�Թϲ�����

Health-care issues are at the top of Congress’s hefty December to-do list. Republicans spent much of the year on a failed bid to repeal and replace ObamaCare. That’s left several programs and taxes hanging in the balance as the year draws to a close, in addition to the latest health-care drama thrust into the GOP tax-reform debate. Here are five of the biggest health-care issues Congress will face next month. (Roubein, 11/26)

Lawmakers returning to Washington are confronting a full slate of health care issues that threaten to complicate a year-end sprint already fraught with debates over a major tax overhaul and immigration. The pileup is in part a consequence of Republicans’ single-minded push to repeal and replace Obamacare, which dominated health care debates for months and repeatedly collapsed in failure. (Cancryn and Pradhan, 11/27)

Senate Republicans began a frenzied week of negotiations to pass a landmark tax overhaul, grappling with several blocs of wavering GOP senators and trying to cobble together enough votes. ... A third group, including Susan Collins (R., Maine) and John McCain (R., Ariz.), helped kill the Republican health-care bill earlier this year and could pose resistance over a variety of provisions, including plans to repeal the Affordable Care Act’s health-insurance mandate as part of the tax bill. Mr. McCain said Monday that he is still undecided and had “a lot of things” he is concerned about. (Rubin and Hughes, 11/27)

Congressional negotiators are making progress towards a bipartisan deal to reauthorize children’s health insurance and several other important health-care programs, sources say. Staff from the relevant committees in both parties and chambers met over the Thanksgiving break and are getting closer to an agreement, according to lobbyists and aides. (Sullivan and Roubein, 11/27)

Colorado’s version of the program is called the Child Health Plan Plus, or CHP+. The state spends about $185 million per year on CHP+, according to a report by the Colorado Department of Health Care Policy and Financing, and nearly 90 percent of that money comes from federal funds given to the state. The program also charges some enrollment fees and copays. Without renewal from Congress, Colorado has enough money to run CHP+ until the end of January, said Marc Williams, a spokesman for Health Care Policy and Financing. (Ingold, 11/27)

In Caguas, south of San Juan, Puerto Rico, Jared Haley is fighting a daily battle at C-Axis, the medical device manufacturer where he's the general manager. The power has been out at his plant for nearly three months, since Hurricane Irma. Operating on emergency generators, the plant restarted operations last month and, Haley says, is delivering all its work on schedule. But he's not happy now with the plant's condition. Walking into his factory, he laments, "This shop used to look like a doctor's office." (Allen, 11/27)

Javier Gonzalez leans over the crib and lifts his infant son, Joshua Jacob, into an embrace, until a tangle of power cords and a plastic tube attached to the boy’s throat get in the way. Gonzalez holds the boy, nicknamed JJ, with one arm, and uses the other to brush aside the connections to the medical devices beside the crib, including a ventilator so he can breathe through a hole in his throat, and a suction machine to keep his airway clear. Gonzalez steadies JJ’s neck with a gentle hand and coaxes the 20-month-old to greet a stranger. (Chang, 11/27)

Health insurers fear they will be on the hook for greater healthcare costs if the CMS finalizes its proposal to allow states to define their own essential health benefits starting in 2019. In comments to the CMS, insurance companies that sell plans on the individual and small groups markets also said that giving states the ability to update their benchmark plans annually would confuse consumers and undermine the markets' stability. (Livingston, 11/27)

For plans sold on and off the exchange, Blue Cross Blue Shield of Arizona had an average premium increase of 51 percent, while Ambetter raised rates 74.5 percent in Maricopa County for 2017, according to Arizona Department of Insurance rate filings. An expert with the Kaiser Family Foundation, a health policy organization, said these averages paint a "broad picture" of what consumers would pay for insurance purchased through the exchange. (Bice, 11/27)

Members of so-called health care sharing ministries write checks every month to cover the health care bills of other members, without the guarantees and oversight of traditional insurance. Even more Iowans are expected to enroll now that some premiums under the Affordable Care Act have skyrocketed. (Russell, 11/27)

Being eligible for the federal subsidy — whether you’re $10 or $10,000 over the cutoff — can translate into thousands of dollars in savings when buying health insurance. And for some people, talking to a tax accountant could be as important as talking to an insurance agent or broker this year. (Boulton, 11/24)

The marketing blitz is on. Californians are getting barraged with online pop-up ads, radio spots and television commercials, all aimed at persuading them to sign up for Affordable Care Act health plans during this year’s open-enrollment season. (Ibarra and Heredia Rodriguez, 11/27)

Common Ground Healthcare Cooperative and Children’s Community Health Plan are on their way to becoming much bigger players in the health insurance marketplaces set up by the Affordable Care Act. Children’s Community Health Plan, which covered 2,900 people in November, projects that 20,000 to 30,000 people in the six southeast Wisconsin counties where it operates will sign up for its plans in the current open-enrollment period for coverage that starts Jan. 1. (Boulton, 11/27)

On Wednesday, Alex Azar, the former drug company executive nominated to take over the country’s top health care agency, will face tough questions from the senators who try to keep that department in check. Azar heads first to the Senate Committee on Health, Education, Labor, and Pensions, whose members share jurisdiction on health care issues with the Senate Finance Committee, which will ultimately preside over his official confirmation hearing. (Mershon and Swetlitz, 11/28)

Five medical centers within the Department of Veterans Affairs failed to report eight potentially dangerous doctors to a national database where such information is collected, according to the results of a government investigation released Monday. The Government Accountability Office found in its of five VA medical centers that 148 providers were reviewed from October 2013 through March 2017 after concerns were raised about their conduct. (Hellmann, 11/27)

The steady growth of e-commerce has been a source of jobs and benefits as employment in traditional stores declines. But at online retailers taken over by Walmart, workers are finding one benefit in retreat: their company-sponsored health coverage. In little more than a year, Walmart has spent nearly $4 billion acquiring e-commerce companies with thousands of workers. Last month, many learned that their potential out-of-pocket costs for medical expenses would increase in 2018 at a rate far exceeding the overall rise in health care costs — reaching thousands of dollars in many cases. (Scheiber and Corkery, 11/27)

Arkansas has again cut off Medicaid funding to Planned Parenthood, the state's Department of Human Services said Monday, following a court ruling upholding the state's decision to defund the group over videos secretly recorded by an anti-abortion group. DHS spokeswoman Amy Webb said the state terminated the group's status as a Medicaid provider last week after the 8th U.S. Circuit Court of Appeals' decision formally took effect. (DeMillo, 11/27)

New Hampshire could become one of just a few states that allows birth control pills to be prescribed by pharmacists. A commission appointed by the state legislature voted unanimously last week to endorse the idea. (Ganley and McIntyre, 11/27)

Bill Crossman is an unlikely candidate to run a pharmaceutical firm. The 71-year-old Connecticut businessman had spent decades growing a diverse collection of companies making everything from elevators to eco-friendly products. He had never run a drug company — and had little to no experience in the industry. But Crossman’s long-lasting struggle to help his stepson overcome an opioid use disorder drove him to search for answers. A scientist who started Phoenix Pharma Labs, a tiny private drug company, introduced Crossman to an opioid he believed could someday treat pain well without increasing risk of addiction. (Blau, 11/28)

More than half of all people who succumbed to an overdose between 2001 to 2007 were chronic pain sufferers who filled an opioid prescription and sometimes even saw a doctor in the month before they died. Only 4 percent were ever diagnosed as having an abuse problem, said Dr. Mark Olfson, one of five researchers who conducted a massive study of the crisis and its causes for Columbia University Medical Center. The findings of the new study, published Tuesday in the American Journal of Psychiatry, split the epidemic into two groups: those who were diagnosed with chronic pain and those who weren’t. In the year before they died, about two-thirds of those studied were diagnosed with chronic pain and prescribed an opioid. (Rausch, 11/28)

Eager to speed development of revolutionary treatments, the Food and Drug Administration recently announced that it would expedite approval of experimental gene therapies. But the regulatory process may not be the biggest obstacle here. Biotech companies have exciting plans to introduce treatments that may be transformative, sometimes curing genetic diseases with a single treatment. And the firms are itching to test their products. (Kolata, 11/27)

The Phage Directory could help  shorten the steps for those who are desperately looking for the right virus. [Jessica] Sacher and [Jan] Zheng designed it as a one-stop-shop where researchers could list the kinds of bacteria that might be fought with the different phages they have in their labs. Originally they were going to call it Phagebook, but the domain name was taken. ...Scientists would still have to test the phages against a particular patient’s bacteria, and then purify the virus so that it doesn’t poison the person with remaining bacterial bits. (Boodman, 11/28)

Their lives may be portrayed as glamorous. In fact, they’re often the opposite. Pity frequent business travelers. Doctors at organizations including the Centers for Disease Control and Prevention and the International Society of Travel Medicine say they are hearing of a range of health problems in frequent travelers, from insomnia and weight gain to viruses. And they said they see a need for more comprehensive research into the health compromises made by business travelers, both short haul and long haul. (La Gorce, 11/27)

In “The Humanizing Voice: Speech Can Reveal, and Text Conceal, The Presence of a Thoughtful Mind in The Midst of Disagreement” in a recent issue of Psychological Science, Juliana Schroeder of the University of California at Berkeley and faculty at the University of Chicago conducted several experiments exposing volunteers to ideas they agreed or disagreed with. In one, about 300 people watched, listened to or read arguments about war, abortion or music (country or rap — genres people tend to have strong feelings about). Afterward, the volunteers were asked to judge the person who communicated the argument. Those who were exposed to someone they disagreed with tended to “dehumanize” the communicator. That is, they regarded the person as “having a diminished capacity to either think or feel.” However, those who listened to the argument, either in a video or audio file, were less dismissive than those who read a transcript of the opposing opinion. (Nutt, 11/27)

The recent surge in accusations of sexual harassment and assault has prompted some admitted offenders to seek professional help for the emotional or personality distortions that underlie their behavior. “My journey now will be to learn about myself and conquer my demons,” the producer Harvey Weinstein said in a statement in October. The actor Kevin Spacey announced that he would be “taking the time necessary to seek evaluation and treatment.” (Carey, 11/27)

Scientists at the Massachusetts Institute of Technology and Harvard University have developed a variety of origami-inspired artificial muscles that can lift up to a thousand times their own weight — and yet be dexterous enough to grip and raise a delicate flower. The devices, described in the Proceedings of the National Academy of Sciences, offer a new way to give soft robots super-strength, which could be used everywhere from inside our bodies to outer space. (Khan, 11/27)

According to the new guidelines, developed by the American Heart Association and American College of Cardiology, nearly half of American adults now suffer from high blood pressure, an increase of 30 million people compared to the previous definition. Often called the "silent killer," high blood pressure often doesn't make people feel ill until it's too late to prevent a heart attack, stroke or significant kidney damage. (Hunt, 11/27)

More than half of LGBTQ Americans older than 50 say the larger problem is discrimination from individuals. Younger generations say biased laws share the blame. (Bebinger, 11/28)

There are many reasons for women to think twice about reporting sexual assault. But one potential consequence looms especially large: They may also be prosecuted. (Armstrong and Miller, 11/24)

Though they continue to see fewer cases and no new deaths have been reported since Oct. 31, San Diego County supervisors on Monday chose to continue the local health emergency status for the region’s ongoing hepatitis A outbreak. Supervisor Ron Roberts noted that, while he considered the latest hepatitis A report from the county Health and Human Services Agency good news, the emergency won't be truly over until new-case rates shrink further. (Sisson, 11/27)

A Senate study committee Monday recommended the state allow advanced practice registered nurses (APRNs) broader medical authority if they work in rural, underserved counties. Under current state law, nurse practitioners and other advanced nurses in Georgia can prescribe medications only under a collaborative agreement with a physician. (Miller, 11/27)

November is men’s health awareness month, and UCHealth is spreading the word. The care system launched a campaign called “MANtenance” to address the importance of physical health and stress management and to talk about topics like masculinity — subjects many believe need greater emphasis in modern life. While more men are paying attention to and talking about health issues like prostate and testicular cancer, MANtenance encourages men to focus on and maintain their everyday health, as well. UCHealth recruited C.J. Anderson of the Denver Broncos, Gabriel Landeskog of the Colorado Avalanche and University of Colorado men’s basketball head coach Tad Boyle to serve as spokesmen for the campaign.  (Rios, 11/27)

A recent Securities and Exchange Commission filing for UM shows that the university lost $94.5 million operating the hospital during the year that ended May 31. That’s more than double the $45 million UM lost on the hospital during the prior year. (Chang, 11/27)

Two weeks after Mayor Megan Barry abruptly announced plans to end inpatient care at Nashville General Hospital, a new 11-member stakeholder team has formed to guide the administration's final proposal. Barry, in a letter last week to the Metro Council, said she will lean on a committee organized by Meharry Medical College President James E. K. Hildreth to help form a final proposal for the city's safety-net hospital that serves Nashville's indigent population. (Garrison, 11/27)

The Nurse-Family Partnership provides first-time, low-income mothers in Dallas-Fort Worth with a personal nurse from the time they're pregnant until their child's second birthday.  The free initiative partners with the WiNGS Dallas center, the Parkland Health & Hospital System and Tarrant County Public Health services to assign mothers a registered nurse to check on them and their baby at their home.  (Limón, 11/27)

The University of South Florida has formed a partnership with a network of hospitals to train more doctors in the Tampa Bay area. The consortium with HCA West Florida could help with the state's looming physician shortage and help the hospital chain keep more qualified doctors in the Tampa Bay area. (Ochoa, 11/27)

On a recent weekday morning, [D'Andre] Alexander glides his wheel chair into an office at HCMC to check in with counselor Farji Shaheer, one of two who staff the hospital's Next Step program. Since 2016, 170 HCMC patients have participated in the program. The majority of whom are, like Alexander, between 14 and 26 years of age, black and have been injured by gun fire. (Williams, 11/27)

Officials at an Iowa school for juvenile offenders are failing to provide adequate mental health care to youth and are instead administering powerful drugs without proper oversight or consent, according to a lawsuit filed Monday by two advocacy groups. Disability Rights Iowa and Children’s Rights, a national watchdog group, accuse administrators at the state-run Boys State Training School of giving juveniles “dangerous” psychotropic medications. The groups allege the drugs are used “as a behavioral management tool” they likened to a chemical straitjacket. (Rodriguez, 11/27)

An Indiana hospital system says a nurse is no longer an employee after she was tied to a message on Twitter claiming white women are raising sons “with the HIGHEST propensity to be a terrorist, rapist, racist, killer, and domestic violence all star.” Officials at Indiana University Health said over the weekend they were investigating “several troubling posts on social media” that appeared to be made by a recently hired employee identified in news reports as Taiyesha Baker. IU Health spokesman Jason Fechner confirmed Monday that the nurse no longer works at Indiana University Health Methodist Hospital in Indianapolis but he would not say whether she was fired, citing company policies. (Bever, 11/27)

It has been just two months since the Senate gave up on trying to pass a series of health care bills that Americans had soundly rejected in poll after poll. Yet the same Republican recipe for health care now is back on the table in the form of the lopsided tax bill that the Senate plans to vote on this week. A lot of people get intimidated by the idea of trying to understand the tax bill. It’s a shame because, much like congressional budgets, tax bills reveal priorities. (Andy Slavitt, 11/28)

The primary lines of attack on the Republican tax cut plan have been twofold: It redistributes incomes upward, from the middle class to the wealthy, and it significantly raises the debt. These attacks have been potent in the sense that the longer this awful plan sits out there, the less popular it becomes. Unfortunately, contemporary tax policy, Republican-style, is not a representative exercise. It’s all about pleasing the rich donor base, posting a win, any win, and shrinking the government at any cost. About that last point, consider the other reason the tax plan is so ill-advised: its potential effect on health care. (Jared Bernstein, 11/27)

Meanwhile, the bill would partially repeal Obamacare, in a way that would sharply reduce aid to lower-income families and raise the cost of insurance for many in the middle class. (Paul Krugman, 11/27)

Child healthcare advocates have been warning, and warning, and warning that Congress' delay on reauthorizing funds for the Children's Health Insurance Program places health coverage for as many as 9 million children and pregnant women at risk. But since the funding expired Sept. 30, there has been no action by Congress. (Michael Hiltzik, 11/27)

[A] dysfunctional Congress is putting insurance for these children in jeopardy. Lawmakers missed a Sept. 30 deadline to extend funding to the popular program. Now it's running out of money for the first time since its creation. ... Officials in nearly a dozen states plan to begin notifying families this week that the health insurance program may come to an end. Iowa expects to have adequate funding for a few more months, but the federal government pays nearly 90 percent of the cost. If Congress fails to act, this state will be faced with finding alternatives, which may include spending millions of additional state dollars we don’t have or shuttering our program. So where the heck is Sen. Chuck Grassley? (11/27)

The legislators passed a budget bill that directed Gov. Gina Raimondo to find $25 million in “undistributed savings,” requiring no legislative oversight and depriving the public the opportunity to weigh in on how the savings would be achieved. In early October, the governor responded, outlining a plan that would draw about 20 percent of those cuts from the state’s Medicaid program. Such a large cut is a burden to Rhode Islanders who rely on Medicaid for their care. Worse, the majority of the Medicaid cuts undermine two of the state’s most important “Reinventing Medicaid” initiatives — “rebalancing long-term care” and “health-care system redesign.” (Linda Katz and Karen Malcolm, 11/27)

Maine made history earlier this month by becoming the first state to adopt Obamacare's Medicaid expansion via ballot initiative. The vote could inspire progressive activists in other states to push for similar referenda. Expanding Medicaid to cover childless, able-bodied adults would blow a hole in state budgets while yielding few, if any, public health gains. That's because Medicaid provides such low-quality care that its beneficiaries often experience worse health outcomes than people with no health insurance. (Sally Pipes, 11/27)

At a time when tax reform is at the top of legislative priorities, it is easy to forget that most of the richest and most profitable hospital systems in the United States enjoy tax-exempt status. They were given this in exchange for providing benefits to their local communities, like charity care and medical outreach. However, as Politico’s Dan Diamond recently reported about the Mayo Clinic, whether those hospitals serve inner-city neighborhoods or sparsely populated rural areas, they frequently overlook the communities they are required to serve. (Haider Warraich, 11/27)

Recently, a coalition of more than 100 health care, business, education, and health advocacy groups comprising the Coalition for a Smoke-Free Tomorrow called on the Kentucky legislature to raise the state tax on cigarettes by $1 per pack, with parallel increases in taxes on other tobacco products. (Ben Chandler, 11/24)

But, as ob-gyn residents who are currently training at UW, we are deeply concerned that this stellar program will end — because of proposed legislation introduced by State Rep. Andre Jacque and State Sen. Chris Kapenga. This legislation (Assembly Bill 206 and Senate Bill 154) would eliminate the UW’s ability to offer ob-gyn residents training in abortion services as required by the national accrediting body, the Accreditation Council for Graduate Medical Education. (Sierra M. Jansen and Ross Harrison, 11/27)