Obamacare. The announcement 鈥 coming in a case brought by Republican leaders in 20 states (but not Colorado) 鈥 could mean the end of insurance protections for people across the country with pre-existing conditions or high-cost medical needs. The states argue that those rules are unconstitutional, especially in light of a vote in Congress last year to slash to zero dollars the penalty for not having health insurance, essentially rendering meaningless the mandate that all people be covered. (Ingold, 6/14)

Minnesotans who buy health insurance on their own will get their first hints Friday about premiums for 2019 with the scheduled release of data on the rates being requested by carriers. The information from regulators is expected even as new questions are brewing at the federal level about the future of the Affordable Care Act (ACA), the health law that started fundamentally reshaping the individual market in 2014. (Snowbeck, 6/14)

Opioid Crisis

First Generic Under-The-Tongue Film For Treating Opioid Addiction Approved

The news is welcome as brand-name Suboxone film costs about $200 a month without insurance. In other news on the crisis: Kentucky sues Walgreens; vulnerable lawmakers look to win big political points with opioids package; mothers in treatment struggle to keep their children; and more.

U.S. regulators have approved the first generic version of an under-the-tongue film for treating opioid addiction. The Food and Drug Administration on Thursday approved a generic version of Suboxone, a film strip that dissolves under the tongue. Used daily, it reduces withdrawal symptoms, cravings for opioids and the high from abusing them. (Johnson, 6/14)

Kentucky鈥檚 attorney general sued Walgreens Thursday, alleging that the company contributed to the state鈥檚 opioid epidemic. Attorney General Andy Beshear, a Democrat, sued Walgreens for its role as both a distributor and a pharmacy. The lawsuit alleges that the company failed to report suspicious shipments of opioids to authorities and that it dispensed large quantities of the painkiller. (Roubein, 6/14)

The lawsuit also asserts the company willfully ignored its own safeguard systems that are designed to protect consumers and monitor their drug consumption. The lawsuit, filed in Boone County, claims parent company Walgreens Boots Alliance fulfilled orders "for such large quantities of prescription narcotic pain medication that there could be no associated legitimate medical purpose for their use." (Romo and Saldivia, 6/14)

Everybody wants their name on a bill addressing the opioid crisis 鈥 especially Republicans facing tough reelection battles. That鈥檚 why House leadership will bring more than 70 such bills to the floor by the end of the month, many sponsored by the most vulnerable members of the GOP conference. (Ehley and Haberkorn, 6/14)

The House debate on opioids legislation turned contentious Thursday with the consideration of legislation to set aside housing vouchers for people with substance abuse disorder.聽The voucher bill (HR 5735) was ultimately approved, 230-173. The bill would allocate 10,000 housing vouchers to people recovering from a substance use disorder, but it would not increase the overall supply of vouchers or increase appropriations. (Raman, 6/14)

Kaiser Health News: In New Hampshire, Even Mothers In Treatment For Opioids Struggle To Keep Children

Jillian Broomstein starts to cry when she talks about the day her newborn son Jeremy was taken from her by New Hampshire鈥檚 child welfare agency. He was 2 weeks old. 鈥淭hey came into the house and said they would have to place him in foster care and I would get a call and we would set up visits,鈥 she said. 鈥淚t was scary.鈥 Broomstein, who was 26 at the time, had not used heroin for months and was on methadone treatment, trying to do what was safest for her child. (Gotbaum, 6/15)

Hospitalizations for pain medication overdoses decreased by 2.2 percent from 2016 to 2017, while those for heroin overdoses increased by 12.7 percent. Those trends are in keeping with other research findings that use of prescription medicines 鈥 often blamed for fueling the opioid crisis 鈥 is being curtailed after years of legal and medical efforts, as well as heightened public awareness of the drugs鈥 addiction potential. (Whelan, 6/13)

New Hampshire will soon see a more than seven-fold increase in federal funds aimed at combatting the opioid crisis, up from about $3 million to $23 million for the fiscal year ending September 30. The money comes from $3 billion in additional funds for the crisis included in the federal budget deal negotiated in March. (Greene, 6/15)

Women鈥檚 Health

Texas Abortion Clinics Challenge Dozens Of 'Restrictive' Abortion Laws, Some Created 20 Years Ago

The Whole Women's Health Alliance, which won a landmark U.S. Supreme Court Case in 2016, filed the lawsuit Thursday, stating the state's abortion restrictions put "medically unnecessary burdens on patients, require doctors to lie to their patients and have led to clinics being shut down." Among the old Texas laws being newly challenged are requirements that only doctors and not clinic staff can perform abortions, licensing standards, required ultrasounds in which the image of the fetus is shown to the patient and 24-hour waiting periods.

Texas abortion providers who won a landmark U.S. Supreme Court ruling in 2016 that blocked a new wave of anti-abortion efforts are now using that decision to try to undo laws on the books for decades in a lawsuit filed Thursday. In suing over anti-abortion measures that stretch back 20 years in some cases, Texas clinics are putting a new spin on what has become a recurring cycle in GOP-controlled states 鈥 legislatures passing new abortion laws, followed by opponents rushing to court before they can take effect. (6/14)

The legal action draws heavily on a 2016 Supreme Court ruling that struck down two Texas regulations that would have closed most abortion clinics in Texas. The court said requiring abortion doctors to have admitting privileges in a nearby hospital and requiring all abortions to be done in hospital-like settings placed an improper burden on access to the procedure that outweighed the regulations鈥 benefits. (Lindell, 6/14)

The move led by the Whole Woman鈥檚 Health Alliance comes two years after the abortion provider successfully challenged two provisions of a Texas abortion law at the Supreme Court. The decision marked the most significant abortion rights ruling in a generation and paved the way for groups to challenge abortion laws in other states. (Rayasam and Haberkorn, 6/14)

鈥淔or years, Texas politicians have done everything in their power to push abortion out of reach for Texans. Today, we join communities and advocates across the state to send the message that we have had enough,鈥 said Amy Hagstrom Miller, President of Whole Woman鈥檚 Health Alliance. (Hellmann, 6/14)

Marc Rylander, director of communications for the Texas attorney general, said the Supreme Court has affirmed several times that the state can have an interest in "safeguarding women's health and protecting unborn life." "Abortion providers have been complying with the laws being challenged in this case for years," Rylander said in a prepared statement. "They are common-sense measures necessary to protect Texas women from unhygienic, unqualified clinics that put women's lives and reproductive health at risk. It is ridiculous that these activists are so dedicated to their radical pro-abortion agenda that they would sacrifice the health or lives of Texas women to further it." (Wang, 6/14)

Stephanie Toti, one of the lawyers representing the reproductive rights organizations, said the lawsuit only challenges laws that are not "medically necessary.鈥 But, she said, it鈥檚 an important first step in increasing access to abortions in the state. She added that Texas is not alone in restricting abortions and that other states have similar restrictions. 鈥淎s time goes on, we鈥檙e going to see more of these cases,鈥 she said. (Choi, 6/14)

Public Health

Feelings Of Sadness Or Hopelessness Are On The Rise In Teens, 'Deeply Disturbing' Report Finds

The Youth Risk Behavior Survey, which is given every two years to nearly 15,000 students in high schools in 39 state, did offer some encouraging trends, suggesting that the overall picture for adolescents is a nuanced one.

One in seven high school students reported misusing prescription opioids, one of several disturbing results in a nationwide survey of teenagers that revealed a growing sense of fear and despair among youth in the United States. The numbers of teenagers reporting 鈥渇eelings of sadness or hopelessness,鈥 suicidal thoughts, and days absent from school out of fear of violence or bullying have all risen since 2007. The increases were particularly pointed among lesbian, gay and bisexual high school students. Nationally, 1 in 5 students reported being bullied at school; 1 in 10 female students and 1 in 28 male students reported having been physically forced to have sex. (Hoffman, 6/14)

鈥淭he overall prevalence of most health-risk behaviors has moved in the desired direction,鈥 wrote a team from the Centers for Disease Control and Prevention鈥檚 Division of Adolescent and School Health. However, they added, 鈥渕any high school students are engaged in health-risk behaviors associated with the leading causes of death鈥 for their age group. (Kaplan, 6/14)

Last year's survey asked about 100 questions on a wide range of health topics, including smoking, drugs and diet. Researchers compared the results to similar questionnaires going back more than 25 years. One trend that stood out was the drop in drinking milk, which started falling for all Americans after World War II. In recent decades, teens have shifted from milk to soda, then to Gatorade and other sports drinks and recently to energy drinks like Monster and Red Bull. (6/14)

Only聽14 percent of high school students admitted to misusing opioids, according to a recently released National Youth Risk Behavior Survey report. The survey found that聽14 percent of students said they had used opioids, including OxyContin, Percocet,聽and聽Vicodin, without a prescription or medical advice.聽 (Manchester, 6/14)

Connecticut high school students engaged less often in risky behaviors, like taking painkillers without a prescription, seriously considering suicide and texting or emailing while driving, when compared to their peers nationwide. But Connecticut students more often carried a weapon and were offered, sold or given an illegal drug, both on school property. (Rigg, 6/14)

These Days It's Easy To Share Your DNA Data Online 鈥 But Erasing It Is A Whole Lot Harder

Deleting your DNA footprint isn't as easy as just deleting your Ancestry.com account. In other public health news: HIV, suicide, bacteria and DNA, and the mysterious illness striking U.S. diplomats.

Your genetic code includes details about not only your own health and family, but also similarly intimate information about your relatives. When police recently used a genetic genealogy website to find a suspect in the case of the Golden State Killer, it illuminated the unexpected ways that your genetic data can be used by people you had no idea you were sharing it with. Recently, I started feeling uneasy about how freely my DNA data flowed. So I decided to try to erase my DNA data footprint from all the websites and databases and laboratories in which it was stored. It turns out that isn鈥檛 so easy. (Brown, 6/15)

The tourist mecca of Miami is also a hotbed of HIV transmission. While city and state officials have launched an ambitious plan to tackle the crisis, William Brangham and Jason Kane join Jon Cohen of Science magazine to look at how and why it鈥檚 gotten so bad. (Brangham and Kane, 6/14)

Two House lawmakers are asking for more funds for suicide prevention efforts聽in the wake of a report that showed rising rates across the country. Reps. Don Beyer (D-Va.) and John Katko (R-N.Y.), co-chairs of the bipartisan House Suicide Prevention Task Force,聽noted Wednesday that funding for suicide prevention programs has remained flat or decreased in recent years. (Hellmann, 6/14)

Two bacteria are sitting near free-floating DNA. Suddenly, one bacterium shoots out a long appendage, latches onto a DNA fragment and reels in its catch. It happens fast, but it鈥檚 clear: this organism had just gone fishing. Biologists at Indiana University recently captured this maneuver on camera for the first time. (Yin, 6/14)

The United States on Thursday renewed calls for the Cuban government to determine the source of health "attacks" on U.S. diplomats in Cuba that have affected some two dozen people. Cuba again denied any involvement or knowledge of any such attacks. At a senior-level meeting with Cuban officials in Washington, the State Department said it had again raised the issue, which has prompted a significant reduction in staffing at the U.S. Embassy in Havana. It reiterated "the urgent need to identify the source of the attacks on U.S. diplomats and to ensure they cease." (6/14)

Vitamin D May Play Protective Role Against Colorectal Cancer

Some researchers warn, though, that the new study doesn't prove cause and effect.

Higher concentrations of vitamin D circulating in the bloodstream are linked to a lower risk of colorectal cancer, according to a large international study published Thursday. The researchers said the results strengthen the evidence that the vitamin may play a protective role against the disease, which is the third-most common cancer in the United States, killing more than 50,000 people a year. Previous studies exploring a possible link were inconclusive, they said. The latest research, which appears in the Journal of the National Cancer Institute, was conducted by scientists from NCI, the American Cancer Society, the Harvard T. H. Chan School of Public Health and 20 other medical centers and organizations around the world. (McGinley, 6/14)

To determine what role vitamin D might be playing, researchers looked at participants' blood samples collected in the years before their cancer diagnosis. They also considered the established risk factors for colorectal cancer, including smoking, low physical activity and high body mass index. "Our findings suggest what's optimal for bone health may not be optimal for colorectal risk reduction," McCullough says, which could mean higher doses are needed to prevent cancer. Current recommendations for vitamin D supplementation are based solely on studies showing conclusively that it does preserve bone health. (Neighmond, 6/14)

State Watch

State Highlights: Former USC Gynecologist's House Raided; Six States Warned About Potential Hep A Outbreak

Media outlets report on news from California, Iowa, Michigan, Massachusetts, New Hampshire, Minnesota, Missouri, Louisiana, Maryland, Wisconsin, Kansas and North Carolina.

Police detectives on Thursday served search warrants at the Los Angeles home of a former USC gynecologist and a storage facility as they investigate allegations that he sexually mistreated patients. Los Angeles Police Department Capt. Billy Hayes said sex-crimes detectives talked to George Tyndall and seized evidence during the search but did not provide further details. The LAPD has been in contact with 135 women about Tyndall, who served as the campus鈥 gynecologist for nearly 30 years. More than 400 women have called a university hotline since a Times investigation detailed how USC allowed Tyndall to continue practicing at a student health clinic on campus despite a record of complaints that spanned more than two decades. (Winton, 6/14)

The Centers for Disease Control and Prevention (CDC) is warning public health officials in six states about an outbreak of Hepatitis A聽among drug users and the homeless. From January 2017 to April of this year, the CDC has received more than 2,500 reports of infections from California, Indiana, Kentucky, Michigan, Utah and West Virginia.聽 (Hellmann, 6/14)

The share of state and local government budgets dedicated to healthcare is expected balloon by 2025 as healthcare inflation continues its upward trajectory, according to a new report from Fitch Ratings. Fitch analysts forecast that ongoing inflation will drive the proportion of budgets dedicated to healthcare and social services to 38.3% in 2025, a bump from 30.7% in 2015. As a result, other priorities like education, transportation and public safety are expected to shrink under the weight of healthcare, social services and other areas less likely to be cut. (Bannow, 6/14)

Under current Iowa law, mental health commitment orders may be imposed only if a person poses an immediate threat to themselves or others. The law was used to involuntarily commit Iowans more than 5,200 times last year. Legislators added a new option in the 2018 legislative session that allows judges and magistrates to order treatment for people who in the past have become dangerously ill because they failed to comply with doctors鈥 recommendations. (Leys, 6/14)

Michigan on Thursday began enforcing the nation鈥檚 strictest rules for lead in drinking water, a plan that eventually will result in replacing all 500,000 lead service pipes statewide in the wake of the contamination of Flint鈥檚 supply. The lead and copper rules will drop the 鈥渁ction level鈥 for lead from 15 parts per billion, the federal limit, to 12 in 2025. Underground lead service lines connecting water mains to houses and other buildings will be replaced by 2040, unless a utility can show regulators it will take longer under a broader plan to repair and replace its water infrastructure. (6/14)

An unusually candid memo from a longtime physician at Massachusetts General Hospital highlights the tension between some doctors at the hospital and its parent company, Partners HealthCare. Dr. Walter J. O鈥橠onnell, who recently resigned from an executive committee at Mass. General because of frustration over the relationship with Partners, accused the company of failing to consult with doctors on key corporate decisions. (Dayal McCluskey, 6/14)

Over the past 10 years, an unlikely team of gun owners and public health experts in that state has come together to work on a prevention campaign. The Gun Shop Project educates gun sellers about the signs of suicide and encourages them not to make a sale if they think someone is struggling. (Choolijan, 6/14)

A city report shows Minneapolis police officers have repeatedly requested that Hennepin County medical responders sedate people with ketamine, a powerful tranquilizer known as a "date rape drug." The draft report obtained by the Star Tribune says that in multiple instances, the ketamine caused heart or breathing failure and suspects had to be revived or intubated. (6/14)

A school nurse told St. Louis health officials in February about students under the nurse鈥檚 care hospitalized by asthma attacks and teachers forced to stay home with respiratory illnesses, but neither the school district nor the health department warned those afflicted about a possible connection in their ailments. It was not until a St. Louis Public Radio investigation published last month that some parents and staff of the Gateway school complex said they first learned the respiratory illnesses may have been caused by dirt and dust kicked up by nearby demolition work funded and overseen by the city. (Delaney, 6/14)

LSU Health New Orleans announced Thursday (June 14) it will collaborate with a Nashville-based company called Cumberland Emerging Technologies Inc. to develop and commercialize new biomedical products. According to their website, Cumberland Emerging Technologies works to identify promising biomedical technologies being developed by researchers, universities and entrepreneurs seeking a corporate partner to help them develop and commercialize those products. (Clark, 6/14)

Chet Burrell came on as CEO of CareFirst BlueCross BlueShield as the health insurance company鈥檚 reputation suffered after previous leadership had attempted to turn it into a for-profit business. During his nearly 11 years at the helm of the state鈥檚 largest insurer, Burrell has rebuilt trust in the company, significantly modernized its operations and ushered it through adoption of the Affordable Care Act. (McDaniels, 6/15)

Froedtert Hospital, Children鈥檚 Hospital of Wisconsin, the Medical College of Wisconsin and the BloodCenter of Wisconsin Blood Research Institute have tentatively agreed to buy the land they now lease 鈥 in some cases for as little as $1 a year 鈥 at the Milwaukee Regional Medical Center in Wauwatosa from Milwaukee County. The initial agreement 鈥 in the works for more than five years 鈥 would free Milwaukee County from obligations and potentially costly liabilities while generating $800,000 to $1.6 million a year in payments until 2073. (Boulton, 6/14)

Kaiser Health News: Podcast: KHN鈥檚 鈥榃hat The Health?鈥 California Here We Come

Health care is a big political issue, but no place more than in California. In San Francisco last week, voters overwhelmingly approved a ballot measure upholding a ban on flavored tobacco products聽鈥 over the vehement objections of the tobacco industry. And the state鈥檚 activist attorney general, Xavier Becerra, is leading a group of Democratic officials from more than a dozen states defending the Affordable Care Act in a case filed in Texas. That is important given that the Trump administration鈥檚 Justice Department decided not to defend the law in full from charges that changes made by Congress in last year鈥檚 tax law invalidates the health law. (6/14)

Blue Valley Hospital offered employee discounts on weight-loss surgery and asked workers to falsify records to try to pump up its inpatient numbers enough to continue getting Medicare money, according to inspectors. (Marso, 6/14)

New Hampshire's medical marijuana law turns 5 next month, and the Therapeutic Cannabis Advisory Council will be issuing a five-year status report on how the program has operated. State Sen. John Reagan, a Deerfield Republican who sponsored the medical marijuana bill, says it's received positive feedback so far. (Tuohy, 6/14)

At least seven women have accused Phillip Warren, a substance abuse counselor and operations director at Recovery Connections Community, of sexual harassment and misconduct. He made lewd comments, inappropriately touched them and tried to force himself on at least one of them, according to state records and interviews with several of the women and former program participants. (Harris and Walter, 6/14)

A state assembly bill would make a human trafficking awareness training modeled after the Santa Clara Valley Transit Authority鈥檚 procedure mandatory for public transportation workers across the state. Inspired by the VTA training started in 2015, the bill aims to equip public transit workers with the skills to identify and report signs of human trafficking in and around transit systems. (Lam, 6/14)

Health Policy Research

Research Roundup: Medicaid; Infections; And Medicare

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

The courts have shaped virtually all aspects of Medicaid policy, including eligibility, benefits and coverage, access to care, provider participation and payment, and the scope of federal agency demonstration powers under Section 1115. Furthermore, underlying the cases that focus on what federal law requires of participating states is a key threshold question of importance to lawsuits brought against states by beneficiaries and providers: whether, in advance of federal agency review, federal courts can intervene to prevent potentially unlawful state policies from taking effect before they cause immediate and irreparable injury. This question has commanded the attention of a more conservative judiciary, whose rulings increasingly are narrowing access to the courts. (Rosenbaum, 6/12)

In January 2018, the Centers for Medicare and Medicaid Services (CMS) issued new guidance for state Medicaid waiver proposals that would impose work requirements in Medicaid as a condition of eligibility. As of June 2018, four states have approved waivers to implement Medicaid work requirements, seven states have waiver requests pending with CMS, and other states are considering or developing work requirement programs. These states are all imposing or seeking to impose work requirements on populations already covered (both expansion and non-expansion populations); however, Virginia passed legislation to adopt the Medicaid expansion that included a provision to submit a waiver to impose a work requirement on a new expansion population. This brief builds on previous analyses to provide data on Medicaid enrollees and some of the policy implications of work requirements. (Garfield, Rudowitz, Musumeci and Damico, 6/12)

Preventing the spread of infectious organisms is a priority for hospitals and health care systems. A prominent concern is that cross-transmission can lead to patients becoming colonized and acquiring infections, such as hospital-onset Clostridium difficile infection and methicillin-resistant Staphylococcus aureus bacteremia, as well as infections from other emerging drug-resistant organisms. Minimizing risks for health care personnel is also paramount, as illustrated by the self-contamination and subsequent illness of 2 nurses caring for a patient with Ebola virus disease. (Krein et al, 6/11)

We analyzed data from Medicare and the American Hospital Association Annual Survey to compare characteristics and baseline performance among hospitals in Medicare鈥檚 voluntary (Bundled Payments for Care Improvement initiative, or BPCI) and mandatory (Comprehensive Care for Joint Replacement Model, or CJR) joint replacement bundled payment programs. BPCI hospitals had higher mean patient volume and were larger and more teaching intensive than were CJR hospitals, but the two groups had similar risk exposure and baseline episode quality and cost. BPCI hospitals also had higher cost attributable to institutional postacute care, largely driven by inpatient rehabilitation facility cost. These findings suggest that while both voluntary and mandatory approaches can play a role in engaging hospitals in bundled payment, mandatory programs can produce more robust, generalizable evidence. Either mandatory or additional targeted voluntary programs may be required to engage more hospitals in bundled payment programs. (Navathe et al, 6/1)

Editorials And Opinions

Different Takes: Lawsuit Against Pre-Existing Conditions Is Flawed; Thumbs Up For Not Defending Health Law

Editorial pages focus on the suit against the health law, which requires insurers to provide coverage for people with pre-existing conditions.

A lawsuit against Obamacare may well turn out to be a bigger story in the news than in the courts. When the Donald Trump administration declined to defend the law, and partly endorsed the lawsuit, critics denounced it for flouting its alleged duty to defend duly enacted federal laws in court. They said the lawsuit threatens everyone with pre-existing conditions, who would lose the protections that Obamacare provides. But the lawsuit is highly unlikely to succeed. It makes two basic arguments, one of which is trivial and the other absurd. It is on far weaker ground than the two major anti-Obamacare lawsuits that preceded it. (Ramesh Ponnuru, 6/14)

Polls suggest that the public considers health care the most important issue in the midterm elections. This immediately raises the question: Do voters understand what鈥檚 at stake? In particular, do they realize that if Republicans hold Congress, they will strip away protections for the 52 million Americans 鈥 more than a quarter of nonelderly adults 鈥 who have pre-existing conditions that, before passage of the Affordable Care Act, could have led insurers to deny them coverage? (Paul Krugman, 6/14)

Ask Americans whether the federal government should require health insurers to provide coverage for people with pre-existing conditions, and a vast majority 鈥斅92% of Democrats and 79% of Republicans 鈥 say yes.聽聽So what part of Obamacare is the Trump administration trying to kill?聽The mandate to cover pre-existing conditions, which聽has been a blessing for people who buy insurance on the individual market. This would harm聽those people, and聽politically聽it鈥檚 not very smart, either. It hands Democrats another issue to use in their battle to win back the House and the Senate in November's elections. (6/14)

In the Trump administration鈥檚 response to the lawsuit brought by Texas and the Texas Public Policy Foundation challenging the current constitutionality of the Affordable Care Act (ACA), the Department of Justice agreed that several key portions of the ACA were unconstitutional. Immediately, several commentators reported that the Justice Department鈥檚 failure to defend the law in its entirety was a radical and dangerous departure from precedent. The Associated Press called the move a 鈥渞are departure from the Justice Department's practice of defending federal laws in court.鈥 Former Solicitor General Donald Verrilli, called it 鈥渁 sad moment鈥 and 鈥渋mpossible to believe.鈥 ...The truth is, the government鈥檚 decision not to defend a clearly unconstitutional law is neither unprecedented, nor even rare. Indeed, it is what the founders expected and precisely how we should want government lawyers to behave. (Chance Weldon, 6/14)

The Trump administration鈥檚 decision to argue that part of the Affordable Care Act is unconstitutional 鈥 the requirement that every American purchase health insurance, known as the individual mandate 鈥 raises real doubts about the law鈥檚 future. (Robert Henneke, 6/14)

Viewpoints: During Opioid Crisis, Also Develop Treatments For Family Mental Trauma; Wrong Time To Legalize Marijuana At Federal Level

Opinion writers look at these and other health topics.

The S.2680 Opioid Crisis Response Act of 2018, introduced by the Senate Health, Education, Labor, and Pensions Committee (HELP), and the Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018, introduced by the Senate Committee on Finance, aim to improve the ability of federal agencies to not only address the crisis, but also its ripple effects on children, families, and communities. One such consequence can be found in the foster care system. (Marlo Nash, 6/14)

Congress is in the midst of considering many proposals focused on solving the opioid addiction crisis. With more than 115 people dying every day, it is a tragedy of epidemic proportions. We have watched for nearly two decades as the crisis has ruined families, laid waste to communities, and crippled our workforce. Yes, Congress must take swift action, but true progress will depend on new policies that are guided by the irrefutable medical evidence 鈥 and not the bias and stigma that has traditionally permeated the debate and government decision-making. When it comes to doing the right thing for America, Congress needs to embrace and understand two fundamental truths about opioid addiction 鈥 and acknowledge and dispose of a big, deadly lie. (Newt Gingrich, 6/14)

Sens. Cory Gardner and Elizabeth Warren have introduced a bill to legalize marijuana at the federal level in the name of 鈥渟tates鈥 rights.鈥 In reality, it would give birth to Big Tobacco鈥檚 successor. This dangerous proposal would allow the marijuana industry to market high-potency pot candies, gummies and 99% pure extracts (compare that with 5% potent Woodstock weed). With 70% of today鈥檚 illicit drug users having started with marijuana, not prescription drugs, according to the National Institute on Drug Abuse, this is exactly the wrong time to legalize pot. (Patrick Kennedy and Kevin Sabet, 6/14)

The University of California and the California State University have nearly three dozen campuses scattered across the state and every one of them has a student health center. All of those centers provide basic reproductive healthcare, including gynecological exams and contraception. Senate Bill 320 would extend that to include what is known as a medication abortion 鈥 a simple and safe nonsurgical procedure that involves taking two pills. This is a sensible and smart addition to the healthcare services already provided to hundreds of thousands of women at UC and Cal State campuses, many of whom fall into the age range of women (20-24) with the highest rate of abortion. (6/15)

The Energy and Commerce Subcommittee on Oversight and Investigations has been holding hearings on the current state of U.S. public health biopreparedness. Its goal is to improve the country鈥檚 ability to respond to biological attacks, pandemics, and outbreaks of emerging infectious diseases. Among the topics for discussion is the reauthorization and funding for an essential piece of legislation, the Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018. Aimed at reauthorizing an earlier law, this act would ensure that the U.S. is poised to effectively prevent, detect, and respond to threats that could weaken public health. (Nicolette Louissaint, 6/15)

As the Trump administration continues to attack women鈥檚 reproductive rights, an important, but little understood trend is already reshaping health care options for women. Catholic-run or -affiliated health care institutions are taking up a growing share of the U.S. health care sector. Why should this matter? Although Catholic facilities are in some ways comparable to their secular counterparts, there is one major exception. They are governed by a set of 72 Directives set by popes, bishops and Vatican councils that restrict women鈥檚 reproductive care and other services. And this week, the US Conference of Catholic Bishops (USCCB) annual Spring General Assembly seems primed to discuss how to tighten implementation of these Directives. (Cynthia Romero, 6/14)

On the very day he was inaugurated, President Trump issued his first executive order directing all federal agencies to cooperate with and 鈥減rovide greater flexibility to states鈥 as they looked for ways to stop the premium pains of ObamaCare. So far, 500 days later, that order has yet to be followed. Sure, Secretary of Health and Human Services, Tom Price and the administrator of the Centers for Medicare and Medicaid Services, Seema Verma promptly called for innovative solutions and promised to work with states to numb the pain that ObamaCare continues to inflict on health-care markets. But actions always speak louder than words and, thus far at least, federal action has denied or delayed most of the state innovation waivers requested under Section 1332 of the Affordable Care Act.聽(Rea S. Hederman Jr., 6/14)

Recent celebrity suicides have sparked much discussion about depression and mental illness. There was, however, little talk of spiritual health. That鈥檚 unfortunate. Even as the suicide rate rises, a growing body of research testifies to a positive relationship between faith and mental health. The help so many need may be as close as the nearest house of worship. Suicide is now the 10th leading cause of death among American adults and the second leading cause among youth and adolescents. (Emilie Kao, 6/15)

If Iowa leaders needed another reason to follow through with improving mental health services,聽it arrived in a recent report from the Centers for Disease Control and Prevention.Suicide rates among Americans age 10 or older have risen significantly in nearly every state, making it the 10th-leading cause of death in the country. Iowa鈥檚 rate increased 36.2 percent since the late 1990s. Last year,聽433 of our neighbors died by suicide.聽(6/14)

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