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Morning Briefing

Summaries of health policy coverage from major news organizations

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Tuesday, May 16 2017

吃瓜不打烊 Original Stories 3

  • Overwrought Marketing? Ads, Not Research, Create Some Pharma Best-Sellers
  • Preexisting Conditions And Continuous Coverage: Key Elements Of GOP Bill
  • Segregated Living Linked To Higher Blood Pressure Among Blacks

Health Law 3

  • Preexisting Conditions Took Spotlight In House Debates, But Medicaid Moves To Center Stage In Senate
  • Health Industry, Shunted To Sidelines In House Negotiations, Eager For A Chance At The Senate
  • In Latest Move To Roll Back Health Law, Administration Dismantles Small-Business Marketplace

Administration News 2

  • Trump's Abortion 'Gag Rule' Will Block $8.8B In Aid To Fight Malaria, AIDS And Other Diseases
  • Credentials Of Trump's Anticipated Choice To Be USDA 'Chief Scientist' Questioned

Women鈥檚 Health 1

  • Texas May Become Litmus Test For Banning Medicaid Funds For Planned Parenthood

Health IT 1

  • Experts Race To Patch Vulnerable Health Networks Following Massive International Cyberattack

Public Health 2

  • With Opioid Crisis Continuing To Escalate Cherokee Nation Takes Drug Distributors To Court
  • Up To 59 Percent Of Nursing Home Residents Could Be 'Colonized' With Superbugs

State Watch 1

  • State Highlights: Blue Cross Blue Shield Of KC Asks Mo. Regulators For Filing Deadline 'Flexibility'; Harken Health Shuts Down In Ill., Ga.

Editorials And Opinions 2

  • A Hard Look At GOP Repeal-And-Replace Efforts: Examining Who Is Left Behind; Defending The House Vote
  • Viewpoints: 'Biomedical Ecosystem' Requires Care; How Smart Phones Could Revolutionize Medical Care

From 吃瓜不打烊 - Latest Stories:

吃瓜不打烊 Original Stories

Overwrought Marketing? Ads, Not Research, Create Some Pharma Best-Sellers

A look at how and why strategic, star-studded advertising brought a drug for a little-known neurological condition into your home. ( Julie Appleby , 5/16 )

Preexisting Conditions And Continuous Coverage: Key Elements Of GOP Bill

The Republican health plan would require insurers to offer coverage to people who have preexisting medical conditions. But if states opt to allow insurers to charge sick people more than healthy ones, people who have been more than 63 days without coverage could see significantly higher insurance costs. ( Michelle Andrews , 5/16 )

Segregated Living Linked To Higher Blood Pressure Among Blacks

Blood pressure for African-Americans who moved permanently out of segregated areas into medium-segregation locations decreased on average nearly 4 points while those who went to low-segregation locales dropped almost 6 points, a 25-year study finds. ( Carmen Heredia Rodriguez , 5/15 )

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Summaries Of The News:

Health Law

Preexisting Conditions Took Spotlight In House Debates, But Medicaid Moves To Center Stage In Senate

Senators are searching for trade-offs in an effort to save the health law's Medicaid expansion.

Senate negotiators, meeting stiff resistance to the House鈥檚 plans to sharply reduce the scope and reach of Medicaid, are discussing a compromise that would maintain the program鈥檚 expansion under the Affordable Care Act but subject that larger version of Medicaid to new spending limits. With 62 senators, including 20 Republicans, coming from states that have expanded Medicaid under the Affordable Care Act, the House鈥檚 American Health Care Act almost certainly cannot pass the Senate. (Pear, 5/15)

Sens. Rob Portman and Pat Toomey have been trying to strike a compromise that bridges disagreements between Republican moderates who want to keep Medicaid expansion and conservatives who want to rapidly eliminate it and rein in spending. The two senators have discussed proposals to significantly alter the Medicaid provisions of the House鈥檚 Obamacare repeal bill, which capped the program's funding and phased out its expansion. (Pradhan, 5/15)

Meanwhile, moderates from both sides of the aisle came together on Monday to talk health care聽鈥

Moderate senators from both parties met Monday to explore whether they can work on bipartisan legislation overhauling the nation's health care system. The evening session came as Republican senators have begun closed-door meetings aimed at crafting a GOP bill scuttling much of President Barack Obama's health care law. (5/15)

A bipartisan group of senators met in the Capitol on Monday night to discuss whether there is a bipartisan way forward on healthcare reform.聽The meeting was organized by Sens. Susan Collins (R-Maine) and Bill Cassidy (R-La.), who have put forward a more centrist healthcare plan that would allow states to keep much of ObamaCare in place if they choose.聽While senators said the meeting was preliminary and just discussing ideas broadly, the push for a bipartisan solution could potentially emerge as an alternative to the Republican-only repeal and replace approach from leadership. (Sullivan, 5/15)

Health Industry, Shunted To Sidelines In House Negotiations, Eager For A Chance At The Senate

Meanwhile, under the reconcilliation process that Republican lawmakers are using to dismantle the Affordable Care Act, each provision they change has to be directly related to the budget. But Sens. Ted Cruz (R-Texas) and Rand Paul (R-Ky.) argue that the rules aren't set in stone.

The health-care world is gearing up for a lobbying offensive to persuade Republican U.S. senators to address their problems with an Obamacare replacement that was conceived in the House in a virtual vacuum. Insurers, doctors, patient groups and most health-care experts are pinning their hopes on the Senate being more receptive after House Republicans -- led by Speaker Paul Ryan -- deliberately avoided discussing their plans with the main groups that would be affected by repealing the 2010 law. (House, Edney and Edgerton, 5/16)

Conservative GOP Sens. Ted Cruz and Rand Paul are pushing to test the limits of how much of Obamacare can be repealed under Senate rules, setting up a potential 鈥渘uclear鈥 showdown. The firebrands want to overturn long-standing precedent for what can be done under reconciliation, the fast-track budget process the GOP is using to dismantle the Affordable Care Act. They argue Republicans are allowing stale Senate norms to tie their hands and are forfeiting a chance to completely abolish the law. (Haberkorn and Kim, 5/16)

The White House fired a shot across the Senate鈥檚 bow Monday, signaling President Donald Trump feels 鈥渧ery strong鈥 about the health overhaul passed by the House. Several Senate groups, including one composed of Republicans and Democrats, are holding talks about how to alter the House measure or craft an entirely new bill. But just as senators return to Washington to get back to work, Press Secretary Sean Spicer walked a tightrope about what Trump wants them to pass. (Bennett, 5/15)

In related news,聽a look at the Wisconsin high-risk pool that House Speaker Paul Ryan (R-Wis.) uses to counterattack criticisms of the concept; what the deal is with preexisting conditions and continuous coverage; Trump administration rhetoric; and how efforts to improve the uninsured rate have stalled聽鈥

U.S. House Speaker Paul Ryan (R-Wis.) has touted Wisconsin鈥檚 former high-risk insurance pool to counter concerns that some of those people could be priced out of the market under the health care bill recently passed by the House. The state鈥檚 Health Insurance Risk-Sharing Plan, known as HIRSP, was considered a model. But it was an exception, not the norm 鈥 and it worked only for people who could afford insurance in the first place. (Boulton, 5/15)

As House Speaker Paul Ryan prepared to address hundreds of Karen Handel supporters Monday inside a Dunwoody hotel, a throng of protesters chanting 鈥渢his is what democracy looks like鈥 massed outside the event. A few dozen protesters, many wielding pink Planned Parenthood signs, lined the entrance to the hotel to greet Handel supporters. (Bluestein, 5/15)

Representative Bruce Poliquin was hard to find the week after casting his vote in Washington to repeal the Affordable Care Act and slash Medicaid spending. So when 30 or so unhappy Mainers descended on his district office in this old mill town, they brought a 5-foot-tall poster version of the Republican lawmaker and stood it in front of the building where they say the real Poliquin will not meet with them. (McGrane, 5/15)

Before he was diagnosed with head and neck cancer in 2015, Anthony Kinsey often went without health insurance. He is a contract lawyer working聽for staffing agencies on short-term projects in the Washington, D.C., area, and sometimes the 90-day waiting period for coverage through a staffing agency proved longer than the duration of his project, if coverage was offered at all. When Kinsey, now 57, learned he had cancer, he was able to sign up for a plan with a $629 monthly premium because the agency he was working for offered group coverage that became effective almost immediately. (Andrews, 5/16)

Health and Human Services Secretary Tom Price argued that people are currently uninsured because they don鈥檛 like Obamacare. ...聽Price鈥檚 characterization leaves out a lot. Many of the 20 million are likely uninsured not as a personal preference, but because they still can鈥檛 find coverage. (Sherman, 5/15)

Mick Mulvaney, director of the Office and Management and Budget, told a Stanford University forum that the GOP health care bill聽should cover some pre-existing conditions, but not others. Asked about late night comedian Jimmy Kimmel's statement that "no parent should ever have to decide whether they can afford to save their child's life," Mulvaney said聽that he agreed, but "that doesn't mean that we want to take care of the person, or should be required to care of the person, who sits at home, drinks sugary drinks, and doesn't exercise, and eats poorly and gets diabetes." (Young, 5/15)

After five consecutive years of coverage gains, progress toward reducing the number of uninsured Americans stalled in 2016, according to a government report that underscores the stakes as Republicans try to roll back Barack Obama's law. The Centers for Disease Control and Prevention estimated that 28.6 million people were uninsured last year, unchanged from 2015. The uninsured rate was 9 percent, an insignificant difference from 9.1 percent in 2015. (Alonso-Zaldivar, 5/16)

In Latest Move To Roll Back Health Law, Administration Dismantles Small-Business Marketplace

Relatively few people will actually be affected by the decision, but it shows the direction in which the administration wants to go.

The Trump administration said Monday that it will dismantle part of the Affordable Care Act that created online insurance marketplaces for small businesses and tried to foster a greater choice of health plans for their workers. Moving to end the ACA鈥檚 small-business enrollment system by 2018 represents the first public step by the Health and Human Services Department to implement an executive order President Trump signed his first night in office, directing agencies to ease regulatory burdens of the health-care law. (Goldstein, 5/15)

Under the ACA, employers with as many as 50 workers could sign up for small-group plans through the Small Business Health Options Program, often called SHOP, where some employers could qualify for tax credits to lower premiums. As the exchange was originally envisioned, small employers could use the platform to make contributions to their employees鈥 health coverage, allowing workers to pick which plans they preferred. But the health law鈥檚 small-business tax credits proved insufficient to attract a large number of employers to the SHOP exchange, and most small-business owners shunned the federally run marketplaces in favor of working with private brokers. (Hackman, 5/15)

"Our goal is to reduce ACA burdens on consumers and small businesses and make it easier for them to purchase coverage," CMS Administrator Seema Verma said in a statement Monday. "This new direction will help employers find affordable healthcare coverage for their employees and make the SHOP exchanges function more effectively." (Dickson, 5/15)

About 85,000 people from 11,000 small businesses are covered under the SHOP exchanges, though millions more were expected to participate when the program launched. (Hellmann, 5/15)

Firms could still be eligible to utilize the 2010 law鈥檚 Small Business Tax Credit, even if the plan was obtained outside the SHOP marketplaces, said Sabrina Corlette, a professor at Georgetown University鈥檚 Center on Health Insurance Reforms. 鈥淲hat the feds are trying to do here is say: 鈥楨ven though there鈥檚 no real SHOP because we can鈥檛 get any carriers to participate, you can still get the small business tax credit,鈥欌 she said in a phone interview. (Reid, 5/15)

Administration News

Trump's Abortion 'Gag Rule' Will Block $8.8B In Aid To Fight Malaria, AIDS And Other Diseases

With the rule in place, any foreign nongovernmental group that wants American money for any of its health activities must promise not to 鈥減romote abortion as a method of family planning.鈥

The Trump administration said on Monday it would vastly expand the so-called global gag rule that withholds American aid from health organizations worldwide that provide or even discuss abortion in family planning. The new policy could disrupt hundreds of clinics in Africa and around the world that fight AIDS and malaria. It affects about $8.8 billion in global health funding, up from about $600 million during the administration of President George W. Bush. (Harris and Sengupta, 5/15)

Senior administration officials confirmed聽Monday聽that Trump鈥檚 version will impact聽$8.8 billion for programs, including those related to AIDS, malaria and child health. About $6 billion of that supports programs for聽HIV/AIDS services, primarily in Africa, as part of the President鈥檚 Emergency Plan for AIDS Relief established in 2003. Another program that could be hit hard is the President鈥檚 Malaria Initiative, started under George W. Bush and expanded under Barack Obama. Defense Department grants related to global health security will also be聽impacted. The new policy, which is being called 鈥淧rotecting Life in Global Health Assistance,鈥 affects any organization deemed to promote abortion 鈥渁s a method of family planning鈥 through abortion counseling, referrals, lobbying聽or public information campaigns. Trump has said聽taxpayer dollars should not be used for this purpose. (Cha and Morello, 5/15)

How the new policy will affect the U.S. war on聽HIV/AIDS overseas will depend聽in part on which foreign nongovernmental organizations sign the new clause to receive PEPFAR funding, a senior State Department official said. The official said that the detailed data PEPFAR regularly collects on the use of its funding would be watched closely for signs that its reach is either being restricted or expanding. 鈥淪ecretary [Rex] Tillerson wanted to assure that we are carefully following implementation to be able to see if there is an unforeseen impact on our delivery of services,鈥 the senior State Department official said. 鈥淭hese are lifesaving service-delivery programs that need to be performing at the highest level.鈥 (McKay, 5/16)

Anti-abortion groups praised a Trump administration policy announced Monday that will vastly expand abortion-related foreign aid restrictions by blocking money from more organizations. Past implementations of the聽Mexico City policy affected $500 to $600 million in yearly funds administered by the State Department and U.S Agency for International Development (USAID). The State Department's new "Promoting Life in Global Health Assistance" policy will affect $8.8 billion administered by all federal departments or agencies. (Eaton, 5/15)

Credentials Of Trump's Anticipated Choice To Be USDA 'Chief Scientist' Questioned

ProPublica reports that Sam Clovis, who is expected to be named undersecretary of the agency's department that manages research on everything from climate change to nutrition, has never taken a graduate course in science. In other Trump administration news, the Cleveland Clinic plans to continue to hold its annual Florida fundraiser at Mar-A-Lago, despite some complaints.

The USDA鈥檚 research section studies everything from climate change to nutrition. Under the 2008 Farm Bill, its leader is supposed to serve as the agency鈥檚 鈥渃hief scientist鈥 and be chosen 鈥渇rom among distinguished scientists with specialized or significant experience in agricultural research, education, and economics.鈥 But Sam Clovis 鈥 who, according to sources with knowledge of the appointment and members of the agriculture trade press, is President Trump鈥檚 pick to oversee the section 鈥 appears to have no such credentials. (Huseman, 5/12)

The Cleveland Clinic intends to return to President Trump鈥檚 Palm Beach home for its annual Florida fundraiser, despite calls from some within the hospital鈥檚 community to stay away. ... The Cleveland Clinic has held a fundraiser at the Mar-a-Lago club for the past eight years, but this year鈥檚 event came soon after Trump鈥檚 January executive order on immigration, which prevented a Cleveland Clinic doctor from returning to the country, prompting protests and calls for the February fundraiser to be moved or canceled. (Swetlitz, 5/15)

Women鈥檚 Health

Texas May Become Litmus Test For Banning Medicaid Funds For Planned Parenthood

After refusing federal Medicaid money so that it could ban Planned Parenthood from its family planning program, Texas is asking for the money back. If it's granted, it could be a green light for other states to do the same.

Four years after Texas gave up millions of dollars in federal Medicaid funds so it could ban Planned Parenthood from participating in a family planning program for low-income women, the state is asking the Trump administration for the money back. The request presents an important early test for the administration of President Trump, who recently appointed an anti-abortion official to oversee federal family planning programs. Under President Obama, federal health officials would not allow Medicaid funds to flow to the Texas program after it excluded Planned Parenthood, because federal law requires states to give Medicaid beneficiaries their choice of 鈥渁ny willing provider.鈥 (Goodnough, 5/15)

The stakes potentially extend far beyond Texas. Abortion-rights groups worry that if Texas succeeds, other conservative states will also cut off Planned Parenthood and put clinics in jeopardy. "There is a new administration, and we're looking at what opportunities may exist for us," said Carrie Williams, a spokeswoman for the Texas Health and Human Services Commission. (Weber, 5/15)

Health IT

Experts Race To Patch Vulnerable Health Networks Following Massive International Cyberattack

Some medical devices were infected, but primarily the latest attack reinforced the need to correct any weaknesses in medical cybersecurity systems.

The international cyberattack that swept the globe has had some impact on the U.S. health-care system, as hospital systems scramble to prevent its further spread. On a conference call with health-care organizations Monday, U.S. federal officials said several medical devices had been infected with the ransomware that proliferated across dozens of countries, but declined to identify the devices, according to a person on the call. The Department of Health and Human Services, which organized the call, referred questions to Homeland Security, which didn鈥檛 immediately respond to a request for comment. (Evans, 5/15)

It's one thing to fall victim to a burglar. It's another to realize the thief got in because you left the front door wide open. The distinction could lead to difficult legal battles for organizations affected by the WannaCry cyberattack, which crippled an estimated 300,000 of the 2 billion Windows computers worldwide in recent days, slowing factories, canceling surgeries, eating homework assignments and shuttering gas stations. (Dave and Peltz, 5/15)

In other health IT news聽鈥

Children鈥檚 Mercy Hospital has teamed with a local tech company to develop a smartphone app that can help doctors and nurses spot the scary cases. Russell McCulloh, an infectious disease specialist at the hospital, presented the CMPeDS: Pediatric Decision Support app to an international audience last week at the Pediatric Academic Societies Meeting in San Francisco. (Marso, 5/15)

Public Health

With Opioid Crisis Continuing To Escalate Cherokee Nation Takes Drug Distributors To Court

This first-of-its-kind lawsuit takes on companies such as CVS Health, Walgreens and Wal-Mart and alleges that they did not properly monitor prescription drugs. Meanwhile, New York health officials have issued new warnings for the western part of the state regarding a weekend spike in overdose deaths associated with various drug combinations of fentanyl.

As the nation鈥檚 opioid addiction and overdose crisis grows, the Cherokee Nation is launching the first-ever lawsuit against drug distributors that will be litigated聽in a tribal court. The suit takes on companies including pharmacies CVS Health, Walgreens and Wal-Mart, and drug distributors Cardinal Health, Inc. and McKesson Corporation, alleging that they didn鈥檛 properly monitor prescription painkillers, which eventually "flooded" every Cherokee county. (Young, 5/15)

A weekend spike in overdose deaths has led to new warnings from western New York health officials. Erie County saw eight suspected fatal overdoses over the weekend. Chautauqua County also is reporting deaths in recent days. (5/16)

Up To 59 Percent Of Nursing Home Residents Could Be 'Colonized' With Superbugs

The group is particularly susceptible to the dangerous germs. In other public health news: pesticides, sunscreen, teeth, c-sections, genetic testing and more.

There鈥檚 a bug problem in some nursing homes, and it鈥檚 not what you think. Residents of long-term care facilities are vulnerable to drug-resistant infections known as superbugs and can easily spread the deadly germs to others. (Lagnado, 5/15)

Some of the most compelling evidence linking a widely used pesticide to developmental problems in children stems from what scientists call a 鈥渘atural鈥 experiment. Though in this case, there was nothing natural about it. (Rabin, 5/15)

The Sunbeatables curriculum, designed by specialists MD Anderson Cancer Center, features a cast of superheroes who teach children the basics of sun protection including the obvious: how and when to apply sunscreen. There鈥檚 just one wrinkle. Many of the about 1,000 schools where the curriculum is taught are in states that don鈥檛 allow students to bring sunscreen to school or apply it without a note from a doctor or parent and trip to the nurse鈥檚 office. (Reddy, 5/15)

As the distance between rich and poor grows in the United States, few consequences are so overlooked as the humiliating divide in dental care. High-end cosmetic dentistry is soaring, and better-off Americans spend well over $1 billion each year just to make their teeth a few shades whiter. Millions of others rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth. Unable to afford expensive root canals and crowns, many simply have them pulled. Nearly 1 in 5 Americans older than 65 do not have a single real tooth left. (Jordan and Sullivan, 5/13)

The most common major surgery performed in the U.S isn鈥檛 to remove an appendix or replace a knee. It鈥檚 to deliver babies by cesarean section, or C-section. Roughly one out of every three babies born in this country鈥攐r about 1.3 million children each year鈥攁re delivered this way, instead of vaginally. Yet the vast majority of women prefer to deliver vaginally, according to a January 2017 study in the journal Birth. So what鈥檚 going on? (Haelle, 5/16)

A year and a half ago, few health insurers would cover a noninvasive prenatal test 鈥 which draws blood from a pregnant woman to analyze fetal DNA 鈥 unless the pregnancy was considered high-risk, which usually meant the woman was over 35. The test, which screens for chromosomal abnormalities linked to genetic disorders like Down syndrome, seemed less essential for women with average- or low-risk pregnancies. Today, at least 30 major U.S. insurers 鈥 including Anthem, Cigna and more than a dozen Blue Cross Blue Shield affiliates nationwide 鈥 cover the test for average-risk single-gestation pregnancies, expanding access to millions more people. (Ho, 5/15)

As she rose from the dinner table one night in February 2016, Annie Karp winced as she felt a penetrating ache deep in her hips. Unable to straighten up for a minute or two, she took small steps toward the medicine chest in her parents鈥 Florida home in search of an over-the-counter painkiller. Karp assumed she had pulled several muscles during an overzealous workout earlier in the day. (Boodman, 5/15)

The more red meat you eat, the greater your risk of dying from one of nine diseases, according to a new report. Researchers studied more than 536,000 men and women ages 50 to 71, tracking their diet and health for an average of 16 years. They recorded intake of total meat, processed and unprocessed red meat (beef, lamb and pork), and white meat (poultry and fish). (Bakalar, 5/15)

Women who entered menopause at an earlier age or who never gave birth may be at higher risk for heart disease, according to a new study by UC San Francisco researchers. In a study of more than 28,000 women without heart disease over an average of 13.1 years, researchers found that while only 5.2 percent of the women were hospitalized for heart failure during the study, those who never gave birth were 2.75 times more likely to develop diastolic heart failure. (Seipel, 5/15)

For African-Americans, the isolation of living in a racially segregated neighborhood may lead to an important health issue: higher blood pressure. A study published Monday in JAMA Internal Medicine suggested blacks living in such areas experienced higher blood pressure than those living in more diverse communities. Moving to integrated areas was associated with a decrease in blood pressure, and those who permanently stayed in localities with low segregation saw their pressure fall on average nearly 6 points. (Heredia Rodriguez, 5/15)

State Watch

State Highlights: Blue Cross Blue Shield Of KC Asks Mo. Regulators For Filing Deadline 'Flexibility'; Harken Health Shuts Down In Ill., Ga.

Media outlets report on news from Missouri, Illinois, Georgia, Wisconsin, Texas, Kansas, California, Louisiana, Minnesota, Massachusetts, Ohio and Florida.

A spokeswoman for Blue Cross Blue Shield of Kansas City said Monday the company has 鈥渞equested flexibility鈥 from the Kansas Insurance Department on a deadline to file plans to sell on the Affordable Care Act exchange next year. The company鈥檚 decision not to file by Monday鈥檚 midnight deadline casts uncertainty on 2018 鈥淥bamacare鈥 coverage options for people in two eastern Kansas counties and 30 western Missouri counties. (Marso, 5/15)

Insurer Harken Health is closing its doors in Illinois and Georgia, ending an experiment to combine health insurance and care. The insurer, which operates five health clinics in Chicago, Skokie and Des Plaines, began selling plans in Illinois and Georgia in 2015. A subsidiary of UnitedHealthcare, Harken offered its members unlimited free doctor visits at its health centers, which also offer wellness programs, such as acupuncture, yoga and meditation. (Schencker, 5/15)

By one important measure, doctors in the Milwaukee area are paid 41% more than the estimated national average for the services they provide, a new study says. The same was true across much of eastern Wisconsin: Fees paid to doctors by employers' health plans in the Sheboygan area were 63% above the national average, ranking them the highest among the 61 markets included in the study by the Health Care Cost Institute. (Boulton, 5/15)

HB 810 is one of three bills being considered in the Texas Legislature that would make it easier for sick people to try unproven therapies at their own risk, and cost. Springer鈥檚 bill would allow clinics offering unapproved stem cell treatments to treat patients聽in Texas. HB 661 would permit people with chronic illness to get therapies in early-stage clinical trials 鈥 not just terminally ill patients, as the state鈥檚 current 鈥渞ight-to-try鈥 law does. And HB 3236 would allow companies to charge patients for unproven therapies. (Joseph, 5/16)

Missouri is poised to strip additional providers from a state-run program that provides family planning services for uninsured women. The budget lawmakers are sending to Gov. Eric Greitens聽contains a provision that prohibits hospitals and clinics from participating in the Missouri Women's State-Funded Health Services Program if the organization also provides abortion services, as defined by a state law for sexual education in schools. (Bouscaren, 5/15)

Family preservation services 鈥 including training for parents, referrals for food assistance and other support 鈥 are designed to promote that healing. According to DCF, most families that receive preservation services succeed: About 82 percent of families who participated statewide were able to avoid having a child removed from the home. But many at-risk families don鈥檛 receive preservation services, and some people who have worked for years in the social services system say the lack of help is pushing more children into foster care. (Wingerter, 5/15)

Kaiser Permanente Monday posted a record $1 billion operating gain in its first quarter, just days after holding its largest-ever bond offering. The Oakland, Calif.-based health plan and hospital giant eclipsed the $1 billion barrier on revenue of $18.1 billion. That compared with an operating gain of $701 million on revenue of $16.3 billion in the year-earlier quarter. The 5.5% operating margin in the first quarter beat the strong 4.3% operating margin from the year-earlier period. (Barkholz, 5/15)

What happened to [Steve] Fair is known as "balance billing," an increasingly common practice in our nation's convoluted health care system. Rather than staff their own ERs, many hospitals around the country hire physicians employed by staffing companies like Schumacher, experts say. Insurance companies then pay these contract physicians a pre-negotiated rate for their hospital services. Because they have no contract with the insurer, however, these doctors don't have to accept the negotiated rate as their total fee. Instead, they go after patients for the full amount. Since the prices of most medical procedures are hidden from view, doctors have no incentive to lower them. 聽(Lipinski, 5/15)

Minnesota health officials say the number of measles cases rose by four over the weekend and the highly contagious disease has now moved into a southern Minnesota county. Two new cases of measles were discovered in Le Sueur County, the Minnesota Department of Health reported Monday in its daily measles tally. (Zdechlik, 5/15)

Cristal is a 2-year-old girl born with spina bifida, a condition that has required multiple surgeries and left her with limited sensation in her lower extremities.Over the past month, she has endured long, uncomfortable commutes between the Lowell homeless shelter where the state is housing her family and frequent appointments with her medical providers in Boston, according to recent court filings...聽The case illustrates the human dimension of one of thorniest entitlement program debates facing Massachusetts as Baker works to reduce the number of homeless families in motels at state expense to zero. (Miller, 5/15)

As national Republican leaders continue to try to defund Planned Parenthood, California and other states are considering steps to protect access to family planning services. California legislators have introduced a bill that would lock into state law a federal rule that allows Medicaid patients to see family planning providers of their choice. The bill is designed to preserve Californians鈥 access to Planned Parenthood and other reproductive health clinics should聽federal officials drop the rule. (5/16)

A federal judge approved a $7.5 million settlement Monday in a class-action lawsuit against Walmart that found the retail giant violated gender-discrimination laws for years when it denied spousal benefits to same-sex couples. The lawsuit was filed on behalf of a New Bedford woman by the advocacy group GLAD. The settlement was based in large part on US Supreme Court rulings affirming the rights of same-sex couples to marry and, in an earlier ruling, their entitlement to federal spousal benefits. (Valencia, 5/15)

Rachel Dovel didn't mean to become a crusader for transgender rights. But the library employee found herself cast in that role last year when the library's health insurance refused to pay for her gender confirmation surgery - and the library's board wouldn't budge. She underwent surgery in December - and Monday she and her legal team announced she settled a lawsuit against the Public Library of Cincinnati and Hamilton County. (Coolidge, 5/15)

Beth Israel Deaconess Medical Center and Lahey Health have enlisted another hospital in their campaign to create a stronger rival to Partners HealthCare, the market leader. Anna Jaques Hospital of Newburyport said Monday that it plans to join the Beth Israel Deaconess-Lahey merger, which was announced in January after years of on-again, off-again talks. (Dayal McCluskey, 5/15)

Spaulding Rehabilitation Network, part of the Partners HealthCare network, is slashing 35 jobs to cut costs. The cuts come as the entire Partners network embarks on a three-year initiative to rein in spending and become more efficient. (Dayal McCluskey, 5/15)

The Environmental Protection Agency is warning that the Orlando area鈥檚 air quality is not healthy for sensitive groups. That means people with asthma and lung disease, as well as the elderly and children, should cut down on prolonged or heavy exercise outside. They recommend keeping asthma medication nearby. (Aboraya, 5/15)

Editorials And Opinions

A Hard Look At GOP Repeal-And-Replace Efforts: Examining Who Is Left Behind; Defending The House Vote

Opinion writers and stake holders offer their takes on the current health policy debate.

Simply put, the status quo on health care is unsustainable. ... Congress has the responsibility to fix this mess and lower health care costs. At the same time, these changes must be made in a way that doesn鈥檛 leave people behind. ... After the House of Representatives passed its bill, I said I could not support it as currently constructed because it does not do enough to help those currently receiving coverage, including the 700,000 Ohioans who receive health care through expanded Medicaid, especially those who are receiving treatment for drug addiction. Our state is in the midst of an unprecedented drug crisis right now. About half of all expanded Medicaid dollars spent in Ohio go to mental health and substance abuse treatment 鈥 much of that driven by the opioid epidemic. (Sen. Rob Portman, 5/15)

We鈥檝e said it before and we鈥檒l say it again: In the ridiculous mess that is the American healthcare system, there鈥檚 one indisputable success 鈥 children鈥檚 health coverage. Over the last two decades, the uninsured rate for children under 18 has fallen from 14% to less than 5%. Today that achievement is under threat as never before. 鈥淲e鈥檙e at real risk of moving backward,鈥 says Joan Alker, executive director of the Center for Children and Families at Georgetown University. That鈥檚 because children鈥檚 healthcare in the U.S. is heavily dependent on three public programs, Medicaid, the Affordable Care Act, and the Children鈥檚 Health Insurance Program, or CHIP. (Michael Hiltzik, 5/15)

There is a petition-driven movement 鈥 sure to fail 鈥 to strip members of Congress of their health care coverage. We don鈥檛 have the heart to deny people the coverage they need to keep themselves and their families healthy, even if they are making a minimum of $174,000 annually. But we understand the argument. (5/15)

I was arrested last week after asking Health and Human Services Secretary Tom Price a question about the American Health Care Act while he walked toward a meeting in the West Virginia State Capitol. He didn鈥檛 respond, so I asked a few more times, holding my phone out to record the reply he didn鈥檛 make. The criminal complaint accused me of a misdemeanor 鈥 鈥渨illful disruption of governmental processes鈥 鈥 and said I was 鈥渁ggressively breaching the secret service agents.鈥 I wasn鈥檛. I went to the capitol to do my job and ask a question 鈥 not looking for trouble or intending to disrupt some state process. But for asking a question, the capitol police took my phone, handcuffed me, fingerprinted me and sent me off in an orange jumpsuit. (Dan Heyman, 5/16)

Between rounds of聽jeering that interrupted his every sentence, Rep. Rod Blum (R-Iowa) took聽a little more than two minutes to explain what else he'd like to change about the Obama-era聽health-care law now that he聽has voted聽for聽the GOP's partial repeal of the Affordable Care Act. 鈥淕et rid of some of these crazy regulations that Obamacare puts in,鈥 Blum suggested at an Iowa town hall meeting Monday, 鈥渟uch as a 62-year-old male having to have pregnancy insurance.鈥澛燭he crowd聽yelled all the louder. (Avi Selk, 5/15)

House Republicans have long promised to repeal and replace Obamacare, and earlier this month, we delivered. After voting more than 60 times to repeal and replace Obamacare, I supported the American Health Care Act when it passed the House of Representatives on May 4. (John Carter, 5/16)

With President Trump鈥檚 reaffirmed commitment to passing health-care reform, lawmakers have a fresh chance to overcome recent setbacks and modernize the American health care system. The business community remains committed to helping our leaders expand access to coverage, improve quality of care聽and reverse the rise of health-care costs.鈥 We applaud the members of the House who worked diligently to put together the American Health Care Act (AHCA). (Thomas Donohue, 5/15)

Healthcare industry groups are guardedly hopeful they will have more influence on the Senate's healthcare overhaul bill than they had on the House bill passed earlier this month. That's not saying much, given how House Republicans shut them out. And it's far from a sure thing, because Senate GOP leaders hope to push through their legislation rapidly to clear the way for passing a major tax overhaul in late summer or fall. (Harris Meyer, 5/15)

Viewpoints: 'Biomedical Ecosystem' Requires Care; How Smart Phones Could Revolutionize Medical Care

A selection of public health opinions from around the country.

There is no better example of the power of the innovation produced by this biomedical ecosystem than Massachusetts, which is the envy of the world. ...聽But like any ecosystem 鈥 on a local or national scale 鈥 care is required. If we nurture and support it through continued NIH funding, meaningful intellectual property protections and appropriate rewards for breakthrough innovations, great things will happen for patients, the health care system and our economy. If we don鈥檛, the opportunity in front of us to cure the next wave of serious diseases will be lost. (Jeffrey Leiden and David Torchiana, 5/16)

Smart-phone apps are about to revolutionize medical care. These technologies can predict when cancer patients are about to relapse, detect rare side effects of experimental drugs, and prod patients to maintain healthy behaviors. Pharmaceutical firms could temper widespread concerns about high drug prices by incorporating these technologies into treatment regimens. Doing so would unlock the full potential of existing treatments. It would result in healthier patients and lower medical spending. (Vidya Ramesh and Sandip Shah, 5/15)

President Trump has tapped New Jersey Gov. Chris Christie to tackle America鈥檚 opioid crisis鈥攁 complicated task to say the least. Because the root cause of rising addiction and overdose is still unclear, any government response must be flexible and nuanced. The single biggest question regarding the opioid epidemic remains: Is it driven mainly by patients who become addicted to their prescriptions? Or are recreational users the underlying cause? This is difficult to figure out. Among the many heartbreaking personal anecdotes, hard data is scant and contradictory. (Josh Bloom and Alex Berezow, 5/15)

Now Iowa is left to deal with the aftermath of the 2017 legislative session. For understaffed state government, that means writing administrative rules, changing policies and enforcing new laws. State attorneys will try to muster a legal defense for Senate File 471, a morally indefensible Republican-crafted statute that imposes significant restrictions on access to abortion. (5/15)

A report by the nonpartisan Stanford Justice Advocacy Project finds that 30 percent of California state inmates receive treatment for serious mental disorders, a 150 percent increase since 2000. ... Sen. Jim Beall, D-San Jose, one of the few current members of the Legislature to take an interest in the issue, is carrying Senate Bill 142 to require that judges consider a defendant鈥檚 mental health history when imposing sentences and provide counties incentives in the form of payments if they can find ways to reduce the number of mentally ill felons they send to state prison. ... For the bill to work, however, there must be places to house people in need. Too few humane options exist. (5/15)

With the recent push to increase the tobacco tax in the state of Kansas by a dollar or more per pack of cigarettes, citizens should remember that this issue is not just about reducing the number of people who smoke and improving their health. It is also about the children who are involuntarily exposed to tobacco smoke. (David A. White, 5/15)

When Californians approved Proposition 64 to legalize marijuana in California last November, it was no secret that the drug would remain illegal under federal law. But that fundamental contradiction seemed manageable at the moment .... Now, however, we have President Trump, who seems to have forgotten his laissez faire stance on marijuana, and Atty. Gen. Jeff Sessions, who comes from the 鈥淩eefer Madness鈥 school of law enforcement. Proponents of Proposition 64 ... rightly worry that the federal government may decide to crack down on cannabis operators even if they fully comply with state rules. It鈥檚 understandable that state lawmakers want to resist potential federal intervention. But a proposal to make California a so-called sanctuary state for marijuana is not the way to go. (5/16)

At the end of May, World Health Organization member states will convene their annual meeting in Geneva and elect a new director-general. This leadership transition at WHO unfolds at a defining moment, when shifting demographics are forging a new global public health landscape. Competing priorities 鈥 from non-communicable diseases to universal health coverage and polio eradication 鈥 will drive the agenda. But perhaps none is more suited to the health mandate of a community of nations as the existential threat of a pandemic. When the new director-general takes the helm on July 1, at the top of his or her list should be a focused and targeted approach to ending the pandemic era. (Daniel Schar, 5/15)

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