Morning Briefing
Summaries of health policy coverage from major news organizations
From 吃瓜不打烊 - Latest Stories:
吃瓜不打烊 Original Stories
First Kidney Failure, Then A $540,842 Bill For Dialysis
He needed the lifesaving treatment 鈥 he never expected a half-million-dollar bill for 14 weeks of care.
Your Go-To Guide To Decode Medical Bills
Kaiser Health News gives you a user-friendly toolkit to help patients understand some of the ins and outs of medical billing, what to do if you receive a surprise medical bill and things to keep in mind before getting medical care.
On A Mission To Help People Control Diabetes 鈥 And Save Money On Insulin
Patients with Type 2 diabetes are often steered toward medicine or insulin treatment. But with additional support, it鈥檚 possible to use diet and exercise to control blood sugar. The rising price of insulin drives patients to lower their dependence on the medicine.
Summaries Of The News:
Pharmaceuticals
Trump Cooking Up A Sweeping Executive Order That Would Cut Drug Prices In Medicare's Part D Program, Sources Say
U.S. President Donald Trump is considering a sweeping executive order that would cut prices on virtually all branded prescription drugs sold to Medicare and other government programs, according to two industry sources who had discussions with the White House. The order under discussion would be much broader than the Administration's previously disclosed proposal to lower prices on physician administered, or Part B, drugs by tying prices to lower costs in other countries. (Erman and O'Donnell, 7/24)
President Donald Trump hosted pharmaceutical executives in the Oval Office today as his administration pursues a deal on drug pricing, four individuals with knowledge of the meeting told POLITICO. Steve Ubl, the CEO of PhRMA, was joined by representatives of Pfizer and Amgen. HHS Secretary Alex Azar and Domestic Policy Council chief Joe Grogan also attended the meeting, as well as House Majority Leader Kevin McCarthy and Rep. Mark Meadows (R-N.C.). (Diamond and Owermohle, 7/24)
Senate's Proposed Package To Target High Drug Prices Is A Big Overhaul That Comes With Even Bigger Questions
The Senate Finance Committee鈥檚 new bipartisan drug pricing package has the potential to change Medicare more dramatically than almost any piece of health care policy in the last 20 years. But with that big of an overhaul comes even bigger questions. The package, which was unveiled Tuesday, fundamentally reworks the complicated scheme used to split Medicare drug costs between the government, patients, insurers, and drug makers. It caps how much Medicare patients can pay out of pocket for drugs each year, and it imposes strict limits on how much drug makers can hike their prices. (Florko, 7/24)
The Senate's major proposal to cut drug prices is roiling Washington's pharma lobbying world, but with the sectors of the U.S. healthcare system so deeply entwined, hospitals and doctors would see some financial changes too, as the package would save more than $100 billion over a decade. Here are five ways the legislation from Senate Finance Chair Chuck Grassley (R-Iowa) and ranking member Ron Wyden (D-Ore.) bleeds into the provider world. (Luthi, 7/24)
Secretary of Health and Human Services Alex Azar is calling Republican senators to encourage them to vote for a bill to lower drug prices being considered on Thursday in the Senate Finance Committee, according to sources familiar with the matter.聽The calls from Azar are a sign of the Trump administration鈥檚 support for the bipartisan deal between Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.), amid blowback from some in the GOP. (Sullivan, 7/24)
Lawmakers will wade through more than 100 potential amendments when the Senate Finance Committee takes up its sweeping new drug pricing package on Thursday. Some of the amendments could significantly rework the package, like an amendment from Sens. Pat Toomey (R-Pa.) and Pat Roberts (R-Kan.) that would eliminate the controversial provisions in the bill that would restrict drug makers from raising prices beyond the rate of inflation. A separate amendment from Sen. John Cornyn (R-Texas) would only allow that provision to go into effect if HHS certifies it won鈥檛 lead to higher launch prices. (Florko, 7/24)
U.S. Sen. Chuck Grassley has a warning for fellow Republicans: If they kill his new compromise bill to rein in prescription drug costs, they鈥檙e likely to see President Donald Trump back more radical ideas pushed by Democrats. 鈥淚 assume that if the Republicans can鈥檛 accept this moderate position 鈥 then something鈥檚 going to get done with the president throwing in with (Nancy) Pelosi,鈥 Grassley said in a phone interview Wednesday, referring to the Democratic speaker of the House. (Leys, 7/24)
Senate Finance Committee members filed 110 amendments ahead of Thursday鈥檚 markup of a measure to reduce spending on prescription drugs in Medicare and Medicaid, demonstrating the intense interest in a proposal projected to save $100 billion over a decade.聽It鈥檚 unlikely that all of the amendments will be offered, but lawmakers will likely highlight concerns about the bill's impact on the drug industry, doctors and patients. Finance Chairman Charles E. Grassley, R-Iowa, is also expected to release a modified version of the draft released Tuesday that incorporates some changes his colleagues were seeking. (Siddons and Clason, 7/24)
Medicare Spent $2.8 Billion On Drugs That Other Wealthy Countries Wouldn't Cover Or Recommend
As the U.S. grapples with rising prices for medicines, a new analysis finds Medicare spent more than $26 billion in recent years on dozens of medicines that were not recommended for coverage in three other wealthy nations because government advisory groups there found the drugs did not have sufficient value to justify the costs. The researchers identified a total of 134 medicines that were approved by the Food and Drug Administration prior to 2016 but were not endorsed by agencies in Australia, Canada, and the U.K. that conduct so-called health technology assessments, according to the study in the Journal of General Internal Medicine. (Silverman, 7/24)
Meetings of the Institute for Clinical and Economic Review don鈥檛 usually get one鈥檚 heart pumping. But a meeting Thursday at the Massachusetts Institute of Technology may prove to be the exception to that rule. Patients Rising Now, an advocacy group that says it promotes transparency in health care and that is a fierce opponent of ICER鈥檚, is expected to face off with the self-professed 鈥渨atchdog of drug pricing鈥 as it reviews three drugs for Duchenne muscular dystrophy.聽(Sheridan, 7/24)
Sen. Elizabeth Warren is not done with Scott Gottlieb. Already peeved that the former Food and Drug Administration Commissioner joined the Pfizer (PFE) board just weeks after leaving the agency, the Massachusetts Democrat and presidential candidate expressed 鈥渄isappointment鈥 that Gottlieb refused to resign as she requested earlier this month. And so she is now asking the drug maker to disclose its interactions with Gottlieb and whether it examined the ethical ramifications of making him a director. (Silverman, 7/24)
A former Sun Pharmaceuticals sales rep has filed a lawsuit claiming he was fired for balking at alleged off-label marketing practices, the latest in a growing number of incidents concerning business practices at one of the world鈥檚 largest generic drug makers. In his lawsuit, Damian Frantz contended that company policy prohibiting illegal marketing was ignored and, instead, that a supervisor 鈥渆xpressly directed鈥 him to 鈥渄o whatever is needed to get鈥 a clinical team to 鈥渢alk off label鈥 to physicians and health plans, among others. In general, the company sought to 鈥渁ggressively solicit opportunities to present off-label information to decision-makers about its drugs.鈥 (Silverman, 7/24)
A young couple in Aventura was running out of time and praying for a miracle. Their daughter, Eliana Cohen, fast approaching her second birthday, was diagnosed with a rare disease that could keep her from walking, eating and breathing on her own.But her best hope also happened to be the world鈥檚 most expensive drug 鈥 a $2.1 million treatment called Zolgensma. Without support from insurance, her parents Ariel and Shani Cohen turned to their Jewish community through social media in hopes of covering the staggering cost. The outpouring of support, from South Florida and around the world, proved equally staggering. (Rosa, 7/24)
Kaiser Health News: On A Mission To Help People Control Diabetes 鈥 And Save Money On Insulin
In a former church parsonage in Grundy County, Tenn., Karen Wickham ladled out her lentil stew as people arrived for an evening health education class. Wickham and her husband, Steve, are white-haired, semi-retired nurses who have dedicated the last years of their working lives to helping people with Type 2 diabetes control and even reverse the condition with diet and exercise. Wendy Norris is in the group, and she has brought along her father and daughter. Since her diagnosis several years ago, Norris said, her doctor prescribed insulin shots and told her to watch what she ate. (Farmer, 7/25)
The Pharmaceutical Research and Manufacturers of America, a leading industry trade group, spent $16.1 million on lobbying in the first six months of the year, up 4% from the $15.5 million it spent in the first half of 2018. PhRMA spent $27.5 million over the full year in 2018, also a record. (Rosenberg, 7/24)
Administration News
Textured Breast Implants That Have Been Linked To Unusual Cancer To Be Recalled Globally
Textured breast implants made by Allergan that have been linked to an unusual cancer are being recalled in the United States at the request of the Food and Drug Administration, and will also be recalled globally, the agency announced on Wednesday. The F.D.A. decision, based on an increasing number of cases and deaths from the implant-associated cancer, lags far behind action in Europe, where the Allergan devices were effectively banned late last year. (Grady, 7/24)
The FDA is not recommending women with the implants have them removed because the cancer is so rare, but say they should check with their doctor if they have symptoms, which include pain and swelling. Biocell implants feature a textured surface designed to prevent slippage and to minimize scar tissue. Those models account for just 5 percent of the U.S. market. The vast majority of breast implants used in the U.S. have a smooth surface. (Perrone, 7/24)
The FDA said the new data shows that 573 cases worldwide have linked the rare cancer to the implants since the agency began tracking the issue in 2011. The vast majority of those cases involve Allergan products. Thirty-three women have died of what鈥檚 known as breast implant-associated anaplastic large cell lymphoma, a cancer of the immune system. Of those fatalities, authorities identified the implant manufacturer in 13 cases 鈥 and it was Allergan in all but one. (McGinley, 7/24)
鈥淲hile the overall incidence appears to be relatively low, once the evidence indicated the Allergan product was linked to patient harm including deaths, the FDA took action,鈥 Amy Abernethy, the FDA鈥檚 principal deputy commissioner, said on a conference call with reporters. 鈥淲e know that today鈥檚 news will be alarming to patients with breast implants.鈥 (Loftus, 7/24)
It's not clear whether the texturing is actually responsible for the cancer or is just associated with a higher incidence of the disease. But Maman and others say the surface can interact with the surrounding scar tissue that the body forms as an immune response to the implant. "It's that response that is believed to cause the formation of the lymphoma," Maman said, noting that he only uses smooth, round implants. Given the risks linked to textured implants, he said, "taking them off the market is very prudent and the right approach." (Aubrey and Laidlaw, 7/24)
Dr. Elisabeth Potter, a plastic surgeon in Austin, Texas, has cared for women with cancer after receiving textured implants. She says the recall is an important step to protect women from聽the potential risks of textured implants. "It was influenced by folks speaking up when the FDA didn鈥檛 act quickly enough," Potter says. "The power is now back in a woman鈥檚 hands, and the FDA is backing her up." Potter says women with textured implants should talk with their doctors and monitor for any symptoms such as pain, swelling, redness or anything abnormal.聽(Alltucker, 7/24)
The products have already been banned or recalled from the market in other countries. (Weixel, 7/24)
Capitol Watch
Senate's Measure Targeting High Health Care Costs, Surprise Medical Bills Kicked To The Fall
The Senate will not vote on a bipartisan measure aimed at lowering health care costs before lawmakers leave Washington for the August recess.聽Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) said in a joint statement that the Senate 鈥渄oes not have time before the August recess鈥 to consider the bill.聽(Sullivan, 7/24)
Senate health committee Chair Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.) said Wednesday that the Senate "does not have time before the August recess" to consider legislation, although Alexander previously told reporters this week that he hoped for a vote before the recess. Disputes are ongoing over the proposal to ban surprise medical bills with a cap on charges for out-of-network care. "We are engaged in very productive conversations about this legislation with our colleagues in the Senate and the House, and will continue to work during August and into September to move this legislation forward," the senators said. (Luthi, 7/24)
The timing gives lawmakers and powerful health industry lobbies several weeks to try to influence the legislation, S. 1895 (116), which passed out of the committee in a 20-3 vote last month. The legislation also includes measures on public health, transparency and health IT. (Roubein, 7/24)
Meanwhile 鈥
An advocacy group that supports the 2010 health care law will launch聽a national tour next month with the hope聽of carrying its聽success from last year's campaigns into the 2020 election cycle. Protect Our Care, a group formed to聽defend the 2010 health care law (PL 111-148, PL 111-152), plans聽at least 22 events in August across the country,聽according to information first shared exclusively with CQ Roll Call. The effort will highlight an issue that helped Democrats win control of the House last year and is likely to be a key issue in next year鈥檚 election. (McIntire, 7/25)
Legislation Setting Health Care, Safety And Hygiene Standards For Detained Immigrants Passes House
The House passed a Democrat-led bill that would require Customs and Border Protection (CBP) to enact safety and hygiene standards聽for migrants in their custody in a 233-195 vote on Wednesday. Just one Republican joined Democrats in voting for the measure.聽聽Under the Humanitarian Standards for Individuals in Customs and Border Protection Custody Act 鈥 spearheaded by Rep. Raul Ruiz (D-Calif.) 鈥 CBP would be required to conduct health screenings, provide emergency care and provide access to medication, translators and emergency transportation for undocumented immigrants.聽聽(Brufke, 7/24)
The Department of Health and Human Services plans to have enough聽permanent facilities to house unaccompanied or separated migrant children by the end of next year to be able to phase out the temporary influx facilities criticized by Democrats and advocates for a lack of oversight. 鈥淛ust like you, I prefer small, licensed shelters," Lynn Johnson, the assistant secretary of聽HHS' Administration for Children and Families that oversees care for migrant children, said Wednesday at a House Appropriations Subcommittee hearing. (Misra, 7/24)
HHS' refugee director told House appropriators Wednesday that the agency is still sharing information about the sponsors of unaccompanied and separated migrant children with immigration enforcement agencies. But Office of Refugee Resettlement Director Jonathan Hayes told the panel that oversees HHS' budget that officials don't disclose the immigration status of any sponsors, and no longer fingerprint parents, grandparents or adult siblings of detained children who come forward as sponsors. (Ollstein, 7/24)
Opioid Crisis
A Look At Defense Tactics Expected In Opioid Case: No Evidence Shows Drugmakers--Not Criminal Cartels--Caused Crisis
Major opioid manufacturers have asked a judge to throw out the first test case of whether they must pay for the nation鈥檚 drug crisis, arguing that two Ohio counties cannot prove the drug companies鈥 actions were responsible for overdose deaths or other harms, newly unsealed court documents show. Lawyers for Purdue Pharma, Mallinckrodt Pharmaceuticals and other drug companies contend that Cuyahoga and Summit counties cannot sufficiently connect the tens of billions of legal painkillers the companies produced to fatalities and addiction. Nor can the counties show that drug company sales calls caused doctors to overprescribe the medications, they said. (Bernstein and Zezima, 7/24)
An executive at one of the nation鈥檚 largest drug distribution companies said under questioning recently that the business has no obligation to the public when it comes to the amount of prescription opioid painkillers it ships. That鈥檚 one of the exchanges included in thousands of pages of court documents, including depositions and internal emails, made public this week in lawsuits brought against the pharmaceutical industry over the nation鈥檚 deadly opioid crisis. (Hoyer and Mulvihill, 7/24)
In 2012, as the death toll from the nation's opioid crisis mounted, drug companies shipped out enough of the powerful and addictive painkillers for every man, woman and child in the U.S. to have nearly a 20-day supply. In some counties, mostly in Appalachia, it was well over 100 days.An Associated Press analysis of drug distribution data released as a result of lawsuits against the industry also found that the amount of opioids as measured by total potency continued to rise early this decade even as the number of pills distributed began to dip. (7/24)
At her very worst, Amber Wood was so desperate for the opioid high she had a dentist pull a tooth 鈥 and not even a particularly bad tooth, just one of those molars she didn鈥檛 think she鈥檇 need as much as she needed a pill. The dentist, she said, gave her a prescription for the opioid painkiller Lortab. She鈥檇 been abusing drugs since the age of 13. 鈥淣one of us said when we went to pre-K, 鈥榊ou know what I want to be when I grow up? I want to be a drug addict.鈥 Nobody thought that. (Achenbach, Koh, Bennett and Mara, 7/24)
News comes out of Massachusetts and Missouri as well 鈥
Attorney General Maura Healey is investigating whether an Andover pharmacy that specializes in workers compensation patients properly dispensed controlled substances, a spokeswoman said Wednesday. The Injured Workers Pharmacy, a national mail-order pharmacy, was recently revealed to be the largest recipient of opioid pills in Massachusetts during 2006 to 2012, in data from the Drug Enforcement Administration. (Freyer, 7/24)
The CARE clinic is open half a day each week and is open to all people, insured or not. In addition to prenatal care from high-risk obstetricians, pregnant people receive mental health treatment from psychiatrists and addiction counselors. Most of the women at the clinic receive medication-based treatment such as methadone and buprenorphine, which helps prevent cravings and reduce withdrawal symptoms. (Fentem, 7/25)
Elections
Sanders Targets Racial Disparities In Medicine With Plan To Boost Number Of Minority Medical Professionals
Sen. Bernie Sanders (I-Vt.) unveiled a plan Wednesday seeking to boost the number of black employees in the health care industry as the聽White House hopeful works to shore up support in Democratic presidential primary. Sanders's campaign unveiled the plan shortly after he appeared at a presidential forum in Detroit for the NAACP National Convention. The聽plan would work to train and hire more black health care providers and supplement his 鈥淢edicare for All鈥 plan. (Axelrod, 7/24)
Sen. Bernie Sanders' (I-Vt.) presidential campaign slammed former Vice President Joe Biden on Wednesday for "continued lies" about Medicare for All. "Thank you, Joe Biden, for crediting our campaign for honesty," senior advisor Jeff Weaver said in a statement. "I'm sorry we can't return the favor. Your continued use of the same insurance company scare tactics that were used against the Affordable Care Act is truly disheartening." (Rodrigo, 7/24)
Marketplace
Anthem Beats Q2 Expectations But Worries About Medicaid Business Has Shares Sliding
Anthem Inc shares fell as much as 4% on Wednesday after the U.S. health insurer missed Wall Street expectations for a key medical cost gauge as a result of higher costs of selling Medicaid health plans for low-income customers. Anthem reported a 10.2% fall in operating profit from its unit which sells government health plans, in the quarter, saying the decline was driven by continued elevated medical cost trends in Medicaid in some states. (7/24)
The Blue Cross-Blue Shield insurer said it has added nearly 700,000 Medicaid customers over the past year, but expenses were coming in higher than expected in a handful of states. Chief Financial Officer John Gallina told analysts the issue was "very manageable," and he expected the business's profitability to improve in the second half of the year. He said the populations covered in these states, which he declined to name, had changed slightly since rates were set, and they were seeking rate adjustments. (Murphy, 7/24)
Anthem said the launch process for its new pharmacy-benefits manager, IngenioRx, was moving ahead of expectations, and the company now expects IngenioRx鈥檚 results to hit the higher end of its previous projections. The insurer also said it had enrolled a new IngenioRx client, Blue Cross of Idaho, for next year. Anthem has said that it sees fellow Blue Cross Blue Shield insurers as a potentially fertile source of business across various areas. Anthem raised its outlook for multiple 2019 earnings metrics, but tightened its projected medical-loss ratio range to the higher end of its prior suggestion. The company expects an MLR of 86.2% to 86.5%. It had been expecting that ratio to be 86.2% plus or minus 30 basis points. (Wilde Mathews and Prang, 7/24)
CVS Health is rolling out a network to provide its most vulnerable patients with access to local support for their social care needs. The retail healthcare giant announced on Wednesday it will collaborate with social care coordinator platform provider Unite Us to launch a platform that will allow Medicaid and dual-eligible beneficiaries covered through its insurance arm Aetna to more easily find and access help from social care providers within their communities. (Johnson, 7/24)
After nearly two years of fielding underwhelming offers for its revenue-cycle subsidiary, Tenet Healthcare Corp. has settled on a decidedly different maneuver: It will spin it off as a separate, publicly-traded company. Leaders with Dallas-based Tenet have spent the past 18 months finalizing a deal on Conifer Health Solutions. While CEO Ron Rittenmeyer conceded on an investor call Wednesday that an outright sale would have been the company's first choice, there are several benefits to a tax-free spin off. (Bannow, 7/24)
The widening legal nightmare over Roundup weedkillers isn鈥檛 the only potential multi-billion-dollar liability Bayer AG inherited last year when it acquired Monsanto Co. While thousands of damage claims over Roundup have grabbed headlines and hogged the attention of investors, the German conglomerate also has become a target of lawsuits by American states and cities trying to clean up toxic PCBs, a widely used fire-resistant chemical compound that the U.S. banned four decades ago. (Feeley and Loh, 7/23)
Trinity Health sued a Michigan anesthesiology group for allegedly compromising operations at a handful of its hospitals amid rate disputes with several insurers. The lawsuit filed in a Michigan federal court Tuesday alleged that Anesthesia Associates of Ann Arbor, which employs more than 100 doctors and is the exclusive provider for six Trinity hospitals, and its parent company, Siromed Physician Services, are terminating contracts with Blue Cross and Blue Shield, Aetna and Priority Health and have sued or are pursuing litigation against those insurers. (Kacik, 7/24)
Advocate Aurora Health has pared back its CEO office from two to one, with Jim Skogsbergh emerging as the not-for-profit health system's sole CEO. Newly merged Advocate Aurora's short-lived foray into the co-CEO model lasted just over a year. The Illinois and Wisconsin systems' union became official in April 2018. The health system's announcement Wednesday follows other co-CEO structures, which typically last less than three years. (Bannow and Kacik, 7/24)
Threats To Marketplace From Lawmakers, Administration Wearing Thin On Health Care Investors
Optimism is in short supply when it comes to health-care stocks as investors can鈥檛 see when the sector will recover from an array of regulatory threats. Plagued by concerns about drug pricing and jitters over proposals for a U.S. government-run system, health care has gone from the top-performing group in the S&P 500 Index last year to its worst in 2019. Facing an election in less than 16 months, President Donald Trump may have run out of time in this term to enact meaningful changes affecting the industry, but observers say political questions are still likely to overshadow business fundamentals. (Darie, 7/24)
In other news 鈥
Health-insurance stocks sank across the board after Anthem Inc. became the third insurer to report it is paying out a higher percentage of the premiums it takes in to cover patients鈥 medical claims. Investors watch the so-called medical-loss ratio reported by health insurers closely. The number is a key measure of the companies鈥 financial health; when the ratio goes up, it can suggest that money is leaving the companies faster than it is arriving. Other issues, such as changes in tax law, can also affect the ratio. (Tozzi, 7/24)
Private equity firms have acquired nearly 200 dermatology practices across the country over the past six years, raising concerns about how this ownership trend affects quality and costs, according to the most comprehensive study so far tracking these deals. The JAMA Dermatology study found that 17 private equity-backed dermatology management groups rolled up 184 practices from 2012 to 2018, accounting for 381 clinics in at least 30 states. More than a third of the clinics were located in Florida and Texas. (Meyer, 7/24)
The Cost Of Unwarranted ER Visits: $32 Billion A Year
At the heart of the findings are some staggering price differences. For instance, a trip to the emergency room is on average 12 times higher than being treated at a physician's office for common ailments. That translates to $2,032 on average compared to $167. That same trip is also 10 times higher than a visit to urgent care, which on average costs $193. This can be a crucial difference in Texas, where patients continue to be confused between urgent care clinics and the states' hundreds of free-standing emergency rooms, health analysts say. (Deam, 7/24)
And while the poor and uninsured may be unable to afford or without access to a primary care doctor, the analysis by the health insurer of its own data and claims found that of 27 million emergency department visits annually by patients with private insurance, two-thirds are "avoidable" and "not an actual emergency." The average cost of such visits for common conditions that could have been remedied through primary care tops $2,000.The problem: an inconvenient and perhaps outdated primary care delivery system that's not always open or accessible when people need immediate treatment. (Williams, 7/22)
In other news on health costs 鈥
Kaiser Health News: First Kidney Failure, Then A $540,842 Bill For Dialysis
For months, Sovereign Valentine had been feeling progressively run-down. The 50-year-old personal trainer, who goes by 鈥淪ov,鈥 tried changing his workout and diet to no avail. Finally, one Sunday, he drove himself to the hospital in the small town of Plains, Mont., where his wife, Jessica, happened to be the physician on call. 鈥淚 couldn鈥檛 stop throwing up. I was just toxic.鈥 (Gold, 7/25)
Kaiser Health News: Your Go-To Guide To Decode Medical Bills
In 2018 Kaiser Health News and NPR teamed up to create 鈥淏ill of the Month,鈥 a crowdsourced investigative series in which we dissect and explain medical bills you send us. We have received nearly 2,000 submissions of outrageous and confusing medical bills from across the country. Each month we select one bill to thoroughly investigate, often resulting in the bill being resolved soon after the story is published. But what about the large number of Americans who receive surprise medical bills that reporters can鈥檛 examine? (7/25)
More Bills Of The Month: Check out KHN's special coverage on surprisingly high medical bills.聽
'A Slow-Moving Train Wreck': Most Americans Don't Have Long-Term Care Insurance Yet Many Will Need It
Long-term care insurance is, for most of us, prohibitively expensive. Employer-based health insurance doesn鈥檛 cover daily, extended care. Medicare pays for only a short stay in a nursing home or a limited amount of care at home. Ninety percent of Americans don鈥檛 have long-term care insurance 鈥 even though half of all people 65 and over will need such care at some point. Without it, seniors can go bankrupt paying for assisted living, nursing home care or home health care. (Wiltz, 7/25)
Medicare could save $1.57 for every dollar spent delivering free healthy meals to frail seniors after a hospitalization, according to a new study that comes as lawmakers look to restrain costs by promoting patients' well-being. The report Thursday from the Bipartisan Policy Center addresses ways that Medicare can do a better job coordinating care for chronically ill patients, who account for most of the program's $650 billion annual cost. (Alonso-Zaldivar, 7/25)
Public Health
Only About One In Three High-Risk Americans Take PrEP Despite Proven Effectiveness Of Drug To Protect Against HIV
Among men who are at high risk for H.I.V. infection, only about one in three is taking a drug to prevent transmission of the virus, according to a survey from the Centers for Disease Control and Prevention. The drug, Truvada, is taken daily as part of a preventive strategy called pre-exposure prophylaxis, or PrEP. For the report, published in MMWR, C.D.C. researchers studied 7,873 high-risk men from 20 American cities who were negative for H.I.V. and completed a behavioral survey in 2014 or 2017. (Bilanow, 7/25)
Critical Medical Mystery Illuminates The Dramatic Role AI Could Play Not In Replacing Doctors But Guiding Them
It was developed as part of an ambitious project funded by the National Institutes of Health to link and make searchable decades worth of biomedical data collected by universities and research labs on genes, proteins, disease symptoms, patient outcomes, drugs, and more. This information is now dispersed among hundreds of databases, in a confusing patchwork of formats and terminology that defies easy analysis. (Ross, 7/25)
Higher temperatures across the globe could expose almost a billion more people to risks for diseases like Zika and Ebola by 2080 and that may be a boon for some drugmakers, Morgan Stanley tells investors. Climate change could spell the rapid spread of infectious diseases and Europe in particular is at risk, analysts led by health-care specialist Matthew Harrison wrote in a note to clients. (Flanagan, 7/24)
Precision medicine is the field of dreams for human health 鈥 drugs and treatments that would take into account a person's individual DNA configurations, as well as lifestyle and environment, would presumably be better tailored to each person's needs. Still, while the goal of precision medicine is to help everybody, the current research available has a major flaw 鈥 it's largely based on the genes of people who are predominantly of white and European descent. (Huang, 7/25)
Johnson & Johnson, seeking to head off claims by thousands of women that its iconic Baby Powder caused their cancer, took aim at some of the science cited in lawsuits alleging the company鈥檚 talc-based products were tainted in the past with asbestos. During a hearing Wednesday, lawyers for the world鈥檚 largest maker of health-care products questioned the procedures used by Dr. William Longo, who tested talcum powder for asbestos. J&J hopes a judge will bar Longo from testifying for the women suing the company in cases consolidated in federal court in Trenton, New Jersey. (Feeley, 7/24)
Other than sleeping and working, Americans are more likely to watch television than engage in any other activity. A wave of new social science research shows that the quality of shows can influence us in important ways, shaping our thinking and political preferences, even affecting our cognitive ability. In this so-called golden age of television, some critics have pointed out that the best of the form is equivalent to the most enriching novels. (Rothwell, 7/25)
Keven Walgamott, a real estate agent who lost his left hand and part of his arm in an electrical accident in 2002, got emotional when he was able to clasp his hands together and "feel" the space between his thumb and his index finger using a 3D-printed prosthetic hand in 2016. "That was the first time I ever felt anything in my left hand since my amputation," Walgamott says. He got emotional a second time when he was able to grasp his wife's hand and "feel" her touch, this time through a newly designed, experimental prosthetic hand that can be directed with the user's mind. (Torres, 7/24)
Juul sent representatives into high schools 鈥渦nder the guise of education鈥 and sought partnerships with American Indian tribes to switch people onto its popular e-cigarettes, witnesses testified during a House hearing Wednesday. A Juul official spoke to ninth graders in a New York school last year, showing the children how the products work, calling them 鈥渢otally safe鈥 and saying FDA would soon state that they were 99 percent safer than traditional tobacco, said Meredith Berkman, co-founder of Parents Against Vaping E-Cigarettes, who testified along with her teenage son and his friend. (Owermohle, 7/24)
Depression and anxiety. The state of the country. Climate change. Mass shootings. Today鈥檚 students are grappling with a variety of issues beyond the classroom. To that end, lawmakers in two states have recently recognized the importance of the mental health of their students by allowing them to take sick days just for that. The measures 鈥渆mpower鈥 children to take care of their mental health, one expert said. (Taylor, 7/24)
Former players from the National Football League may face an increased risk of a type of irregular heartbeat that could lead to stroke, a new study suggests. Researchers found that retired NFL players were nearly six times as likely to develop atrial fibrillation as men of the same age in the general population, according to results published in the Journal of the American Heart Association. (7/24)
State Watch
State Highlights: Oregon Makes It Easier For Most-Critical Patients To Access Aid-In-Dying Meds Quicker; 125,000 Texans Could Lose SNAP Benefits Under New Rule
Legislation allowing certain terminally ill patients to have quicker access to life-ending medications under the state鈥檚 first-in-the-nation assisted suicide law has been signed into law, Gov. Kate Brown鈥檚 office announced Wednesday. The law allows those with 15 days left to live to bypass a 15-day waiting period required under the Death with Dignity Act, something proponents say will reduce bureaucracy and bring relief to gravely ill people. (Zimmerman, 7/24)
The Trump administration is proposing tightened requirements for the Supplemental Nutrition Assistance Program 鈥 also known as food stamps 鈥 that could end food assistance for more than 3 million Americans and jeopardize assistance for thousands of Texans. The proposed rule would curb states鈥 abilities to set eligibility requirements for the food assistance program that helps feed millions of Americans each month. (Korte, 7/24)
According to new reports, the number of adults and children with mental illness waiting to get into New Hampshire Hospital has fallen over the past year, ending the long streak in what had become an out-of-control system. Gov. Chris Sununu, his administration and legislative leaders from both parties celebrated the new, much-lower numbers in contrast to just two years ago when as many as 72 adults and 27 children were left without a bed in the Concord-based program. (Landrigan, 7/24)
An operator of hospitals and clinics began offering free DNA testing on Wednesday to 10,000 Floridians in a partnership with a private genomics company. Some biomedical ethicists warn that participants need to realize their data can be used for purposes other than their health care. Researchers at AdventHealth in Orlando said the DNA test screens for an inherited condition that can lead to high cholesterol and heart attacks if left untreated. (7/24)
Former Iowa Department of Human Services Director Jerry Foxhoven said Wednesday that shortly before Gov. Kim Reynolds ousted him, he objected to having his agency continue to pay an administrator who had transferred to the governor's office. The governor's spokesman said Foxhoven never raised such a concern, and was not asked to sign the聽pay-shifting agreement for the staffer. The governor asked Foxhoven to resign June 17 as head of the state's largest agency. She has declined to specify why.聽Her spokesman, Pat Garrett, said Wednesday that the pay-shifting issue was not the reason the governor asked Foxhoven to resign. (Leys and Gruber-Miller, 7/24)
Weight management, mental health and substance abuse are among the top health concerns for people living in Hillsborough County, according to a recent countywide survey of residents. Health care professionals and advocates gathered at George M. Steinbrenner Field in Tampa Wednesday morning to discuss those and other findings in the survey, conducted every five years by the Florida Department of Health in Hillsborough County. More than 5,300 people responded as officials sought input from residents with varied ages, locations and backgrounds. (Griffin, 7/24)
Facing community opposition, a Colorado school district said on Wednesday that it would drop a proposal to tear down Columbine High School, which has been confronting growing threats and thousands of curious trespassers since the 1999 massacre there. In June, the Jefferson County Public Schools in suburban Denver asked for community input on what, to many, was a radical idea to reduce Columbine鈥檚 morbid allure. (Healy, 7/24)
The Minnesota Historical Society is something like the state鈥檚 memory, preserving the state鈥檚 past. The society is also taking on the role of helping Minnesotans whose memories are waning because of dementia. (Cox, 7/25)
Enter the Hmong American Farmers Association and HealthEast. Since 2016, they鈥檝e partnered to provide fresh fruit and vegetable boxes to patients, giving people the opportunity to eat healthier on a regular basis. In turn the Veggie Rx partnership supports local Hmong farmers and helps doctors build stronger relationships with their patients. (Yang, 7/25)
Researchers at Johns Hopkins Medicine and the University of Alabama at Birmingham will study of a condition that mysteriously began ramping up in 2014 and has caused paralysis in hundreds of children around the world as well as in Maryland. Acute flaccid myelitis has been called polio-like, but doctors don鈥檛 know what causes it, though they suspect it鈥檚 a rare response to common enteroviruses that normally lead to far more mild infections. (Cohn, 7/24)
On Thursday, the anti-poverty nonprofit Tipping Point Community will debut a new campaign called 鈥淎ll In.鈥 It aims to secure 1,100 new permanent supportive housing units throughout San Francisco within two years. The goal is to add 100 units to each of the city鈥檚 11 supervisorial districts. (Knight, 7/24)
The North Carolina Council of Churches has been traveling around the state hosting these clergy breakfasts, wherever they鈥檙e invited, to discuss the opioid crisis and introduce harm reduction principles to the faith community. Just over 200 people have come to the breakfasts across 12 cities. Established in 1935, the council is comprised of 6,200 congregations and 18 denominations across North Carolina. Their clergy breakfasts are facilitated by Chris Pernell, the coordinator for their program Partners in Health and Wholeness, and Elizabeth Brewington, coordinator of their opioid response program. (Davis, 7/25)
Bright Health, the Minneapolis startup designed for the fast-changing U.S. insurance market, plans to double the number of U.S. markets where it will sell health coverage next year.The company said Wednesday that it plans to expand to 22 markets in 12 states, including offering insurance products for the first time in Chicago, Cleveland and Orlando. (Carson, 7/24)
Health Policy Research
Research Roundup: Infant Deaths; Type 2 Diabetes Risks; Aging; And Health Care Spending
Annually, several hundred infant deaths occur in sitting devices (eg, car safety seats [CSSs] and strollers). Although American Academy of Pediatrics guidelines discourage routine sleeping in sitting devices, little is known about factors associated with deaths in sitting devices. Our objective was to describe factors associated with sleep-related infant deaths in sitting devices. (Liaw et al, 7/1)
In this systematic review and meta-analysis of prospective observational studies assessing the association between plant-based dietary patterns and risk of type 2 diabetes among adults, higher adherence to plant-based dietary patterns was associated with a lower risk of type 2 diabetes; this association was strengthened when healthy plant-based foods, such as fruits, vegetables, whole grains, legumes, and nuts, were included in the pattern. Findings were broadly consistent in several prespecified subgroups and in sensitivity analyses. (Qian et al, 7/22
Social Security cuts, shrinking employer-sponsored pensions, low savings rates, and longer life spans have raised fears of a looming retirement crisis. But other trends point to better retirement outcomes, such as women鈥檚 increased employment and earnings, longer working lives, and economic growth that raises wages. How will these conflicting trends play out? How will the next generations of older Americans fare in retirement relative to those who came before? And what will happen to retirees if Congress cuts Social Security benefits to address the program鈥檚 long-term financing gap? (7/23)
Health care spending is highly concentrated, with a small share of people accounting for a large share of expenditures during any year 鈥 just 5% of people are responsible for at least half of overall spending. This makes understanding and effectively managing the care for this group vital to improving the quality and efficiency of health care delivery. People with high health care spending are not a homogeneous group: some have very high spending during a short spell of illness, while others have ongoing high spending due to one or more chronic illnesses. (Claxton, Rae and Levitt, 7/22)
Editorials And Opinions
Viewpoints: Public Option Is A Trojan Horse For Unsustainable Single-Payer System; 'Cadillac Tax' May Be Unpopular But It Should Be Retained
The Affordable Care Act was signed into law nearly a decade ago, significantly expanding the role of the federal government in the U.S. health-care system. It鈥檚 telling that many have called for yet another overhaul of health care. This dramatic shift indicates a rare bipartisan consensus that the ACA has failed to achieve its objectives. The question then becomes what comes next. One common proposal is the so-called public option. It would introduce a government-run plan into the commercial health insurance market or, alternatively, allow consumers under age 65 to buy in to traditional Medicare. (CMS Administrator Seema Verman, 7/24)
There鈥檚 one provision of ObamaCare almost everyone wants to repeal. Last week the House voted 419-6 to repeal the so-called Cadillac tax, a 40% excise on high-cost employer-sponsored health insurance. The bill now moves to the Senate. Congress has twice delayed the tax鈥攐riginally set to take effect in 2018鈥攁nd weakened it by allowing employers to deduct the levy itself from their profits. But repealing the Cadillac tax is a bad idea. Instead, Congress should modify it to encourage the use of health savings accounts. (Brian Blase, 7/24)
Acting on the principle 鈥淲hy put it off until tomorrow when you can do the wrong thing today?,鈥 the House of Representatives last week voted to repeal a tax that is not scheduled to take effect until 2022. The vote against the 鈥淐adillac tax鈥 was 419 to 6, a reminder that 鈥渂ipartisanship鈥 often is the political class coming together to sacrifice the national interest to its own. Repeal of the promised tax of 40鈥塸ercent on a portion of the most lavish employer-provided health-care plans would enlarge projected budget deficits by almost $200 billion over a decade. (George F. Will, 7/24)
Should America create a broad right to health care? Americans already have a limited right to health care under the Emergency Medical Treatment and Active Labor Act, commonly known as EMTALA. Medicare-participating hospitals must provide emergency screening and stabilizing health care regardless of ability to pay. The leading Democratic presidential candidates support the creation of a broad 鈥渞ight to health care鈥 through 鈥淢edicare for All鈥 proposals. (George A. Nation, 7/24)
On Tuesday, the Trump administration announced proposed rules that would cut more than three million people off food assistance. This latest plan confirms what many have long suspected: The only thing unifying its policies on poverty is cruelty. Prior right-ring assaults on the poor at least claimed some semblance of a coherent theme. In contrast, this proposal, and earlier ones, are a grab-bag of mutually inconsistent ideas seemingly selected only to maximize harm. When President Ronald Reagan attacked anti-poverty programs, he claimed to be limiting assistance to the poorest of the poor. He insisted he was protecting a 鈥渟afety net鈥 for the 鈥渢ruly needy.鈥 To do this, he denied aid to millions of working families. (David A. Super, 7/24)
When Ronald Reagan ran for president in 1976, he liked to badmouth people who received government benefits as undeserving. His prime example: a Chicago fraudster named Linda Taylor, dubbed 鈥渢he welfare queen鈥 by local tabloids. 鈥淗er tax-free cash income alone has been running $150,000 a year,鈥 Reagan proclaimed. This tale set the table for the welfare cutbacks of the 1980s and 1990s, in which millions of poverty-struck people lost access to welfare programs they desperately needed to help them make ends meet. History, as they say, doesn鈥檛 repeat, but it sure does rhyme. (Helaine Olen, 7/24)
Growing up in the rural community of Fort Kent, Maine (population just shy of 4,000), I watched my parents struggle to find and keep a primary care physician. When I was young, this town in Aroostook, the state鈥檚 northernmost county, had a few die-hard general practitioners and surgeons, but as they retired I witnessed firsthand the toll their departure took on patients and families. I started dreaming of becoming a family doctor when I was 12. After medical school, I hoped to practice in a community like Fort Kent, but married a city boy from St. Louis who was tentative about rural life and tall snowbanks, and who wouldn鈥檛 go any further north than Connecticut. (Traci Marquis-Eydman, 7/25)
Between January 2015 to January 2018, the drugs that multiple sclerosis patients rely on have skyrocketed from $60,000 to close to $100,000. In the last decade, the top three insulin manufacturers 鈥 Eli Lilly, Novo Nordisk, and Sanofi 鈥 have increased the price of insulin by 700 percent in lockstep as 1 in 4 diabetics rations or forgoes this lifesaving medication due to cost. And within this year alone, over 3,400 drugs have already seen price spikes of an average 10.5 percent, representing five times the rate of inflation. The American people are crying out. Prescription drug prices are literally killing them. (Rep. Jan Schakowsky, 7/25)
Since my cancer diagnosis, I have lived intimately with thoughts of death. Cancer patients of all ages and stages, as well as people with other ruinous conditions, often experience 鈥渁 double frame of mind,鈥 as the polemicist Christopher Hitchens once put it. Laboring to survive in the present, we simultaneously imagine our future demise. Of course, feelings and beliefs about mortality range widely. But a number of thinkers have set out to help those who suspect that introspection about this state of mind may be the most important work we can undertake. (Susan Gubar, 7/25)