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Morning Briefing

Summaries of health policy coverage from major news organizations

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Wednesday, May 24 2017

吃瓜不打烊 Original Stories 1

  • Putting A Lid On Waste: Needless Medical Tests Not Only Cost $200B 鈥 They Can Do Harm

Administration News 5

  • Trump's 'Skinny Budget' Puts Health Care On A Drastic Diet
  • Medicaid Cuts In Trump's Budget Would Be 'Just Awful,' Advocates Say
  • Proposed Cuts Land With A Thunk In Congress: 'The Budget Was Dead Before The Ink Was Dry'
  • President's Blueprint Targets The Very People Who Helped Put Him Into Office
  • Proposed Gutting Of Drug Czar's Funding Rolled Back To Just Trims After Vocal Outcry

Health Law 3

  • Washington Waits With Bated Breath For CBO Score On GOP Health Plan
  • A Plea To Congress From The Industry: Give Us A Short-Term Fix To Stabilize Marketplace
  • Moderate At Center Of House Health Bill Negotiations Gives Up Chairman Position

Quality 1

  • Review Of H-1B Visa Practices Imperils Efforts To Attract Foreign Doctors To Underserved Areas

Public Health 3

  • Who Should Be Punished When A Child Dies From An Accidental Gunshot? The Answer Varies State To State
  • Teaching Hospitals Have Lower Death Rates For Older Patients Than Less Costly Community Hospitals
  • WHO's Next Director-General Will Be First To Come From Africa

State Watch 1

  • State Highlights: Contract Dispute In Ariz. Leaves Many Out Of Network At Dignity Health Hospitals; Texas Lawmakers OK Maternal Health Bills

Prescription Drug Watch 3

  • With Little Federal Progress Being Made, States Step Up Own Efforts To Curb High Drug Prices
  • Amazon Mulls Entering PBM Field, Even As These Middlemen Bear Brunt Of Blame Over High Drug Costs
  • Perspectives: FDA Wades Into Pricing Controversy, But Doesn't Have Authority To Actually Fix It

Editorials And Opinions 2

  • Different Takes On Doing The Math: Trying To Add Up 'Trumponomics;' The Trump Budget's 'Best New Idea'
  • Viewpoints: The Rule Of Law And Subsidies; Anticipating CBO's Score On The GOP Health Plan

From 吃瓜不打烊 - Latest Stories:

吃瓜不打烊 Original Stories

Putting A Lid On Waste: Needless Medical Tests Not Only Cost $200B 鈥 They Can Do Harm

The health care industry thrives on ordering up tests and treatments, but some hospitals are urging restraint. ( Chad Terhune , 5/24 )

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Summaries Of The News:

Administration News

Trump's 'Skinny Budget' Puts Health Care On A Drastic Diet

The 2018 budget proposed by the president makes deep cuts across the health care industry, from cancer research and public health to infectious diseases and drug safety. Media outlets break down which agencies and missions will be affected the most.

Under the heading 鈥淧utting America鈥檚 Health First,鈥 the Trump administration鈥檚 2018 budget blueprint includes a $5.8-billion cut for the National Institutes of Health, a move that would slash the medical research agency鈥檚 funding by just over 18%. It would reduce public health spending by the U.S. Centers for Disease Control and Prevention by $1.32 billion, a 17% decline from 2017 spending levels. And it would cut the Food and Drug Administration鈥檚 spending by $854 million, a 31% decrease cut from current funding levels. (Healy, 5/23)

The NIH, which funds research into medical treatments and basic science, would see cuts of almost $6 billion, to about $26 billion. That would include a $575 million cut to the National Heart, Lung and Blood Institute and $838 million cut to the National Institute of Allergy and Infectious Diseases, which is involved in a wide range of diseases including AIDS and Zika. The National Institute of Diabetes and Digestive and Kidney Diseases would be cut by $355 million. (Kodjak and Stein, 5/23)

President Trump鈥檚 2018 budget proposal would bar Planned Parenthood and other abortion providers from receiving federal funds that help pay for health-care services for millions of Americans. The budget, the 鈥淣ew Foundation for American Greatness,鈥 was released Tuesday, proposing to cut trillions of dollars in spending during the next decade. The budget is part of the Trump administration鈥檚 effort to follow through on a campaign promise to exclude 鈥渃ertain entities that provide abortions, including Planned Parenthood鈥 from participating in any Department of Health and Human Services programs, according to a fact sheet from the White House. (Bever, 5/23)

At least one million people will die in sub-Saharan Africa and elsewhere, researchers and advocates said on Tuesday, if funding cuts proposed by the Trump administration to global public health programs are enacted. The United States currently spends more than $6 billion annually on programs that buy antiretroviral drugs for about 11.5 million people worldwide who are infected with H.I.V., the virus that causes AIDS. The Trump administration has proposed slashing those programs by at least $1.1 billion 鈥 nearly a fifth of their current funding, said Jen Kates, a vice president at the Kaiser Family Foundation. (Harris, 5/23)

True to its word, the Trump administration released its 2018 budget that includes a notable change for drug and device makers 鈥 they would face a stiff increase in so-called user fees that industry pays for to fund product reviews conducted by the Food and Drug Administration. And the higher fees, which are slated to nearly double to $2.4 billion, would be used to cover the entire cost of those reviews...The notion was widely anticipated after a May 15 letter, which written by US Health and Human Services Secretary Tom Price to the Senate Health, Education, Labor, and Pensions Committee, leaked out. (Silverman, 5/23)

The budget outline released by the White House Tuesday contains sharp cuts to everything 鈥 from a $76 million reduction in聽global health funding聽that includes HIV programming聽to grass-roots community health grants. And while it鈥檚 not clear what cuts will survive the congressional budget process, the聽proposal聽reveals a White House that, for the most part, wants a leaner public health system, and less American money used聽overseas. (Facher, 5/24)

How does science fare under President Trump鈥檚 proposed budget? Not too well. The American Assn. for the Advancement of Science (AAAS) estimated that the budget released Tuesday morning represented a 16.8% decrease in overall funding for scientific research compared with the current budget. (Netburn, 5/23)

The release of President Donald Trump鈥檚 $4.1 trillion spending plan for the fiscal year starting in October sparked concern on Tuesday in Boulder鈥檚 scientific community for its potential impact on the work that many see as critical to public safety in the face of a changing global climate. At the national level, much of the early focus has been on the budget鈥檚 slashing to Medicaid and anti-poverty efforts. But its cuts to scientific research are also being viewed warily at the local level. (Brennan, 5/23)

The leaders of agencies responding to the spread of聽Zika聽virus told lawmakers Tuesday that theyneed consistent support to combat the disease, an聽appeal that came on the day the White House released its budget proposal that would strip billions of dollars from those same agencies and from public health systems strained by the effects of聽Zika. The Trump administration wants to cut $7 billion from the $34-billion National Institutes of Health in fiscal 2018, an amount that includes a $1.1 billion cut to the $4.9 billion National Institute for Allergy and Infectious Diseases, which is developing a promising vaccine to prevent the Zika virus. (Siddons, 5/23)

The budget initiates deep cuts to health insurance programs for people with modest incomes, including coverage for children. Those cuts would go beyond the House GOP bill that repeals much of the Affordable Care Act, also known as "Obamacare," and limits future federal financing for Medicaid. (5/24)

Medicaid Cuts In Trump's Budget Would Be 'Just Awful,' Advocates Say

President Donald Trump is proposing $800 billion in cuts to the program, as well as deep trims to the Children's Health Insurance Program.

The poor and the disabled are big losers in President Donald Trump's $4.1 trillion budget proposal while the Pentagon is a big winner. Trump's plan for the budget year beginning Oct. 1 makes deep cuts in safety net programs, including Medicaid and the Children's Health Insurance Program. The proposal also includes big cuts in Social Security's disability program. (Ohlemacher, 5/24)

Advocates for low income people struggled to find the words to describe the likely effect of the proposed $800 billion in聽cuts聽proposed to Medicaid in the Trump administration's budget released Tuesday. Depending who you ask, it will be devastating or "just awful"聽to the聽lowest income Americans, especially children and those with chronic health conditions, mental illness or substance use disorder. (O'Donnell, Saker and Robinson, 5/23)

Lower-income children would have their federal health benefits cut sharply under President Trump鈥檚 proposed budget, which analysts say could reverse gains that have pushed uninsured rates for this vulnerable population below 5聽percent. The shift stems from a combination of factors, including a plan to reduce Medicaid by $1.4聽trillion over the next decade and a roughly 20聽percent decrease in funding for the Children鈥檚 Health Insurance Program (CHIP), along with proposed changes to eligibility requirements and the way federal matching funds are calculated. (Eilperin, 5/23)

A group of Republican senators is fighting desperately to preserve health coverage for millions of low-income constituents who have benefited from Obamacare. And the president of their own party seriously undercut their negotiating position with his budget Tuesday. By proposing hundreds of billions of dollars in Medicaid cuts in combination with the House-passed health care bill鈥檚 more than $800 billion in Medicaid spending reductions, President Donald Trump is effectively throwing in with fiscal conservatives looking to constrain the program鈥檚 growth and wind down its coverage as quickly as possible. And that could be perilous for more than a dozen GOP senators who have been meeting for months over how to preserve the law's benefits. (Everett and Cancryn, 5/23)

Special education, which is hugely reliant on Medicaid, is one factor that didn't get much attention in the debate over the Republican health care bill. If the bill becomes law and triggers billions of dollars of cuts to Medicaid, how would it affect the millions of public school kids who receive special ed services? William Brangham talks to Sasha Pudelski of the American Association of School Administrators. (5/22)

Proposed Cuts Land With A Thunk In Congress: 'The Budget Was Dead Before The Ink Was Dry'

The severe cuts contained in President Donald Trump's proposed budget are meeting stiff bipartisan resistance in Congress.

While some fiscally conservative lawmakers, particularly in the House, found a lot to praise in Trump鈥檚 plan to balance the budget within 10 years, most Republicans flatly rejected the White House proposal. The divide sets up a clash between House conservatives and a growing number of Senate Republicans who would rather work with Democrats on a spending deal than entertain Trump鈥檚 deep cuts. 鈥淭his is kind of the game,鈥 said Senate Majority Whip John Cornyn (R-Tex.). 鈥淲e know that the president鈥檚 budget won鈥檛 pass as proposed.鈥 (Snell, Paletta and DeBonis, 5/23)

鈥淚 hate to say it, but I would say the budget was dead before the ink was dry,鈥 Rep. Don Young (R., Alaska), who opposes the budget鈥檚 elimination of two programs in his state. Payments to Medicaid, the federal-state health program for the poor, would be cut by more than $600 billion over a decade from levels projected under current law in addition to proposed Medicaid cuts under the House bill repealing and replacing much of the Affordable Care Act. (Davidson, Peterson and Andrews, 5/23)

Longtime GOP Rep. Hal Rogers of Kentucky declared proposed cuts to safety net and environmental proposals "draconian." "I don't think the president's budget is going anywhere," said Republican Sen. Bill Cassidy of Louisiana, asked if he's concerned about the message sent by slashing the Medicaid program for the poor and disabled. (Werner, 5/23)

Finally some good news for President Trump: His new budget stands absolutely no chance of being enacted by Congress. Moving forward with the cuts outlined in the $4.1 trillion spending plan created by the budget director, Mick Mulvaney, formerly one of the most determined fiscal hawks in Congress, would no doubt have major repercussions and compound the peril of Republicans already facing upheaval over their health care proposals. It would most likely hurt some of the very voters in rural and economically distressed corners of the nation who catapulted Mr. Trump to the White House and Republicans to control of the House and Senate. The effect on those constituents would be quickly felt. (Hulse, 5/23)

Top officials in President Donald Trump鈥檚 Cabinet are heading to Capitol Hill to defend his plans to cut domestic programs and parry Democratic criticism of his tax proposals. Budget Director Mick Mulvaney appears Wednesday before the House Budget panel while Treasury Secretary Steven Mnuchin will testify at the tax-writing House Ways and Means Committee. The budget contains virtually no further detail on taxes beyond the cuts the administration proposed in a one-page outline last month. (Taylor, 5/24)

President Donald Trump may have handed Republicans leery of supporting him a great gift: a spending plan that calls for deep cuts to some of the country鈥檚 most popular programs 鈥 and one they can rail against. Indeed, it did not take long for congressional Republicans on Tuesday to distance themselves from the White House鈥檚 $4.1 trillion budget blueprint, promising their constituents they鈥檇 fight Trump鈥檚 ideas. (Clark, 5/23)

The administration's聽Medicaid proposals draw particular criticism from both sides of the aisle聽鈥

GOP senators are balking at President Trump鈥檚 proposed steep cuts to the nation's healthcare system for the poor, worrying that it could leave millions without health plans. Trump鈥檚 budget proposal would gut Medicaid by $627 billion over the next decade, on top of the $839 billion that would be cut under the House-passed ObamaCare repeal-and-replace bill. Combined, Trump and House Republicans have proposed slashing $1.4 trillion from Medicaid. (Hellmann and Weixel, 5/23)

The OMB budget says Medicaid outlays would drop by $627 billion in the decade ending in fiscal 2027, falling to $4.70 trillion. This appears to largely reflect a Trump administration plan to reduce the flow of federal dollars to state Medicaid funds beyond the reduction proposed in the House GOP bill (HR 1628). OMB then has a separate placeholder item in its budget for $1.25 trillion in expected savings from Republican revisions to the 2010 health care law. (Young, 5/23)

Meanwhile,聽Hillary Clinton blasts the president's budget聽鈥

Hillary Clinton proclaimed Tuesday that President Donald Trump's budget shows an "unimaginable level of cruelty" for millions of Americans and children. The former Democratic presidential nominee, who recently declared herself part of the Trump resistance, lashed out at the Republican president's spending plan in aggressive terms after being honored in New York City by the Children's Health Fund, a nonprofit organization that helps provide health care to poor and homeless children. (Peoples, 5/23)

President's Blueprint Targets The Very People Who Helped Put Him Into Office

The proposed cuts are "a slap in the face," some voters say.

President Donald Trump鈥檚 proposals to slash federal aid to the poor, the sick and people living in rural areas reflect conservatives' demands for a smaller federal government but target many of the very people who voted for him last November. In his first detailed budget submission to Congress on Tuesday, Trump requested major reductions to programs that help poor families afford groceries and poor and disabled people get healthcare. (Cowan, 5/23)

Two of farmers鈥 most powerful Republican advocates in the Senate slammed President Donald Trump鈥檚 proposal Tuesday to slash crop insurance, warning those and other budget cuts would badly wound one of the president鈥檚 most loyal constituencies. Voters who live in rural areas gave Trump a 61-34 percent advantage over Democrat Hillary Clinton in November, according to network exit polls. (Wise and Lowry, 5/23)

Proposed cuts in President Donald Trump's 2018 budget for HHS would reduce funding for rural hospitals and hurt the supply pipeline for black and Hispanic healthcare professionals. The budget proposal targets several rural hospital grants in its projected cuts. The Rural Hospital Flexibility Grant, at $42 million, is proposed for elimination. The Obama administration previously had recommended cutting the program, saying it was duplicative. The new budget also zeroes out grants to state offices of rural health, a $9 million program. (Lee, 5/23)

More than 5,200 staffers would be cut from the agency that oversees food stamps, farm loans, animal and plant disease prevention, and other programs under the 2018 budget proposal President Donald Trump sent to Congress on Tuesday...聽While lawmakers on both sides of the aisle quickly proclaimed the spending plan overly aggressive and likely dead on arrival, Perdue during the call recalled getting through tough fiscal times as governor of Georgia and said he would lead the USDA amid any approved cuts. (Brezosky, 5/23)

Meanwhile, governors in California and Louisiana react to the budget聽鈥

President Trump鈥檚 proposed budget would likely result in billions of dollars of cuts to vital health and human services programs in California, state Democratic lawmakers and advocates for the poor said Tuesday. 鈥淚t鈥檚 unconscionable and un-American,鈥 said Gov. Jerry Brown in a written statement. (Myers, 5/23)

[Gov. John Bel] Edwards said the budget proposal also threatens key health care services such as the聽Children's Health Insurance Program, which offers health care to 122,000 Louisiana children.聽He urged the state's congressional delegation to oppose Trump's budget, "including cutting federal funding for Medicaid patients and health care providers by eliminating Medicaid expansion coverage and cutting health care for elderly and disabled residents." (Shleifstein, 5/23)

Proposed Gutting Of Drug Czar's Funding Rolled Back To Just Trims After Vocal Outcry

A draft of the president's budget had shown a proposed 95 percent cut to the office in the middle of an opioid epidemic. But the released plan walks that back. Meanwhile, Food and Drug Administration Commissioner Scott Gottlieb is calling on his staff to increase efforts to fight the crisis sweeping the country.

After an outcry, the Trump administration has rolled back a proposed gutting of the Office of National Drug Control Policy, instead asking for relatively small trims to the office and largely preserving two main grant programs. President Trump鈥檚 2018 budget 鈥 released Tuesday 鈥 is just a proposal; Congress actually allocates government spending. (Joseph, 5/23)

The administration鈥檚 final budget proposal, released Tuesday, continues funding for the office, which oversees two key national anti-drug programs. A document leaked earlier this month proposed cutting funding for the program by 95 percent. (Reid, 5/23)

Lawmakers in states where opioid abuse is rampant praised the Office of Management and Budget for not proceeding with the original cuts. 鈥淚鈥檓 happy to see OMB reversed course and included funding for the office in its budget,鈥 said Sen. Shelley Moore Capito, R-W.Va., a member of the Appropriations Committee. "We still have a long way to go when it comes to the drug epidemic, and it is essential that we remain fully committed to fighting it. We need to be doing more 鈥 not less.鈥 (Siddons, 5//23)

Food and Drug Commissioner Scott Gottlieb called on his staff Tuesday to explore 鈥渕ore forceful鈥 efforts to curb the epidemic, including requiring training for doctors and ensuring patients aren't prescribed the medications for unnecessarily long periods聽that increase the risk of addiction. 鈥淥pioid prescriptions should be written only for appropriate patients and for appropriate durations,鈥 Gottlieb said in his first interview since becoming commissioner. 鈥淣o more 30-day supplies for tooth extractions鈥 or uncomplicated hernia repairs. (McGinley, 5/23)

And in opioid news from the states聽鈥

New York lawmakers working to address the heroin and opioid epidemic want to hear from the experts 鈥 and people with first-hand experience with addiction. A state Senate Task Force is holding a public hearing Wednesday at the Fulton-Montgomery Community College in Johnstown. (5/24)

CVS drugstores聽will begin selling Naloxone 鈥 an opioid-overdose reversal drug聽鈥斅爓ithout a prescription in Arizona,聽the company said Tuesday.聽Arizona Attorney General Mark Brnovich said he has been working with pharmacies to combat opiod addiction in Arizona. (Gundran, 5/23)

A new report from Florida medical examiners finds fentanyl caused more deaths than any other drug in Florida last year. With fentanyl coming into the U.S. illegally in pill and powder form, it鈥檚 now being cut with heroin. (Aboraya, 5/23)

Amid Georgia鈥檚 opioid problem, a new drug has entered the market. 鈥淕ray death,鈥 a cocktail of several opioids, was reported to have claimed its first death in Georgia last week.聽Despite efforts to curtail the spread of opioids in the Southeast, drugs are getting even stronger and more deadly, according to Georgia Bureau of Investigation public affairs director Nelly Miles. (Such, 5/23)

Health Law

Washington Waits With Bated Breath For CBO Score On GOP Health Plan

The politically bruised agency is expected to release the score Wednesday, which will determine whether the Senate can move forward with any plans to repeal and replace the Affordable Care Act.

Congressional Republicans are about to learn more about whether their drive to dismantle President Barack Obama's health care law has been worth the political pain they've been experiencing. The Congressional Budget Office planned to release its estimate Wednesday of what impact the GOP's House-passed health care overhaul would have on coverage and premiums. (Fram and Alonso-Zaldivar, 5/24)

Republicans are bracing for a report Wednesday expected to say their Obamacare repeal plan would leave millions of Americans without health insurance, further complicating their efforts to pass legislation quickly. The CBO鈥檚 analysis of the bill comes three weeks after House Republicans rushed to vote on the legislation without an update on its cost, or its impact on the nation's uninsured. The agency's score will serve as the unofficial framework for Senate lawmakers negotiating their own version of repeal and will likely help those eager to make big changes. It's also expected to become a rallying point for Democrats critical of an effort that could strip health care from millions. (Cancryn and Ferris, 5/23)

A Plea To Congress From The Industry: Give Us A Short-Term Fix To Stabilize Marketplace

Hospitals, physician groups, health insurers and the U.S. Chamber of Commerce are all asking lawmakers to step in to make sure the marketplaces don't collapse amid the uncertainty around the Affordable Care Act and the Republicans' efforts to dismantle it. Meanwhile, there's growing pressure for the Senate to pass a version of the legislation before August recess. And CEOs are hiding behind big lobbying groups when it comes to wielding influence on the plan.

Senate Republicans face increasing pressure to rescue health insurance markets and protect coverage for millions of Americans amid growing fears the Trump administration is going let the markets collapse. In recent days, leading hospitals, physician groups, health insurers and the U.S. Chamber of Commerce have pleaded with the Senate to step in, effectively going around the White House. (Levey and Mascaro, 5/23)

Sen. Lamar Alexander has found himself in an uncommon position for most Republicans this year: Trying to save the shaky insurance markets created by the 2010 health care law before attending to a major overhaul of the law. The opinions of the Tennessee鈥檚 senior senator carry significant weight among his colleagues. He is a close confidant of Senate Majority Leader Mitch McConnell and also chairs the Health, Education, Labor and Pensions Committee. And while Alexander has been a near constant critic of former President Barack Obama鈥檚 signature domestic achievement, he is now one of the leading voices in the chamber for saving it, at least for 2018 and 2019. (Williams, 5/24)

Senate Majority Leader Mitch McConnell sent a warning to staffers last week amid growing frustration at the amount of information leaking from private Republican discussions on repealing the 2010 health law. At a May 16 meeting of his health care working group, the Kentucky Republican excused all non-leadership staffers after expressing annoyance over the number of leaks about the closed-door discussions, GOP senators and aides told Roll Call. He was particularly frustrated with a report that cited a verbatim conversation that took place during a prior meeting, according to one lawmaker who spoke on the condition of anonymity. (Williams and Mershon, 5/23)

Senate Republicans are under mounting pressure to pass an ObamaCare repeal-and-replace bill before the congressional recess in August. While Senate Majority Leader Mitch McConnell (R-Ky.) is wary of committing to a specific deadline after the House struggled to pass a bill, the White House wants the upper chamber to hit the gas. Health and Human Services Secretary Tom Price and House GOP lawmakers are publicly nudging the Senate to vote before lawmakers leave town at the end of July. (Carney, 5/24)

House Republicans' Affordable Care Act repeal-and-replace bill is likely to undergo serious changes before the Senate votes on the legislation. But few healthcare CEOs are wielding their influence publicly to shape the legislation that will significantly affect their companies' bottom lines and customers. Insurer and provider executives are hiding behind industry lobbying groups, including America's Health Insurance Plans and the American Hospital Association, instead of using their power to influence lawmakers on the GOP's American Health Care Act. Their silence is a missed opportunity to serve their patients' best interests, some experts say. (Livingston, 5/23)

In other news on the American Health Care Act聽鈥

In a $2 million ad campaign to support the House GOP health plan, the right-leaning American Action Network (AAN) features a California woman named Elizabeth Jacinto who says she suffered under Obamacare and expresses enthusiasm for the American Health Care Act. The ACHA only narrowly passed the House and was greeted lukewarmly by the Senate, so a key part of the effort appears to assist 21 GOP lawmakers who cast a tough vote to support proposal. (Kessler, 5/24)

Meagher County, Montana, may not be much different than the rest of the rural enclaves across America that voted overwhelmingly for Donald Trump last fall. The median annual household income is $38,000 鈥 about 25 percent below the national average. Nearly 20 percent of its 1,800 residents live in poverty. And more than one in four people don't have health insurance. (5/23)

Facing a repeal of the Affordable Care Act and potential premium hikes next year, New Hampshire lawmakers are proposing to give state regulators broad authority to quickly respond...Under the measure, the state insurance department can work with the New Hampshire Health Plan to take steps meant to maintain coverage and stabilize prices in the individual market. Those could include reviving a high-risk pool or seeking waivers from the federal government to get money, officials said. Gov. Chris Sununu said in a letter that it is not his intent to waive requirements that insurers cover pre-existing conditions. Any changes would need a public hearing and sign-off from a legislative oversight committee. (Morris, 5/24)

Massachusetts, the state with the highest rate of residents with health insurance, could see its uninsured rate jump above 10 percent if the sweeping health care bill approved by the US House becomes law, according to a new analysis. The bill known as the American Health Care Act, which is backed by House Republicans and President Trump, would repeal huge portions of former president Obama鈥檚 health care law. (Dayal McCluskey, 5/23)

For more than a decade, Massachusetts has had the lowest number of residents without health insurance in the nation. The rate dropped after the passage of a 2006 state coverage law and has remained low under Obamacare. But a study聽from the Urban Institute, a D.C.-based think tank that bills itself as independent,聽projects the state's uninsured rate would rise from聽2.8 percent to 10.3 percent by 2022 鈥 a nearly four-fold increase. (Bebinger, 5/23)

As America waits to hear from Washington about the future of health care, CVS Health is one major company that stands to feel a big impact from repealing the Affordable Care Act. The company has made major changes to its business to focus more on consumer health, including a 2014 decision to stop selling tobacco products. (Hobson, 5/23)

Moderate At Center Of House Health Bill Negotiations Gives Up Chairman Position

Rep. Tom MacArthur (R-N.J.), who worked with Rep. Mark Meadows (R-N.C.) to get the GOP health plan through a reluctant House, said his decision to quit his position as head of the Tuesday Group was because some of the members have "a very different view of governing."

A New Jersey Republican congressman who helped push the House health care bill to passage quit his post Tuesday as a chairman of the chamber's moderate Tuesday Group, criticizing colleagues for having "different objectives and a different sense of governing than I do." Rep. Tom MacArthur, a second-term congressman, announced his decision at a closed-door meeting of the group, which has roughly 50 members. (Fram, 5/23)

"I realized through the health care debates that people in my group wanted different things. They had a very different view of governing," MacArthur told reporters during a House vote Tuesday. MacArthur became co-chairman of the Tuesday Group at the beginning of this year. A聽former insurance executive now in his second term in the House, he was the first New Jersey Republican to support House leaders' bill to repeal and replace the Affordable Care Act, or Obamacare. (Jackson, 5/23)

鈥淐learly, our group is divided. Many in the Tuesday Group are eager to live up to our ideal of being problem-solvers, while others seem unwilling to compromise,鈥 MacArthur, 56, told the group, according to prepared remarks obtained by POLITICO New Jersey. (Jennings, 5/23)

MacArthur鈥檚 brief and uneasy turn under the national spotlight has been telling. Exchanges from his packed forum this month in deep-blue Willingboro 鈥 mostly of supporters of the Affordable Care Act fuming about his attempts to repeal and replace the law 鈥 have been replayed endlessly on cable news. And the centrists MacArthur once led are increasingly nervous about their reelection chances 鈥 and have groused that his eagerness to cut a deal with Freedom Caucus hard-liners is partly responsible for their vulnerability. (Costa, 5/23)

Quality

Review Of H-1B Visa Practices Imperils Efforts To Attract Foreign Doctors To Underserved Areas

The Trump administration has suspended the 15-day expedited process to obtain an H-1B visa. Those visas are often used by hospitals and medical groups to hire foreign-born workers in specialty fields.

For parts of the country that have difficulty attracting American-born doctors, the uncertainty swirling around the H-1B program is already creating problems, with doctors tied up in legal uncertainty rather than treating patients. ... Hospitals in distressed urban neighborhoods also rely on foreign-born medical school graduates to fill medical residencies that might otherwise go vacant. (Ollove, 5/23)

President Trump鈥檚 push to repeal the Affordable Care Act, crack down on illegal immigration聽and impose a ban on people trying to enter the U.S. from certain Muslim majority countries has many worried. (Plevin, 5/22)

Public Health

Who Should Be Punished When A Child Dies From An Accidental Gunshot? The Answer Varies State To State

A series by USA Today and The Associated Press offers a look at gun safety and children in different states.

Amy Pittman learned on her first day in jail to bottle up her grief. As soon as she arrived, guards took her shoelaces so she wouldn鈥檛 try to hang herself. Cry too much or scream too loud and she feared they would come back to take everything she had left 鈥 her clothes, a sheet, a plastic spork. (Penzenstadler, Foley and Fenn, 5/24)

In state after state, proposals that would create or toughen laws intended to keep kids from getting ahold of unsecured guns have stalled 鈥 caught up in a debate over whether they are effective prevention measures or just government overreach. Child access prevention laws allow prosecutors to bring charges against adults who fail to safely store their loaded guns, especially when they are obtained by minors and used to harm. (Foley and Penzenstadler, 5/24)

In related news聽鈥

The Kansas Senate Ways and Means Committee on Tuesday advanced a bill that would allow public health care facilities to continue to ban concealed guns. A state law taking effect July 1 will allow people to聽carry concealed guns into any public building聽that is not secured by armed guards and metal detectors. The bill that advanced Tuesday would allow guns to be banned at state-run psychiatric hospitals, publicly owned medical facilities and the University of Kansas Health System. (Koranda, 5/23)

Legislation prohibiting guns in any agency that has a contract with Cuyahoga County to provide preschool, daycare and after-school services to children will be introduced Tuesday in County Council. A state law, that went into effect on March 21, allows licensed Ohioans to carry concealed guns to more places. (Farkas, 5/23)

Teaching Hospitals Have Lower Death Rates For Older Patients Than Less Costly Community Hospitals

Researchers found that the 30-day mortality rate at major teaching facilities was 8.3 percent, compared with 9.5 percent at non-teaching ones. Today's other public health stories cover child fatalities from car crashes, near-death experiences, botulism in California, and the heart benefits of chocolate.

At a time when insurers are steering patients away from expensive academic medical centers, a new study counters the idea that the quality of care is consistent across hospitals, concluding that major teaching hospitals have lower mortality rates for older patients than community hospitals. Using millions of Medicare records, researchers found that the 30-day mortality rate 鈥 the percentage of patients who died within 30 days of hospitalization and one common way to gauge quality 鈥 was 8.3 percent at major teaching hospitals, compared with聽9.2 percent at minor teaching hospitals and 9.5 percent at non-teaching hospitals. The figures accounted for differences in patient populations and hospital characteristics. (Joseph, 5/23)

A new study found that 20 percent of children who were in a fatal car crashes were not buckled in properly, or were not wearing a seat belt at all, and that child fatality rates in deadly car crashes vary widely by state. The results add evidence to the argument that state regulations and public information tactics can affect motor vehicle safety for kids. The Centers for Disease Control and Prevention has noted that, for example, seat belt use across all age groups is higher in states with more stringent seat belt enforcement laws. (Hersher, 5/23)

The state鈥檚 constant warm climate keeps pools open year-round, the most common environment for drownings involving toddlers;聽in fact, toddlers in the Grand Canyon state are far more likely to drown compared with rates of childhood drownings from around the nation鈥 鈥 鈥奱nd authorities say they鈥檙e nearly all preventable. For those who survive, recovery could last a lifetime. (Souse, 5/23)

A deadly botulism outbreak linked to contaminated nacho-cheese dip sold in a California gas station is a rare case of the disease that can cause paralysis and death. The outbreak in the Sacramento area left one man dead and sent nine people to a hospital. Here are some things to know about botulism. (5/23)

Eating chocolate has been tied to a reduced risk of heart disease. Now scientists have uncovered one possible reason. Using data from a large Danish health study, researchers have found an association between chocolate consumption and a lowered risk for atrial fibrillation, the irregular heartbeat that can lead to stroke, heart failure and other serious problems. The study is in Heart. (Bakalar, 5/23)

WHO's Next Director-General Will Be First To Come From Africa

Former Ethiopian health minister Tedros Adhanom Ghebreyesus has been elected to head the World Health Organization, the United Nations agency responsible for coordinating international responses to infectious disease epidemics like Ebola and Zika.

Tedros Adhanom Ghebreyesus of Ethiopia was voted director general of the World Health Organization on Tuesday, the first African ever to head the agency. The election was the first conducted by the W.H.O. under more open and democratic rules. After nearly two years of public campaigning, originally by six candidates, the voting took place in a closed-door session in which the health ministers of 186 countries cast their ballots in secret. (McNeil and Cumming-Bruce, 5/23)

During the third and final round of balloting in Geneva, members of the World Health Assembly voted 133 to 50 to pick Tedros, as he is known, to be the next director-general, according to unofficial tallies. Cheers broke out, observers said, as he beat out David Nabarro, a 67-year-old physician and longtime United Nations official from Britain, and Sania Nishtar, a 54-year-old cardiologist from Pakistan. It was the first time member states took part in a secret ballot that gave each member state an equal vote. In the past, leaders were chosen by an executive board and voting took place behind closed doors. Nishtar was eliminated during the first round of voting. (Sun, 5/23)

State Watch

State Highlights: Contract Dispute In Ariz. Leaves Many Out Of Network At Dignity Health Hospitals; Texas Lawmakers OK Maternal Health Bills

Media outlets report on news from Arizona, Texas, California, Minnesota, Georgia, Colorado and Florida.

A contract dispute has left thousands of Health Net customers without insurance coverage at Dignity Health鈥檚 Arizona聽chain of hospitals, clinics and doctors.聽A three-year contract that guaranteed Health Net-insured customers could access and pay lower, in-network rates at聽Dignity-owned hospitals and health facilities聽expired聽Saturday. (Alltucker, 5/23)

Texas legislators from both chambers passed bills on Tuesday aimed at helping mothers before and after they give birth... About 17 percent of Texas mothers experience postpartum depression, according to a 2016 report from the Texas Health and Human Services Commission and the Texas Department of State Health Services. (Evans, 5/23)

State Sen. Ricardo Lara doesn鈥檛 only want to reconstruct the way health care is delivered and paid for in California. As the debate around publicly funded universal health care heats up in the Capitol, Lara is also seeking to expand the state鈥檚 low-income health program to undocumented adults up to age 26. (Hart and Miller, 5/23)

With state health inspectors overwhelmed by maltreatment complaints, the tiny cameras have become an important tool for families who suspect abuse or neglect but feel nursing home authorities dismiss their concerns. Yet the cameras 鈥 small enough to fit inside a potted plant or a stuffed doll 鈥 have become a major point of controversy. (Serres, 5/23)

The state鈥檚 attorney general has urged the Georgia Supreme Court to reverse a lower court opinion that barred access to Northside Hospital鈥檚 financial records. Chris Carr, in office since late last year, said in a Monday court filing that the Georgia Open Records Act is broader in its applications than what Northside Hospital has argued. (Miller, 5/23)

Georgia law requires open government even when a private party is carrying out the public鈥檚 work, Attorney General Christopher Carr argued in a brief filed Monday in the Northside Hospital open records case before the Georgia Supreme Court...聽The Georgia Supreme Court asked the Attorney General鈥檚 office to file an opinion in the hotly-contested case that started when attorney E. Kendrick Smith requested documents from Northside under the state鈥檚 sunshine law. (Teegardin, 5/23)

As the Texas聽Senate passed a bill on Tuesday聽that would ensure parents can view their deceased child's body before an autopsy is conducted,聽a grieving mother shed tears from the gallery...聽Currently, parents need permission from a justice of the peace or medical examiner to see their deceased child if his or her death occurs outside a hospital or health care institution. (Mansoor, 5/23)

The Texas Senate on Tuesday approved a bill aimed at increasing identification of postpartum depression among mothers participating in federally backed health care programs for low-income families. Under House Bill 2466 by Rep. Sarah Davis, R-West University Place, mothers who bring their kids in for checkups can get screened for postpartum depression by their children鈥檚 pediatricians. (Collins Walsh, 5/23)

Lake County鈥檚 only hospital, St. Vincent in Leadville, has put plans to build a new facility on hold after financial projections came up shorter than expected, indicating the small hospital has recovered from the financial brink but still needs to improve its balance sheet before a much-needed building upgrade. In 2014, the hospital announced it would be shutting down because of critical building repairs and declining revenues, but service cuts and a partnership struck several months later with Centura Health 鈥 which also runs St. Anthony Summit Medical Center in Frisco 鈥 kept the 138-year-old hospital open. (5/23)

Several California clinics advertise the therapy, claiming to be able to undo the effects of the first dose containing mifepristone, which blocks progesterone production and causes the uterine lining to shed. The second set of pills contains misoprostol, which makes the uterus contract and initiates bleeding and cramping. More than 350 providers nationwide perform abortion reversal therapy, according to proponents of the treatment. (Caiola, 5/23)

The head of Kansas鈥 child welfare agency said earlier this month that social workers鈥 last contact with the family of Adrian Jones was in February 2012. But records obtained by The Kansas City Star on Tuesday show that social workers with the Kansas Department for Children and Families investigated a hotline call 10 months later, in December 2012. (Baurer and Woodall, 5/23)

A Missouri hospital, clinic and infusion center have agreed to pay $34 million to settle a federal lawsuit that alleged they defrauded Medicare. The suit alleged that Mercy Hospital Springfield and its affiliate, Mercy Clinic Springfield Communities, had an improper financial agreement that provided kickbacks to oncologists based on the value of their chemotherapy referrals to the infusion center. (Marso, 5/23)

City聽officials would have greater oversight over the Valero refinery under a proposal set to be unveiled聽at聽the Benicia City Council meeting on Tuesday鈥攁 potential reform prompted by the major outage at the facility earlier this month. Mayor Elizabeth Patterson is proposing the city develop聽regulations similar to those聽in Contra Costa County, home to several refineries. That county鈥檚 industrial safety ordinance, considered to be one of the strongest in the country, requires oil refining facilities to undergo聽safety audits and have risk management plans. (Goldberg, 5/23)

John Morgan spent nearly $7 million pushing two statewide ballot initiatives to expand medical marijuana throughout the state of Florida. But that鈥檚 a drop in the bucket compared to what the wealthy Orlando attorney and possible gubernatorial candidate says he鈥檚 prepared to invest in the industry now that it鈥檚 about to explode. (Smiley, 5/23)

Prescription Drug Watch

With Little Federal Progress Being Made, States Step Up Own Efforts To Curb High Drug Prices

Bills in California and Nevada reflect a growing trend across the country. Outlets report on news out of Ohio, Texas and New York, as well.

Two different types of bills advanced through a pair of state legislatures late last week, a pointed reminder to the pharmaceutical industry that its business practices will continue to encounter significant pushback. (Silverman, 5/22)

As a variety of states weigh measures targeting pharmaceutical pricing, Nevada鈥檚 Senate has passed a tough new bill that would publicly spotlight insulin makers' price hikes and profits. Approved by the Nevada Senate on Friday, the bill would force diabetes drugmakers to disclose information on their insulin pricing, profits, costs and more, and would require the state government to publish the information publicly on the internet. (Sagonowsky, 5/22)

Pharma reps may soon have to cancel any doctor dinners they have planned in California. A state-level bill would cut off most drugmaker payments to physicians, including speaking fees for that staple of pharma marketing, the slideshow over dinner. Dinners themselves would have to be cheap, too: Per person, drugmakers could only spend $250 per year on free meals. (Staton, 5/22)

Opponents of a ballot issue aimed at lowering prescription drug prices today announced a broad coalition to fight the proposal Ohioans will see in the Nov. 7 election. The group Ohioans Against the Deceptive Rx Ballot Issue formed to oppose the Ohio Drug Price Relief Act, an initiated statute that, if passed, would require the state government to pay no more for prescription drugs than the lowest price paid by the U.S. Department of Veterans Affairs. (Johnson, 5/23)

The Ohio Drug Price Relief Act will have a high-profile bipartisan campaign team working to pass the ballot issue in the Nov. 7 election. Financed in part by the AIDS Healthcare Foundation, the act would require state agencies to pay no more for prescription drugs than the lowest price paid by the U.S. Department of Veterans Affairs. Supporters say that could lower prices by 40 percent or more and cause a ripple effect for Ohio consumers. (Candisky, 5/16)

Three former Ohio Medicaid directors say a November ballot measure intended to lower prescription drug prices would have the opposite effect for most Ohioans. "The money's going to come from some place and this is not the way to do it," John McCarthy, former Medicaid director under Gov. John Kasich, said in a Tuesday phone call with reporters. The call was organized by opponents to the measure, Ohioans Against the Deceptive Rx Ballot Issue, which launched their campaign earlier in the day. (Borchardt, 5/23)

Ohio medical professionals, veterans' groups and business interests are lining up against a statewide ballot measure promising lower prescription drug prices. Opponents to the "Ohio Drug Price Relief Act" say the proposed law would actually increase drug costs for the majority of Ohioans. (Borchardt, 5/23)

A group of scientists and medical professionals is sounding the alarm in the final days of the Texas legislative session about a little-noticed bill that would allow manufacturers of unproven drugs to sell their products to dying patients. Supporters of House Bill 3236 by state Rep. Kyle Kacal, R-College Station, say it could help incentivize drugmakers to get promising, experimental drugs onto the market and into needy patients鈥 hands. (Walters, 5/23)

New York Medicaid regulators aim to use the threat of imposing increased scrutiny of prescription drugs 鈥 such as eyeing their relative effectiveness and their profit margins 鈥 to coax additional discounts from drugmakers. The rules, signed into law in mid-April as part of the state鈥檚 budget, don鈥檛 go as far as the surcharge that Democratic Gov. Andrew Cuomo originally sought to control the 鈥渟kyrocketing costs of prescription drugs,鈥 but they retain elements guaranteed to get under a pharmaceutical executive鈥檚 skin. (Appleby, 5/22)

Amazon Mulls Entering PBM Field, Even As These Middlemen Bear Brunt Of Blame Over High Drug Costs

News outlets report on stories related to pharmaceutical pricing.

What kind of impact could Amazon have if the ubiquitous company enters the mysterious and complicated world of pharmacy benefit managers? The online retailer is reportedly exploring the pharmacy business and, as part of the plan, may build an internal PBM for its own employees, but later roll this out to the world at large. The possibility is intriguing because it comes at a time when these middlemen 鈥斅爓hich negotiate with drug makers for favorable insurance coverage 鈥斅燼re under varying degrees of financial and political pressure. (Silverman, 5/18)

How high are drug prices in the US? So high that the Canadian government may remove the US from its long-standing list of countries that聽are used as a guide for determining whether prices are excessive. In a proposal issued last week, Health Canada said it wants to overhaul the framework used by the Patented Medicine Prices Review Board, which assesses therapeutic benefits and sets ceiling prices. Right now, this is accomplished, in part, by benchmarking prices against what drug makers currently charge in seven other countries聽鈥 the US, France, Germany, Italy, Sweden, Switzerland, and the UK. (Silverman, 5/22)

Jennifer McNary, a stay-at-home mother, was desperate to find a medicine that might spare her two sons an early death from a rare form of muscular dystrophy. Chris Garabedian, the chief executive of a pharmaceutical firm, was desperate to find a profitable drug that would reverse his company鈥檚 slow fall. They met in June 2012 at a conference on Duchenne muscular dystrophy and joined forces, often behind the scenes and with little public disclosure, in a yearslong mission to push the government to approve a drug to treat DMD, as it is known. (Pulliam and Mullins, 5/19)

For the past three years, various governments and patient advocacy groups have clamored for lower-cost hepatitis C medicines, given the high cure rate for these pricey new drugs. Now, a new study finds that upfront treatment with cheaper generic versions can offer a substantial payback. Using a mathematical model for patients in India, researchers found that copycat versions costing around $300 would increase life expectancy by more than eight years and reduce lifetime health care costs by more than $1,300 per person. (Silverman, 5/18)

The U.S. Food and Drug Administration on Tuesday approved Merck & Co.鈥檚 Keytruda drug to treat tumors with a certain genetic defect鈥攖he first time the agency has cleared a cancer drug for a use not tied to the site of a tumor.聽The FDA approved Keytruda to treat tumors with genetic defects known as 鈥渕icrosatellite instability鈥 or 鈥渕ismatch repair鈥 deficiencies, which are present in an estimated 4% of cancers. Studies showed the drug shrank tumors in a significant number of patients with colorectal and 14 other cancer types that had the genetic defect. (Loftus, 5/23)

Alexion Pharmaceuticals Inc.鈥檚 new chief executive is reshaping the top ranks of the organization following an internal investigation into sales practices prompted by a former employee. (Tweh and Rockoff, 5/23)

Republicans are attempting to address a major priority of the drug and medical device industries as part of a bill to fund the Food and Drug Administration, but in so doing risk injecting a controversial issue into what was supposed to be a smooth bipartisan negotiation. The makers of drugs and devices want the FDA to loosen the regulations governing how they can discuss and promote uses of their products that haven鈥檛 been explicitly approved. Approved uses are typically identified on a product鈥檚 label, but the practice of using drugs or devices in a so-called 鈥渙ff-label鈥 way is common in some areas of medicine where treatment options may be limited, such as for cancer patients or pediatric populations. (Siddons, 5/24)

The many proponents of precision聽medicine have long promised a world where terms like 鈥渓ung cancer鈥 and 鈥渕elanoma鈥 are rendered quaint by the awesome power of genomics. And the FDA, with its latest聽approval, just endorsed that vision of the future. The agency cleared Merck鈥檚 blockbuster cancer drug Keytruda to treat any solid tumor with one of two genetic abnormalities, marking the first time the FDA has聽granted such an agnostic approval. There are, of course, caveats 鈥斅爐he mutations are rare, and聽Keytruda can be used only after a prior treatment has failed 鈥 but it鈥檚 a milestone approval nonetheless, and one that will be heartening to some forward-thinking biotech companies. (Garde, 5/23)

The UK antitrust regulator accused Merck of illegally offering discounts for the Remicade biologic medicine in order to block lower-cost biosimilar versions. In a brief statement, the Competition and Markets Authority said it found that the drug maker 鈥減rovisionally鈥 broke the competition law and was 鈥渁busing its dominant position鈥 in the market with its discount scheme. Remicade is used to treat chronic inflammatory diseases such as rheumatoid arthritis. (Silverman, 5/23)

India's drug pricing regulator has demanded explanations from 65 domestic and global drugmakers for selling new forms of essential diabetes and antibiotic drugs without its approval. The move could bring penalties for the drugmakers, among them Abbott Laboratories, Sanofi, Novartis and Indian firms such as Sun Pharmaceutical Industries and Lupin, the National Pharmaceutical Pricing Authority (NPPA) said on its website. (Siddiqui, 5/18)

Britain's competition watchdog has accused Merck & Co of operating an unfair discount scheme for its medicine Remicade that it said was designed to restrict competition from so-called biosimilar copies. The Competition and Markets Authority (CMA) said on Tuesday it had provisionally found the U.S. company's European unit, Merck Sharp & Dohme, had abused its dominant position through the scheme, opening it up to potential financial penalties. (Hirschler, 5/23)

A federal appeals court ruled last week that Eli Lilly should not have ended disability benefits to a former human resources director who claimed she was unable to continue working because she suffered from fibromyalgia, a chronic neurologic condition. Yet at the same time the former employee was fighting in court to have those benefits restored, the drug maker was marketing a medicine in the US to treat the condition, which one of its own consultants had described as 鈥渧ery disabling,鈥 according to court documents. (Silverman, 5/22)

[Anna] Devane is a soap opera character, as you might have guessed, appearing for the last 32 years on 鈥淕eneral Hospital.鈥 And her dramatic diagnosis is brought to you by Incyte Corp., a biotech company that happens to market a drug for her on-screen disease, the rare blood disorder polycythemia vera. The scene, which aired in February, is a novel twist on what鈥檚 called unbranded advertising, in which drug companies detail the symptoms of a disease but refrain from mentioning the names of any聽drugs. (Garde, 5/18)

Soap operas often include medical mysteries and miracles, but a couple of real-life聽doctors are concerned about Incyte's聽connection to the latest drama on General Hospital. Writing in JAMA, oncologists Sham Mailankody and Vinay Prasad question聽the聽ABC soap opera's聽rare-disease plot enabled by a partnership with the biopharma company Incyte.聽In the General Hospital storyline begun in February, leading character Anna Devane is diagnosed with a rare blood cancer called polycythemia vera (PV). The show doctors explain to the character, who is played by Incyte spokesperson Finola Hughes, that PV is part of a group of rare blood cancers called myeloproliferative neoplasms, and that there are treatments, but no cure. (Bulik, 5/22)

Rather than shunning the company, investors embraced it. Only a small number of them cashed out their shares. (The coauthor of the paper who took responsibility for the error returned the stock, but made the shares聽a donation.) The IPO, delayed by a few weeks, went forward. And within a few years WntResearch stock went on a surge that to date has left it up nearly 500 percent over 6 1/2聽years. In other words: Openness was a risk in the short run but a long-term boon for the company. (Oransky and Marcus, 5/23)

Perspectives: FDA Wades Into Pricing Controversy, But Doesn't Have Authority To Actually Fix It

Read recent commentaries about drug-cost issues.

The Food and Drug Administration may be digging a huge hole for itself by singling out drug pricing and opioid abuse for priority and focused attention. These two highly-visible and highly-charged issues have been pushed into the political arena. The FDA has, unwisely, agreed to take them on. Both issues are mission impossible for the FDA, which has neither the authority nor the resources to solve either problem. The agency is setting itself up to be perceived as having failed. (Wayne Pines, 5/22)

White House budget director Mick Mulvaney has floated an idea to bring down drug prices that's both promising and -- if other Republicans can be persuaded to go along -- bipartisan. At a recent health-care forum, Mulvaney proposed that drugmakers be required to pay rebates to the government on drugs sold to Medicare beneficiaries, as they do with drugs sold to Medicaid patients. ... In an ideal world, the secretary of Health and Human Services would negotiate on behalf of the 41 million people enrolled in Medicare's Part D prescription drug plan. That kind of purchasing power -- accompanied by the right not to cover a drug it deems too expensive -- would give the department great leverage. Unfortunately, Congress not only forbids such negotiation, it requires that Medicare pay for all medicines approved by the Food and Drug Administration. (5/22)

People who volunteer to participate in clinical trials of new drugs provide a valuable service to pharmaceutical companies and to the rest of us. In return, I think that they should have a say in how much these drugs will cost when they hit the market. Not only would that honor their service, but it would also provide a patient-centered mechanism to lower the price of new drugs. (Spencer Phillips Hey, 5/18)

With聽promising trial results and an FDA approval seemingly near, Amgen Inc.'s osteoporosis drug Evenity聽was expected to contribute at least something to the company's top line this year.聽But Amgen on Sunday evening reported the drug raised unexpected heart-safety concerns. Now the best hope is that its FDA approval will only be pushed to next year and that its commercial opportunity will merely be limited, not eliminated. Otherwise, it may not be worth the effort to keep seeking approval. (Max Nisen, 5/22)

Prescription drug prices continue to be a hot political issue, with the Trump administration preparing to release an action plan as soon as repeal and replace legislation clears Congress. Mick Mulvaney, who heads the White House budget office and is participating in the talks, floated an idea last week that should quickly be crossed off the list of policy ideas. (Grace-Marie Turner, 5/18)

Earlier this month, PhRMA 鈥 the trade group representing innovator pharmaceutical companies 鈥 announced a set of new membership criteria. Going forward, PhRMA members will need to meet certain standards regarding their investment in R&D. PhRMA may have felt it needed to take action to restore public confidence in the industry and to constrain the bad press its members have been receiving on the drug pricing front. In my view, the new rules miss the mark. (Rachel Sachs, 5/22)

It's hard to think of an industry Amazon.com Inc. isn't currently trying to conquer, or at least thinking of conquering. Pharmacies might be next. According to a CNBC report, Amazon is considering a leap into the prescription-drug business. It wouldn't be easy, but the industry and its investors shouldn't dismiss the threat. (Max Nisen, 5/17)

The US Food and Drug Administration (FDA) draws a distinction between direct-to-consumer advertising of specific drug products, which it regulates, and advertisements intended to create disease awareness, which it does not. Other nations, including the United Kingdom and the Netherlands, that ban direct-to-consumer marketing permit disease awareness efforts. Challenges arise when disease awareness efforts are made for conditions for which only 1 approved drug product is available; in this case, awareness will boost the sales of a specific drug, and several nations, include the United States, selectively regulate this type of advertising. Recently, a novel form of disease awareness promotion, through a daytime soap opera, raised questions about the role and regulation of this form of marketing. (Sham Mailankody and Vinay Prasad, 5/18)

This November, Ohio voters will decide on a referendum that sounds like a sure thing for passage: lower drug prices. No, this isn鈥檛 a follow-up to last year鈥檚 marijuana measure, which failed anyway. The discount would only apply to drugs purchased by state employees and retirees and through state programs like Medicaid. An estimated 3.7 million Ohioans, close to a third of the state鈥檚 population, would directly benefit. (James McNair, 5/22)

Editorials And Opinions

Different Takes On Doing The Math: Trying To Add Up 'Trumponomics;' The Trump Budget's 'Best New Idea'

Opinion writers take a hard look at how health and safety net programs fare in the Trump administration's proposed budget plan.

One factor holding back economic growth is that too many working-age Americans have fallen out of the labor force. The administration鈥檚 proposed budget for the fiscal year that begins Oct. 1 tries to tackle that problem, as well it should. But rather than grapple with some of the challenges underlying the disappearance of millions of Americans from the workforce 鈥 in particular, the technological changes and globalization that have caused so many blue-collar and middle-class jobs to evaporate, and the gap between the education and training Americans have received and the skills demanded by today鈥檚 employers 鈥 the Trump budget seeks to force people back into the workforce by making it harder to obtain or keep food stamps, Medicaid and Social Security disability benefits, while reducing federal support for welfare and children鈥檚 health. (5/23)

For months, pundits and political advisers聽have tried聽to figure out聽what 鈥淭rumponomics鈥 really stands for. Even President Trump himself struggled to characterize聽it, saying, 鈥淚t really has to do with self-respect as a nation.鈥 Now that we have the president鈥檚 budget in hand, we have a more definitive聽answer: Trumponomics 鈥 like Ryanonomics 鈥 is based on the聽principle that living聽in poverty doesn鈥檛 suck quite enough.聽That is, more聽people聽would be motivated to become聽rich if only being poor weren鈥檛 so much fun. (Catherine Rampell, 5/23)

Yes, Republicans have a blind spot when it comes to acknowledging that revenues must be a part of the fix. But to their credit, many Republicans 鈥 including, notably, Paul Ryan, the speaker of the House 鈥 have made the case for why we have to reform our largest entitlement programs, including Social Security and Medicare (though there has recently been a disquieting silence on the topic). And many Republicans are taking the responsible position that tax reform should at least be revenue neutral. Democrats, many of whom too often act as demagogues on entitlement reform, are clear that taxes must increase (though they also must stop pretending it is just millionaires who will be affected). They also have been admirable in their commitment to the pay-as-you-go principle in recent major legislation, which at least keeps us from digging the hole deeper. (Maya MacGuineas, 5/23)

The new White House budget proposal is built on a deep-rooted conservative belief: The government should help those who are willing to work, and cull from benefit rolls those who aren鈥檛. That emphasis on work underlies deep cuts and proposed changes to food stamps, cash assistance and health benefits for the poor in a budget that boosts spending for the military and border security. Expect the poor to work in exchange for aid, the White House argues, and antipoverty programs will work better while costing the government less. (Emily Badger, 5/24)

Since the passage of the Family and Medical Leave Act in 1993, American parents working for companies with at least 50 employees have had a right to 12 weeks of unpaid leave after the birth or adoption of a child. But many don鈥檛 take advantage of that option for the simple reason that they can鈥檛 afford to go that long without a paycheck. The Trump administration, at the urging of first daughter Ivanka Trump, has included in its budget released Tuesday a plan for paid medical leave of up to six weeks. (5/23)

President Trump鈥檚 budget includes a proposal for six weeks of mandated paid family leave for new parents. Despite its superficial appeal, this idea is likely to harm families more than it helps. The initial Trump proposal, floated in September, would have limited mandated leave to mothers, thereby likely engaging in unconstitutional sex discrimination. Key aspects of the new plan are still unclear. But it avoids legal problems by covering fathers, too. Yet it has serious flaws, nonetheless. (Ilya Somin, 5/23)

It also breaks Trump's campaign commitments to spare Social Security and Medicaid from budget cuts. Budget Director Mick Mulvaney explained this problem away (with Trump in Israel) by asserting in a Monday night briefing that proposals in the plan to cut Social Security disability benefits don't count because they're not retirement payments. (Albert R. Hunt, 5/23)

But tax cuts were only one half of the [Gov. Sam] Brownback experiment. Aided by conservatives in the Legislature, Kansas eviscerated the state鈥檚 social safety net: privatizing Medicaid, imposing new restrictions on welfare benefits, insisting on a tough food stamp work requirement. Humiliating the poor seemed to be a particular focus. For a time, the state told welfare recipients they could withdraw only $25 at a time from an automated teller machine, a decision that prompted anger and derision across the nation before it was repealed. (5/23)

Viewpoints: The Rule Of Law And Subsidies; Anticipating CBO's Score On The GOP Health Plan

A selection of opinions on health care from around the country.

Yes. Congress can mandate subsidies without also mandating a funding source. Medicaid is another example. This is crazy, but there it is. For once the Constitution is admirably clear on how the executive branch should handle this quandary: 鈥淣o Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law; and a regular Statement and Account of the Receipts and Expenditures of all public Money shall be published from time to time.鈥 The law appropriated no money for these cost-sharing reduction payments. But the Obama administration went ahead and paid them anyway. (Megan McArdle, 5/23)

Today, the Congressional Budget Office will issue important numbers about the House-passed version of the American Health Care Act, the Republican bill to repeal and replace portions of the Affordable Care Act. Although the budget office had analyzed an early version of the bill, the House on May 4 took the unusual step of voting before the budget office could gauge how several last-minute amendments might affect the deficit or the number of uninsured. (Margot Sanger-Katz, 5/24)

The U.S. Department of Agriculture said recently it will delay the implementation of school lunch rules aimed at lowering the amount of sodium and raising the whole grain content of meals served to kids. At the same time, the Food and Drug Administration announced it will delay for one year the implementation of Obama administration rules to require calorie labels on menus and prepared food displays. (Deborah A.Cohen, 5/24)

Given that we鈥檙e tangled in knots over how to pay for health care, it鈥檚 remarkable that food and farm policy isn鈥檛 more in the public鈥檚 mind. Heads of hunger programs and food banks have begun to grasp the obvious; as one told WBUR, 鈥渇ood is medicine, food is health,鈥 with good health impossible in the absence of nutritious eating. (Rich Barlow, 5/23)

Sen. Ricardo Lara鈥檚 single-payer legislation was a non-starter in California from day one, even before it was given an eye-popping $400 billion price tag. ... It鈥檚 merely an exercise in politics, which is all well and good except that it detracts from a far more important California health care issue: Can the state fight off President Trump鈥檚 inhumane effort to slash the nation鈥檚 Medicaid budget by more than $880 billion through 2026? (5/23)

Back in 1998, researchers with the legendary Framingham Heart Study created the first heart risk calculator. Using answers to questions about age, cholesterol and blood pressure levels, tobacco use, and the presence of diabetes, it estimated an individual鈥檚 risk of having a heart attack or stroke over the next 10 years. Since then, this calculator has been revised and many others have been developed, including ones that extend the time horizon out to an individual鈥檚 lifetime. Yet much to our surprise, the use of these single-point-in-time risk calculators does little to reduce the risk of heart attack or stroke compared with not using such calculators. ( Kunal N. Karmali and Mark Huffman, 5/23)

The left side of Jacquelyn Garcia鈥檚 face throbbed fiercely. She had tried taking Tylenol and Excedrin for the pain, but threw them up. On a Monday morning straight after working the night shift as a custodian, she rushed to the N.Y.U. emergency dental clinic. Here a student delivered the verdict: decay so deep it had reached the nerve. The tooth needed to be pulled. (Zoe Greenberg, 5/23)

Lead poisoning maims young minds. It steals kids' futures. For too long, Mayor Frank Jackson and his top staff have failed to confront that reality or instill a sense of urgency or direction to city officials to crack down systematically on landlords with toxic housing. (5/23)

Vermont is on the verge of becoming the ninth state to legalize the recreational use of marijuana, but, being Vermont, it is taking an earthier, grow-it-yourself approach 鈥 one that could become a model for others. (5/24)

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