�鶹Ů��

Democratic front-runner Joe Biden was again the main target of his rivals at the second presidential debate on Wednesday, as many of the nine other candidates on stage took aim at his track record on race, criminal justice, immigration and healthcare. "Go easy on me, kid," the former vice president told Senator Kamala Harris of California with a smile as they greeted each other on stage before the debate began in Detroit. But neither one had any plans to go easy, and they went after each other in a series of tough exchanges. (Becker and Renshaw, 8/1)

In the opening moments of the debate, Mr. Biden took particular aim at Ms. Harris, accusing her of peddling “double talk” on health care and insisting that a range of liberal plans to displace the private health insurance system were too disruptive and too costly. He chided Ms. Harris for her proposal of a decade-long transition to a version of single-payer health care, urging voters to be skeptical “anytime somebody tells you you’re going to get something good in 10 years.” “My response is: Obamacare is working,” said Mr. Biden, who has proposed the creation of an optional, government-backed health insurance plan. (Burns and Martin, 7/31)

“To be very blunt, and to be very straightforward, you can’t beat President Trump with double-talk on this plan,” Biden said. Harris responded in general terms, saying health care is a right and that “the cost of doing nothing is far too expensive.” She also challenged Biden for touting the Affordable Care Act, often called Obamacare, noting that Kathleen Sebelius, Obama’s secretary for health and human services, was supporting her plan. (8/1)

“You will lose your employer-based insurance,” Biden said of the Harris plan. He was playing to the political sensitivities of the issue because more than 150 million Americans currently have job-based health coverage, and many are wary of change, polls show. But Harris counterpunched by saying Biden’s plan, which would build on the existing Affordable Care Act, would still leave millions of Americans without affordable healthcare coverage. “We will ensure that everyone has access to healthcare,” Harris said. (Halper, Mehta and Beason, 7/31)

Harris' rising profile made her a target for the first time. Colorado Sen. Michael Bennet derided her recently released "Medicare for All" plan, which he said was not "honest" and would raise taxes to the middle class "to the tune of $30 trillion." (8/1)

Like in the first night of the second set of debates, the moderators spent a hefty chunk of time focusing on healthcare policy. But Wednesday’s candidates seemed clumsy in discussing the intricacies of healthcare, contrasting with the mostly policy-fluent discussion the previous night. ... The sharpest critique came from Bennet, who said Harris’ plan would essentially ban employer-based healthcare, which is how most working Americans get their insurance today. Harris countered by saying her plan would decouple employers from healthcare — which she touted as making benefits more flexible for workers — but her answer lacked the crispness that characterized her June debate performance. (Mason, 7/31)

New York Mayor Bill de Blasio (D) criticized Sen. Michael Bennet (D-Colo.) during Wednesday's Democratic presidential primary debate, accusing him of "fearmongering" when he talks about tax increases being needed to pay for "Medicare for All." "I don't understand why Democrats on this stage are fearmongering about universal health care. It makes no sense," de Blasio said. (Jagoda, 7/31)

Kaiser Health News: Biden-Harris Debate Rematch Highlights Health Plan Differences
New York City Mayor Bill de Blasio puzzled over the “mythology that people are in love with their private insurance.” Washington Gov. Jay Inslee boasted that his state just became the first to provide its citizens with a public option. Biden boldly repeated his version of a claim very similar to the one that once earned President Barack Obama PolitiFact’s 2013 Lie of the Year. At times the back and forth was fast and furious, and it seemed even the candidates were lost in the numbers they were firing across the stage. (Huetteman, 7/31)

Health-care experts said both candidates strained to explain key details. Biden misled viewers when he said during a heated exchange that his proposal would cover everyone — even though by his own plan’s admission, it would leave out 3 percent of Americans, or about 10 million people. Harris downplayed the impact of her proposal on employer-sponsored plans in an exchange with Sen. Michael F. Bennet (D-Colo.), according to health experts. (Stein and Abutaleb, 8/1)

New Jersey Senator Cory Booker uttered it in his remarks on health care, chiding fellow Democrats for their infighting as Republicans wage a legal battle to undo the Affordable Care Act, which prohibits insurers from charging people more for being sick. “The person who is enjoying this debate the most tonight is Donald Trump,” he said. “There is a court case working through the system that’s going to gut the Affordable Care Act and actually gut protections on pre-existing conditions,” Booker said, citing litigation in which the Trump administration and Republican-controlled states seek to strike down Obamacare. (Tozzi, 7/31)

Some candidates appeared frustrated with the divisions on display on Wednesday. Booker, at one point, said that the intraparty dispute over Medicare for All was playing into Trump’s hands by drawing focus away from the president's own efforts to limit health care access. (Greenwood, 8/1)

The issue is not only top-of-mind for voters, but also nuanced enough that it will likely feature prominently in every future debate. Candidates who have dodged the tax implications of their health care plans will be pressed on the cost. And candidates who have taken more moderate positions will be pressed on gaps in coverage. (Siders and Shepard, 8/1)

Mr. Biden and Senator Kamala Harris of California squared off over differences in their approaches to expanding access to health insurance. Ms. Harris said: “Your plan, by contrast, leaves out almost 10 million Americans.” Mr. Biden said: “Your plan, no matter how you cut it, costs $3 trillion when it is in fact employed.” These statements are mostly true. Neither Ms. Harris nor Mr. Biden are backing the “Medicare for all” plan being promoted by Senators Bernie Sanders and Elizabeth Warren, which would replace all private insurance coverage with a government plan. Mr. Biden wants to expand the Affordable Care Act by offering a public option. He says his plan would cover 97 percent of Americans — a figure that Ms. Harris appeared to seize on to justify her statement that his plan would leave 10 million people uncovered. (7/31)

“The [Harris] plan … it will require middle class taxes to go up, not down," said former vice president Joe Biden. Biden’s claim that middle-class taxes would go up under Sen. Kamala D. Harris’s (Calif.) plan is better aimed at the Bernie Sanders version. Harris tried to inoculate against this type of attack by making a significant change earlier this week. Sen. Sanders (I-Vt.) would propose a 4 percent income-based premium paid by households. Sanders estimated that this would raise $3.5 trillion over 10 years, but the “typical middle-class family” would save more than $4,400 a year. But it would kick in on income of more than $29,000 for a family of four. (Kessler, Rizzo and Kelly, 7/31)

“I don’t know what math you do in New York. I don’t know what math you do in California,” he said, talking to de Blasio and Harris. “But I tell ya, that’s a lot of money, and there will be a deductible. The deductible will be out of your paycheck because that’s what we require.” “Yeah, let’s talk about math,” Harris responded, highlighting the $72 billion the pharmaceutical and insurance companies made last year. She told Biden that under his plan, the “status quo, you do nothing to hold the insurance companies to task for what they have been doing to American families.” (McCaskill, 7/31)

The two nights clearly divided the Democratic field into three versions of health care: the progressive wing led by Sanders and Warren, who support a Medicare for All plan that will eliminate private insurance and tax wealthy and middle class Americans for their health care coverage; the middle ground that would allow, but limit, private health insurance, and the moderates, such as Biden, Bennet and former U.S. Rep. John Delaney of Maryland, who support expanding the Affordable Care Act. (Gray and Egan, 8/1)

Sanders has acknowledged that middle-class Americans would see their taxes go up under his "Medicare for All" plan, but says they'd come out ahead because they'd no longer have to pay premiums, deductibles or copays. Under the Sanders plan, households making above $29,000 would be taxed an additional premium to pay for universal health care. (Luhby, 8/1)

If the first night was a showcase of the liberal-vs.-moderate split within the party, the second night put on display other divides and a thirst to have a nominee who represents the party’s growing diversity. Half of the 10 candidates onstage Wednesday at the Fox Theatre were minorities, making it a historically diverse lineup. “Mr. President, this is America,” Biden said, addressing President Trump, pointing to the diversity in race and experience onstage. “And we are stronger together because of this diversity. Not in spite of it, Mr. President. We love it, we are not leaving it. We are here to stay. And we’re certainly not going to leave it to you.” (Viser, Olorunnipa and Wang, 8/1)

In the early segments of the debate in Detroit, the former vice president stammered several times. But his performance, which grew stronger throughout the night, may help silence some questions about his viability as a potential nominee and chief foil of Mr. Trump. The session was the most combative of four debates held so far, two this week and two a month earlier. It exposed deep divisions among the candidates over how far the federal government should reach into the lives of Americans. (McCormick, Day and Collins, 8/1)

Democratic presidential candidates debated Wednesday for the second night in a row in Detroit. [Here] is a transcript from it. (7/31)

Former Vice President Joe Biden sought to gin up support for his presidential campaign's health care policy during Wednesday night's Democratic presidential primary debates. Biden's campaign sent a press release to supporters advertising the gift of a sticker reading "Obamacare: It's a BFD" after his fellow 2020 contenders attacked his health care policy that seeks to "protect and build on Obamacare." (Bowden, 7/31)

Professer Paul B. Ginsburg, director of the University of Southern California-Brookings Schaeffer Initiative for Health Policy, noted that the Medicare Advantage program, which allows private insurers to offer Medicare plans, is one of the fastest growing segments of Medicare. “It is very popular,” said Ginsburg. Harris’ proposal would, however, eliminate the employer-sponsored health insurance that many Americans currently rely on. (Cadei, 7/31)

Former Vice President Joe Biden’s past support for the Hyde Amendment resurfaced as an opportunity for his Democratic rivals to paint him as lacking in progressive credentials. California Sen. Kamala Harris asked Biden if he regrets his past support for the prohibition on federal funding for abortion in most cases. Harris said the rule “directly impacted so many women in our country,” particularly low-income women seeking abortions. Harris asked Biden why he waited to change his position until he was running for the 2020 Democratic nomination. (McCammon, 7/31)

“You made a decision for years to withhold resources to poor women to reproductive health care, including women who were the victims of rape and incest. Do you now say that you have evolved and you regret that?” the California senator and presidential candidate asked. Harris’s question immediately followed a heated exchange between Biden and Sen. Kirsten Gillibrand, when he implied that the New York lawmaker was attacking a former argument he’d made about women working outside the home, simply because she was now running for president. Harris appeared to suggest that Biden’s updated position on the Hyde Amendment was pretty much for the same reason. (Zhou, 7/31)

“Only since you’ve been running for president this time, said that you in some way would take that back or you didn’t agree with that decision you made over many, many years and this directly impacted so many women in our country,” she added. (Bolton, 7/31)

Candidates were asked about how they would prevent a crisis like the one that unfolded in Flint, Michigan, 70 miles from the debate stage in Detroit. Former Housing and Urban Development Secretary Julián Castro said he worked to get water filters to Flint residents during his time in the Obama administration, and he promoted his plan to invest $50 billion to eliminate the threat of lead contamination. (Rascoe, 7/31)

Trash bags still cover the water fountains at First Trinity Missionary Baptist Church to keep thirsty congregants from drinking from them. At another church, the pastor only performs baptisms with bottled water. Every Thursday, a line of cars stretches for more than a mile down Dort Highway, as Flint residents wait hours for bottled water because they are afraid to drink from their faucets. It's hard to grasp the distrust that forms when people fear the water that comes from their tap could make them ill -- or worse. (Kann, 7/30)

Lead contamination was an afterthought to the CNN moderators, though de Blasio and Castro both got questions on how they would convince voters they were the right candidate to handle matters like the Flint water crisis. De Blasio pointed to programs he’s already done as New York’s mayor. “We’re going to literally bring it down to zero because we’re going into every place – buildings, schools, public housing – and take out that lead, remediate that lead once and for all,” de Blasio said. “That needs to be done all over this country.” (Richardson, 8/1)

Obama's former Housing and Urban Development Secretary Julián Castro also took aim Biden on immigration. In a heated back and forth over decriminalizing crossing the U.S. border, Castro argued why it was necessary for reducing crossings to a civil offense. But Biden questioned why Castro hadn't brought up his qualms while serving in Obama's administration. Castro shot back. "One of us has learned the lessons of the past and one hasn’t," he said. "What we need is politicians who actually have some guts on this issue."  (Hayes, 7/31)

Medicare, the federal health insurance program for people who are 65 or older, has become something of a panacea in the Democratic presidential race. Some candidates, including Senators Bernie Sanders and Elizabeth Warren, want to give it to everyone and even expand its benefits. Others, like former Representative Beto O’Rourke, want to give it automatically to people who don’t have other health insurance. Many, including former Vice President Joseph R. Biden, want to give people the right to buy into a Medicare-like public health insurance program. Whatever their positions, Medicare is what most of the candidates are holding up as a model for universal coverage, a goal they all embrace. (Goodnough, 7/31)

In one of the most heated exchanges over health care during the first of this week’s Democratic presidential debates, Montana Gov. Steve Bullock derided the idea of Medicare-for-all as “wish-list economics” that “rips away quality health care for individuals.” “We can get there with a public option,” Bullock declared, using shorthand for letting people buy into a government health plan. That endorsement from a candidate positioned toward the right in the crowded Democratic field reflects a remarkable migration: The notion of a government health plan that many Americans could buy into has gone from being a polarizing liberal wish to a centrist policy favorite within the party. (Goldstein, 7/31)

As Democratic presidential candidates take aim at the health-insurance industry, companies are striking a delicate balance, trying to fight the plans without attracting the political spotlight or sparking investor alarm. The health insurers are deploying a two-pronged approach. Collectively, a number of insurers are putting their might into a coalition mounting an aggressive campaign against Democratic health-care proposals billed as “Medicare for All.” Television ads began running during Tuesday night’s presidential debate. But individual companies are mostly staying out of the public fray. (Wilde Mathews and Armour, 7/31)

Candidates repeatedly castigated insurance companies tonight for profiting off Americans’ health problems and contributing to high health care costs. Health insurance companies’ role in the health care system does contribute heavily to the nation’s health care costs. For example, the U.S. has much higher administrative costs than other countries, in part because of the complex coordination required between providers and multiple private insurance companies, each of them with multiple insurance plans. In addition — and perhaps intuitively — high prices are a big contributor to high costs. And insurers play a part in that. (Kurtzleben, 7/31)

Meanwhile, CMS Administrator Seema Verma assesses the Democrats' plans —

On Wednesday, Seema Verma, the administrator for the Centers for Medicare and Medicaid Services, scrutinized the Democratic health care plans at an event in Washington. The Heritage Foundation had invited her and other conservative policymakers to make the case against Medicare for All. Under her leadership, the Trump administration has encouraged states to develop Medicaid work requirements that recipients must meet to earn care or lose their coverage. Federal judges have hamstrung many of these state proposals that could cut thousands of people from Medicaid, most recently in New Hampshire. (Santhanam, 7/31)

White House advisers, scrambling to create a health-care agenda for President Trump to promote on the campaign trail, are meeting at least daily with the aim of rolling out a measure every two to three weeks until the 2020 election. One of the initiatives would allow states to import lower-priced drugs from Canada and other countries and another would bar Medicare from paying more than any other country for prescription drugs, according to two senior administration officials and lobbyists — controversial ideas in line with Democratic proposals. Yet it remains unclear whether the administration has the legal authority to execute some of these policies without Congress’s approval. (Abutaleb and Dawsey, 7/31)

President Trump is preparing to sign an executive order next week on Medicare and moving ahead with allowing some drug imports from Canada, part of the administration’s effort to engineer a response to Democratic proposals that candidates say would expand health coverage to all Americans. The executive order would aim to strengthen Medicare for 44 million Americans and portray the president as defending it against Democrats who want to expand it nationwide under their Medicare for All strategy, a White House official said Wednesday. (Armour, Restuccia and Lucey, 7/31)

Requiring hospitals to display their insurer-negotiated prices online likely won't lower healthcare spending in the near term. But economists and other experts say it's a worthwhile experiment in bringing transparency to one of the few industries in which patients often don't know the cost of a service before they buy it. The Trump administration earlier this week issued a proposed rule that would force most hospitals in the country to post on their websites the closely guarded rates for certain healthcare services that they work out with insurance companies behind closed doors. The outcry from hospital and insurance trade associations was swift. (Livingston, 7/31)

The Trump administration said on Wednesday that it was taking steps to make it easier to import less expensive prescription drugs from other countries, particularly Canada. The move has long been supported by progressives but has encountered fierce opposition from the pharmaceutical industry. The proposal would permit pilot programs developed by states, pharmacies or drug distributors that sought to safely import prescription medications from Canada. (Thomas, 7/31)

The plan would allow state governments, pharmacies and drug manufacturers to come up with proposals for safe importation and submit them for federal approval. Top officials at Health and Human Services and the Food and Drug Administration outlined two measures the administration could take to allow Americans to purchase lower-cost, Canadian versions of some medicines. That could potentially include insulin — whose price rose about 300 percent from 2002 to 2013 — as well as drugs for rheumatoid arthritis, cancer and cardiovascular disorders, HHS said. (Abutaleb and McGinley, 7/31)

According to HHS, the dual-pronged plan would establish a rule that would allow various entities, like states and pharmacists, to create proposals for the FDA. The FDA would then look at how “they would import certain drugs from Canada that are versions of FDA-approved drugs that are manufactured consistent with the FDA approval,” according to HHS. The second part of the plan would have the FDA create recommendations for drug manufacturers that sell FDA-approved drugs in foreign countries but want to import those drugs to the U.S. (Tatum, 7/31)

“President Trump has been clear: for too long American patients have been paying exorbitantly high prices for prescription drugs that are made available to other countries at lower prices, ” Health and Human Services Secretary Alex Azar said in a statement. “Today’s announcement outlines the pathways the administration intends to explore to allow safe importation of certain prescription drugs to lower prices and reduce out of pocket costs for American patients.” (Lovelace, 7/31)

Only certain drugs could be imported under those state-based plans. Insulin, in particular, which has become a symbol of the striking price differences between the U.S. and Canada, couldn’t be imported under these programs. On a press call Wednesday, Azar emphasized that insulin, which is a biologic, can’t be imported under existing law. Nevertheless, a number of states have already expressed interest in doing just what Trump is proposing: Trump has vocally supported a plan from Florida Gov. Ron DeSantis and has publicly directed Azar to find a way to make Florida’s plan work. Colorado and Vermont have also both passed similar laws supporting importation of prescription drugs. (Florko, 7/31)

Azar and acting FDA Commissioner Ned Sharpless didn't lay out a specific timeline for the new proposals, but an FDA spokesperson said the agency "is committed to advancing these policies as quickly as possible. We expect to have additional announcements in the coming months." The two strategies leave many questions unanswered until all the logistics are worked out through a proposed rule. The second regulatory idea, for instance, doesn't make room for biosimilars competing in Europe with AbbVie's Humira — which holds the U.S. market for arthritis medication until 2023. (Luthi, 7/31)

Kaiser Health News: Trump Administration ‘Open For Business’ On Drug Imports From Canada
In May 2018, Azar said the prospect of importing drugs from Canada was just a “gimmick” because that country is not large enough to meet all the drug needs of the United States. But lowering drug prices has been a key promise of President Donald Trump, and a few months later, Azar said he was forming a work group that would explore allowing certain drugs that had seen major price hikes to be imported. (Galewitz, 7/31)

Azar said that new technologies have allowed importation to be done more safely than in the past and added that Trump, who is a major proponent of drug importation, is always “challenging” him to “find more solutions.” “He is always pushing me, challenging me to find more solutions to help the American patient,” Azar said of Trump. (Sullivan, 7/31)

The move is a step toward fulfilling a 2016 campaign promise by President Donald Trump. It weakens an import ban that has stood as a symbol of the political clout of the pharmaceutical industry. But it’s unclear how soon consumers will see benefits, as the plan has to go through time-consuming regulatory approval and later could face court challenges from drugmakers. And there’s no telling how Canada will react to becoming the drugstore for its much bigger neighbor, with potential consequences for policymakers and consumers there. (Alonso-Zaldivar, 7/31)

The pharmaceutical industry swiftly attacked the plan, citing Azar’s own words from just last year, when he called drug importation a “gimmick.” "Rather than surrender the safety of Americans by importing failed polices from single-payer countries, we should work on solutions here at home that would lower patient out-of-pocket costs at the pharmacy counter," said Stephen Ubl, CEO of Pharmaceutical Researchers and Manufacturers of America, in a statement. (Owermohle and Allen, 7/31)

Alexander Cohen, a spokesman for Canadian Health Minister Ginette Petitpas Taylor, said Canadian officials are in contact with their U.S. counterparts to discuss Wednesday’s announcement. Canadian officials “will be working closely with health experts to better understand the implications for Canadians and will ensure there are no adverse effects to the supply or cost of prescription drugs in Canada,” Cohen said. (Ward, 7/31)

The response from outraged Canadians? Just say no. “It’s crazy,” said Jacalyn Duffin, a medical historian and professor emerita at Queen’s University who doesn’t receive funding from the pharmaceutical industry. “He should be finding out why Americans have to pay more than Canadians to buy the same drugs from multinational companies.” (Pearson and Jagdev, 7/31)

Although the proposal is in its early stages, the news was welcomed by some Minnesota advocacy groups that hope it will bring needed relief to patients struggling with high and rising drug prices. ...But others expressed dismay when they learned that some medications would be ineligible for importation, including insulin used to control diabetes. Insulin prices have soared in recent years, causing some diabetics to ration medicine or even seek out black market sources. (Howatt, 7/31)

A plan published Wednesday by the U.S. Department of Health and Human Services and the Food and Drug Administration could allow for the importation of less expensive Canadian drugs, as well as other medications made for other countries. The idea of importing cheaper medicine has attracted bipartisan support amid a push to control the price of prescription drugs. President Donald Trump has backed the idea, as have New Hampshire’s U.S. Sens. Jeanne Shaheen and Maggie Hassan, both Democrats. (Albertson-Grove, 7/31)

In the first couple of months after a federal judge ordered the Trump administration last year to stop separating most parents and children at the U.S.-Mexico border, the number of children sent to New York fell. Then, advocates say, the children started coming again in a steady stream, many too young to understand their circumstances or how to find their parents. (7/31)

And in other news —

A Guatemalan mother whose toddler died weeks after being released from a Texas immigrant family detention center is suing the private prison company that operates the facility. Yazmin Juárez, who testified in Congress earlier this month about her 21-month-old daughter's death, filed a lawsuit Wednesday seeking $40 million in damages from CoreCivic, which runs the South Texas Family Residential Center in Dilley, Texas. (Shoichet, 7/31)

Georgia leaders’ hopes to get the federal government to pay almost all the costs of providing Medicaid coverage to more people appear to be dashed. And if the state budget is forced to shoulder more of the financial burden of its new Medicaid plan, that raises the question whether the plan will be forced to do less and cover fewer people. (Hart, 7/31)

New Hampshire will appeal a federal court’s decision to dismantle the state’s Medicaid expansion work requirement, a spokeswoman for the state’s Department of Justice said Wednesday, adding to what is expected to be a long legal road. In a decision Monday, the U.S District Court for the District of Columbia vacated the federal waiver allowing the requirement to take effect. Judge James Boasberg found that the federal government had exceeded its authority when it allowed New Hampshire to tack a work requirement onto its expanded Medicaid program. (Dewitt, 7/31)

Gov. John Bel Edwards’ administration marked the third anniversary of Medicaid expansion taking effect in Louisiana by touting a new study that found access to health care has improved for people taking advantage of the health insurance program. The study, which was funded by the Louisiana Department of Health and conducted by Tulane University researchers, found improvements in access to medical care, utilization and provider participation. Fewer people are unable to see a doctor or are not taking their medication as prescribed because of the expansion of Medicaid, researchers found. (Karlin, 7/31)

State economists are struggling to come up with estimates of how much it would cost the state and how it would affect Florida’s economy if voters approve a far-reaching constitutional amendment that calls for expanding Medicaid. Organizers, frustrated by the refusal of the Republican-controlled Legislature to back Medicaid expansion, have been gathering petition signatures to try to force a public vote on the issue. (Sexton, 7/31)

Utah will still ask the Trump administration for permission to impose per-person spending caps for certain Medicaid enrollees, even though the White House rejected a key part of the state’s partial Medicaid expansion plan, officials said today. The state outlined next steps just days after federal officials declined to give Utah enhanced federal funds for a partial expansion of Medicaid up to the federal poverty line — a coverage threshold lower than under the Affordable Care Act. (Pradhan, 7/31)

Senate Democrats will force a vote to block the Trump administration from allowing states to make changes to their ObamaCare markets. Under the Congressional Review Act, the Senate can overrule and block some actions taken by government agencies. While it’s unlikely to pass the Republican-controlled Senate, it gives Democrats another opportunity to hit the GOP on health care and protections for pre-existing conditions ahead of the 2020 elections. (Hellmann, 7/31)

“What we're talking about today is granting waivers to states to offer junk insurance plans,” Senate Minority Leader Charles E. Schumer, D-N.Y., said in a press conference. “These plans let the insurance companies get away with everything, even murder, figuratively speaking.” In October 2018, the administration put forward guidance to make it easier for states to make broader changes and subsidize policies that don’t meet the health care law's standards. All Democratic senators co-sponsored a Congressional Review Act joint resolution to roll back the changes by the Trump administration to the law's 1332 waiver policy. (Lindarte, 7/31)

In other news from Capitol Hill —

A Republican and a Democrat in the Senate on Wednesday proposed a bill meant to ensure that prescription drugs developed with the support of federal dollars aren’t launched with unreasonable prices.  The National Institutes of Health, with its $39.1 billion budget, and other federal programs often support early research into drugs or the clinical testing required to develop a drug. Sometimes, the NIH and other agencies will license their patented discoveries to private companies that further develop products for sale. (Siddons, 7/31)

In May, attorneys general in more than 40 states accused three pharmaceutical companies that make clomipramine — Taro Pharmaceuticals Industries Ltd., Mylan Pharmaceuticals Inc. and Novartis AG's generics arm, Sandoz — of conspiring to raise the drug’s price in concert. The allegation is part of a sweeping lawsuit that names 20 generic drugmakers and subsidiaries in all, as well as 15 current and former industry executives. It says they communicated with one another to fix prices and divvy up customers for more than 100 drugs, treating a range of maladies from HIV to high blood pressure to fungal infections. (Elgin, 7/31)

With a key approval decision less than two months away, Amarin said Wednesday that the Food and Drug Administration is “unlikely” to convene an advisory committee meeting to review data on an expanded use of its heart drug Vascepa. Amarin’s statement, offered as an update with its second-quarter earnings announcement, was meant to quell any residual investor concerns about the FDA’s ongoing review of Vascepa — with a decision deadline of Sept. 28. No FDA advisory committee meeting is good news for the Vascepa review. (Feuerstein, 7/31)

When used together, two drugs that treat the most common leukemia in adults significantly increase survival and lower the risk that the disease will worsen, according to a new study. The interim analysis of a clinical trial for chronic lymphocytic leukemia, published Wednesday in the New England Journal of Medicine, found that the drugs -- ibrutinib and rituximab -- fared better than a combination chemoimmunotherapy that's known to be effective against the cancer. (Nedelman, 7/31)

A bipartisan group of lawmakers announced Monday the beginnings of a plan to help supply emergency insulin to Minnesotans who cannot afford the rising cost of the drug. Insulin prices have tripled over the last 10 years, according to the governor's office. (John, Hallberg and Shiely, 7/31)

And the fight over CRISPR technology continues —

The Broad Institute of MIT and Harvard lied about who invented the use of CRISPR genome editing in animal cells, and its lead CRISPR scientist Feng Zhang made statements to the patent office that he knew were “untrue,” attorneys for the University of California and its partners claim in legal documents filed Tuesday night with the U.S. Patent and Trademark Office. In strikingly tough language, the lawyers accused the Broad of trying to “deceive the Office” in order to win patents on the revolutionary technology, claimed another Broad scientist made a “materially false declaration” about when Zhang’s lab got CRISPR to work, and argued that Zhang didn’t know what molecules the genome editor needed until he read a rival’s key paper — all of which makes Zhang’s work “unpatentable.” (Begley, 7/31)

One of the biggest challenges hospitals face is predicting when frail patients will decline into a life-threatening spiral. Subtle changes in health status get lost in a sea of data that is too vast for humans to effectively monitor. In a paper published Wednesday in the journal Nature, researchers at DeepMind describe a possible solution: A machine learning system capable of crunching hundreds of thousands of data points in electronic health records to alert physicians to an impending crisis long before it happens. (Ross, 7/31)

Google’s artificial-intelligence unit says it has developed an algorithm that can predict who is at high risk of developing a common kidney condition. The algorithm, developed by the DeepMind Health laboratories at Google parent company Alphabet Inc., marks a new application of machine learning in health care. Yet it also shows the shortcomings of many such efforts so far, in this case partly because the algorithm is accurate a little more than half the time. (Olson and Abbott, 7/31)

The condition is more common in older patients and, if not treated quickly, can affect other organs. It accounts for around 100,000 deaths every year in the UK. During a trial at London's Royal Free Hospital, doctors and nurses received warning signals via a mobile phone app in an average of 14 minutes, when patients' blood tests indicated the condition. (Pym, 7/31)

A new study confirms earlier reports that anemia — a condition caused by having too little hemoglobin, the oxygen-carrying component of red blood cells — increases the risk for dementia. It found that having high hemoglobin levels does so as well. Dutch researchers looked at 12,305 people without dementia at the start of the study, measuring their hemoglobin levels and following them for an average of 12 years. Over the period, 1,520 developed dementia, including 1,194 with Alzheimer’s disease. The study is in Neurology. (Bakalar, 7/31)

I’ve been a runner for 25 years and have been practicing yoga for 10. So why do I find it so much less painful to run for an hour than stand for an hour? Even the thought of standing for extended periods makes my back ache, especially during the summer, where standing is part of the fabric of the season, from waiting in line at amusement parks to standing in the security checkpoint queue at the airport. “The way we stand is so important. Our body can only handle so much strain in one position,” said Dr. Diane Koshimune, a podiatrist. When standing, most people’s tendency is to assume a “relaxed” stance, with the arch of the foot collapsed and your foot rolled in slightly, she said. (Ketteler, 8/1)

Virginia Fuchs announced herself to the boxing world at the 2016 United States Olympic Trials, where she twice upset Marlen Esparza, a world champion. In 2017, Fuchs went 18-0. In 2018, she claimed a bronze medal at the world championships by attacking her flyweight opponents, on average, every four seconds during nine minutes of boxing. “That’s an engine!” said Billy Walsh, the head coach for the American team. “She’s a supreme athlete. We joke and call her Seabiscuit because she’s like a racehorse.” (Berg, 7/31)

When North Carolina State University microbiologist Benjamin Chapman makes a smoothie, he like many of us uses frozen berries. But first, Chapman microwaves his frozen berries to boiling and then refreezes them again before tossing them into the blender. Why the extra steps? Chapman wants to be sure that there are no pathogens in the frozen berries that could cause a foodborne illness for him or his family. (Squires, 7/31)

Human Milk 4 Human Babies is a global network that connects local families who have chosen to share and receive breast milk. Through the local Iowa network, Fillmore says she was able to get to know the mothers she was receiving milk from by visiting their home and meeting their own babies. (Woodbury and Nebbe, 7/31)

Kaiser Health News: The Talk Seniors Need To Have With Doctors Before Surgery
The decision seemed straightforward. Bob McHenry’s heart was failing, and doctors recommended two high-risk surgeries to restore blood flow. Without the procedures, McHenry, 82, would die. The surgeon at a Boston teaching hospital ticked off the possible complications. Karen McHenry, the patient’s daughter, remembers feeling there was no choice but to say “go ahead.” It’s a scene she’s replayed in her mind hundreds of times since, with regret. (Graham, 8/1)

New research from the drug court program in Nashua shows a majority of people in the program have suffered from a significant number of childhood traumas. Studies have previously shown that Adverse Childhood Experiences or ACEs can predispose people for a whole host of negative outcomes later in life -- from anxiety and depression to cancer and diabetes. (Moon, 7/31)

Retail and chain pharmacy locations in Ohio received shipments of more than 3.4 billion oxycodone and hydrocodone pills between 2006 and 2012, almost all of the painkillers shipped to the state as the opioid crisis blossomed, according to a cleveland.com analysis of government data. The vast majority of those drugs were shipped to some of the largest chains in the state, including Walgreens, CVS, Rite Aid, Giant Eagle and Kroger. (Heisig, 7/31)

Rochester police have launched a new program aimed at helping people with substance abuse. Local officials are billing the effort as a way to get people into treatment rather than the current options for dealing with them. (Richert, 7/31)

The state of Arizona has taken the highly unusual move of filing a lawsuit at the Supreme Court, asking the justices to order the Sackler family — the owners of Purdue Pharma — to return billions of dollars in connection with their handling of the opioid epidemic. Arizona officials are alleging the family transferred the money from their company in order to prevent paying potential judgements over their alleged role in the crisis, in the process violating a 2007 legal agreement made with the state. The state says the family “reaped profits through misleading marketing tactics.” (Thomsen, 7/31)

Connecticut launched an investigation Wednesday into the marketing practices of Juul Labs, becoming the latest state to probe the vaping product manufacturer’s health claims and appeal to young people. State Attorney General William Tong said his probe is part of a national effort to curb youth vaping, which has included congressional hearings, a lawsuit in North Carolina over Juul’s marketing practices and similar investigations in states such as Massachusetts. (Eaton-Robb, 7/31)

State Attorney General William Tong and Consumer Protection Commissioner Michelle Seagull, who opened the investigation, said they believe the company’s health claims are largely unfounded and that there is mounting evidence to the contrary. The investigation comes on the heels of a study released by Yale University earlier this week, which found that the liquid-based devices not only carry nicotine but the chemicals used for flavoring can irritate lungs and airways. The known and unknown harms of e-cigarettes in large part inspired legislation raising the legal smoking age to 21. (Moore, 7/31)

Terminally ill adults in New Jersey will now be able to ask for medical help to end their lives. In April, Gov. Phil Murphy signed the Medical Aid in Dying for the Terminally Ill Act. It goes into effect Thursday. It allows adults with a prognosis of six months or less to live to get a prescription for life-ending medication. (Romine, 8/1)

A lawyer for the family of a transgender woman who died from an epileptic seizure at New York City's Rikers Island says she never should have been placed in a solitary unit. Lawyer David Shanies said Wednesday that medical records provided to the family show that jail officials knew 27-year-old Layleen Polanco had epilepsy, but decided to put her in a restrictive housing unit anyway. (7/31)

California’s attorney general touted a legal victory this week against drugmakers who he said made secretive, backroom deals to keep less expensive drugs off the market. In nearly the same breath, Xavier Becerra also lamented that he didn’t have enough legal tools to go after all the companies that engage in the practice of “pay for delay,” in which brand-name drugmakers pay off generic manufacturers to keep the more affordable generic versions of their medications off the market. (Ibarra, 7/31)

The American Civil Liberties Union of Illinois wants a federal judge to order the state of Illinois to change its practices for providing medical treatment to transgender prisoners. Current policies fail to provide adequate health care to prisoners diagnosed with gender dysphoria, according to opening arguments made Wednesday by the ACLU in a federal court in East St. Louis. (Petrin, 7/31)

As a new Minnesota state law banning vaping in most indoor public places takes effect, some believe it will slow an explosion in popularity, while others are skeptical. The Clean Indoor Air Act already bans cigarettes and traditional nicotine and tobacco products in most indoor spaces. Starting Thursday, e-cigarettes will join that list. (Moini, 7/31)

Gov. Mike DeWine says Ohio may need to stop executing people by injection because state officials have been unable to obtain the necessary drugs, according to a DeWine spokesman. DeWine, a Greene County Republican, has asked legislative leaders to consider legislation that would change Ohio’s 18-year-old law making lethal injection the state’s sole execution method, according to gubernatorial spokesman Dan Tierney. (Pelzer, 7/31)

Online medical shopping is now available in Missouri and Kansas, and it could be more affordable than going through insurance companies. Launched in March, Sesame allows patients to search for medical care in the Kansas City, Missouri, and Kansas City, Kansas, areas. MediBid is an online portal that allows patients to make requests for care and doctors and hospitals to respond with an offer. (Aiken, 7/31)

Four substance-abuse treatment centers in Michigan owned by U.S. Addiction Services sued Blue Cross Blue Shield of Michigan on Wednesday for more than $40 million in unpaid claims involving more than 4,000 patients, according to a lawsuit filed in U.S. District Court for the Western District of Michigan. A spokesman for New York-based law firm Napoli Shkolnik PLLC, which is representing the plaintiff, said one of the providers was forced to close and the other three turned patients away because Blue Cross "refused to provide meaningful coverage for addiction treatment." (Greene, 7/31)

Staffers here believe that it’s up to places like this to explain unspoken risks and regret. They want First Coast to be a loving pause, an hour of empowerment, a crucial education. Visitors sit, cry, fidget, text, pray, until a volunteer opens a white door, smiles and leads them through. (McNeill, 8/1)

Growing up is hard. Growing up transgender is even harder.That’s why Akron Children’s Hospital’s new Center for Gender Affirming Medicine is providing support, resources and medical treatment for patients as young as 7 years old. (Golst, 7/31)

The goal: Observe every juvenile-dependency case. The hearings revealed moments of kindness and humanity in a system where bureaucracy often reigns, and cases can last two years or longer. What the Republic reporters observed raises questions about the rights of parents and children. (Náñez, Pitzel, 8/1)

Texas businesses are not required to offer their employees paid sick time, which led Austin to approve an ordinance mandating it last year. ...But on Thursday, Dallas will be the first of three major metropolitan areas to see its proposal come to fruition. Supporters and advocates of the proposal across the state are watching closely to measure its impact. (Samuels, 8/1)

The family of an 8-year-old boy with type 1 diabetes is suing the school district in Herriman, Utah, because they say he’s not allowed back in class due to a dispute over his treatment. Type 1 diabetes means the pancreas can’t produce insulin, which is necessary to move glucose from the blood into cells for energy. (Young and Raphelson, 7/31)

A blood-testing company filed for bankruptcy and says it's cutting jobs because Medicare payments have been withheld over allegations of fraud. The Richmond Times-Dispatch reports True Health Diagnostics LLC filed for Chapter 11 bankruptcy protection this week and notified officials of impending layoffs. (7/31)

The ousted Iowa Department of Human Services director will pursue a wrongful termination lawsuit, alleging he was let go after objecting to a pay arrangement for the governor’s deputy chief of staff, his lawyer said Wednesday. Jerry Foxhoven, a 67-year-old legal scholar known for his frequent workplace praise of the late rapper Tupac Shakur, will file a whistleblower claim with the State Appeal Board, his attorney Tom Duff said. That’s the first step toward pursuing a lawsuit against state government. (Foley, 7/31)

The U.S. government plans to send immigrant children to shelters run by a group home recently shut down by North Carolina, a building contractor with no experience in residential care and a Texas children’s shelter with a track record of state violations, a Reveal and WRAL News investigation has found. (Michels, Morel, Browder, Dukes and Fain, 7/31)

If Smyrna carries through on its plans, it will become one of just five communities — out of 109 flagged by the EPA nationally as having higher cancer risks — to get its air tested for ethylene oxide, a toxic gas that is used to sterilize medical equipment as well as make other products such as antifreeze. In other areas that have had their air tested, the estimated cancer risks turned out to be higher than those predicted by the EPA’s modeling, which was released in 2018. (Goodman and Miller, 7/31)

The Ohio Department of Commerce notified Harvest Grows LLC in January it planned to revoke its large-scale cultivation license. The agency reviewed company documents and concluded Harvest was not actually owned and controlled by Ariane Kirkpatrick, an African-American Ohio woman, as claimed on its application. (Borchardt, 7/31)

Access to health specialists is difficult for many individuals in rural communities. Telemedicine, health care service delivered remotely through telecommunications, is one potential solution, but its use varies across regions, potentially associated with the availability of high-speed internet (broadband) access. The Federal Communications Commission (FCC) and Congress have emphasized the need to increase broadband access in rural communities, in part to facilitate the use of telemedicine, and the FCC’s Connect America Fund has set aside billions of dollars to subsidize broadband expansion. Our objective was to examine whether broadband availability in local communities is associated with telemedicine use. (Wilcock et al, 7/29)

In 2010, prompted by compelling evidence that demonstrated better patient outcomes in hospitals with higher percentages of nurses with a bachelor of science in nursing (BSN), the Institute of Medicine recommended that 80 percent of the nurse workforce be qualified at that level or higher by 2020. Using data from the American Heart Association’s Get With the Guidelines–Resuscitation registry (for 2013–18), RN4CAST-US hospital nurse surveys (2015–16), and the American Hospital Association (2015), we found that each 10-percentage-point increase in the hospital share of nurses with a BSN was associated with 24 percent greater odds of surviving to discharge with good cerebral performance among patients who experienced in-hospital cardiac arrest. Lower patient-to-nurse ratios on general medical and surgical units were also associated with significantly greater odds of surviving with good cerebral performance. These findings contribute to the growing body of evidence that supports policies to increase access to baccalaureate-level education and improve hospital nurse staffing. (Harrison et al, 7/1)

Among people with three consecutive years of coverage from a large employer, just 1.3 percent of enrollees accounted for 19.5 percent of overall health spending in 2017, finds a new �鶹Ů�� analysis. These “people with persistently high spending” – people in the top five percent of spending in each of the three years from 2015 to 2017 – had average health spending of $87,870 in 2017. That compared to average per person spending of $5,870 among all large group enrollees during that period. (7/24)

Infants ≤28 days of age with fever are frequently hospitalized while undergoing infectious evaluation. We assessed differences in rates of serious bacterial infection (SBI; bacteremia, bacterial meningitis, urinary tract infection) and invasive bacterial infection (IBI; bacteremia, bacterial meningitis) among the following neonates: (1) febrile at presentation (FP), (2) afebrile with history of fever without subsequent fever during hospitalization, and (3) afebrile with history of fever with subsequent fever during hospitalization. (Ramgopal et al, 8/1)

In this qualitative study of data collected from interviews with 158 key stakeholders at 9 Get With The Guidelines–Resuscitation hospitals, distinct differences were found in the organizational structure and function of rapid response teams. Top-performing hospitals feature rapid response teams with dedicated staff without competing responsibilities, serve as a resource for bedside nurses in surveillance of at-risk patients, collaborate with nurses during and after a rapid response, and can be activated by a member of the care team without fear of reprisal. (Dukes et al, 7/29)

The United States leads the world in health care innovation, but we are tragically dead last as compared with other high-income countries when it comes to keeping our citizens healthy. While those in other countries have access to regular physical exams and a wide range of preventive care regardless of their economic status, the only level of care we, the richest nation in the world, guarantee every resident is a trip to the local emergency room. I believe we can — and should — do better. (Michael Apkon, 8/1)

Over 3.6 million middle and high school students used e-cigarettes last year, up by 1.5 million over 2017. The use of Juul, the most popular brand in the country, appears to have led this alarming increase among middle and high school students. This should not be a surprise. The founders of Juul Labs say that their product is not intended for young people but was designed with the adult smoker in mind. “We want to be part of the solution to end combustible smoking, not part of a problem to attract youth, never smokers or former smokers to nicotine products,” the company says on its website. (David A. Kessler, 7/31)

From digital health startups to primary care groups, companies are increasingly branding themselves as tech companies first, health care companies second. Shunning ties to the mission-driven health care sector may seem counterintuitive at best and sacrilegious at worst.Yet for many new entrants, such an approach — which we call avoidant positioning — is becoming the norm. We unpack three weaknesses of the health care label that may be fueling a broader identity crisis for these firms, and suggest that this trend represents a wake-up call for health care. (Samyukta Mullangi and Medha Vyavahare, 8/1)

Earlier this month, a Nebraska midwife, Angela Hock, was charged with negligent child abuse when a newborn died after complications from a breech birth at home. It’s worth noting that before this delivery, Ms. Hock, the proprietor of a business called Nebraska Birth Keeper, had performed 50 births at home without incident. Nonetheless, Ms. Hock was not certified to practice as a midwife. It’s unfortunate that these are the stories about home birth that make headlines, because they give the practice a bad name, and contribute to a sense that home births are irresponsible, a danger to the mother and baby. (Kate A. McLean, 7/31)

Drug shortages are a major challenge for hospitals. Today, 121 key lifesaving drugs are in short supply and 70% of all hospital pharmacists report at least 50 shortages a year. Without these lifesaving drugs on hand, providers may be forced to delay medically necessary care or substitute therapies that may not be as effective. Health systems like ours can help alleviate the problem. Drug shortages are triggered by a variety of events, including natural disasters or manufacturing quality problems that take producers offline for weeks or months at a time. Some shortages occur when manufacturers have difficulty finding sources of raw materials, others when there is a sudden surge in demand due to a disease outbreak or seasonal spike in cases, such as flu season. (Barclay E. Berdan, Scott Reiner and Terry Shaw, 8/1)

I had been with Bill Thomas for only a few hours when a woman came up to us in tears. She had heard him recently on a podcast talking about his sister Cathy’s still-unsolved 1986 killing and recognized his face from the social media accounts he uses to push out updates and thoughts on the case. Coincidentally, she was about to go camping near the site of the murder, the Colonial Parkway in Williamsburg, Va. “It’s been so heavy on my mind,” she said in a choked voice. She wanted to know if anything bad had happened on the parkway since the so-called Colonial Parkway Murders — a potential serial killer case involving the deaths of four young couples, including Cathy and her girlfriend, Rebecca Dowski. (Britt Peterson, 7/30)

In an extended line of questioning on health care, (Kamala) Harris and (Joe) Biden faced off politely and substantively on their respective plans. Biden argued that the cost of Harris’s plan “will require middle-class taxes to go up” and “what happens in the meantime?” Harris made the case against the status quo: “Your plan will keep and allow insurance companies to remain with status quo, doing business as usual, and that’s going to be about jacking up co-pays, jacking up deductibles.” On points, Biden won this round, sounding informed and passionate. (Jennifer Rubin, 7/31)

On health care, in particular, (Joe) Biden displaying his in-depth policy knowledge while also rebutting repeated attacks from (Kamala) Harris. Biden gave a strong defense of his pragmatic plan to strengthen ObamaCare, while the confusion and lack of clarity around Harris’ plan hindered her position. Biden also successfully took aim at what he has called Harris’ “have it every which way approach.”Health care “is the single most important issue facing the public,” Biden said to Harris. “To be very blunt ... you can't beat President Trump with doubletalk on this plan.” (Douglas E. Schoen, 7/31)

This week’s Democratic debates have had a nasty case of Plan-itis, especially when it comes to health care. It’s important that candidates have plans for what to do about health-care costs and coverage. But we’re way too focused on the details of candidates’ policy plans, and it’s not serving the voters’ needs well. Every big health reform plan has tradeoffs and winners and losers — no exceptions. It’s not really a huge contribution to voters for debate moderators to find elements of the candidate’s plans they can nail them on. (Drew Altman, 8/1)

A car accident that took the lives of my first wife and baby daughter just weeks after I was elected to the Senate for the first time badly injured my sons, Beau and Hunter, who were confined to hospital beds for weeks. At just 4 years old, Beau would turn to his brother in the hospital and say, "Hunt. Look at me, look at me. I love you." He was like that his entire life, up until his death in 2015, after a grueling battle with brain cancer. My family was fortunate enough to have health insurance. ...This is personal for me. This is why I fight. I believe deeply that health care is a right for all -- not a privilege for the few. (Former Vice President Joe Biden, 7/31)

In the video introducing his health-care plan, former vice president Joe Biden said Sen. Bernie Sanders’s Medicare-for-all plan “means getting rid of Obamacare.” And when Senator Kamala D. Harris unveiled her alternative Medicare-for-all proposal on Monday, one that allowed for a decade-long transition period and a continued role of private insurance in the system through Medicare Advantage, well, that wasn’t good enough for Biden either. It would, a spokesperson sniffed, “unravel the hard-won Affordable Care Act that the Trump Administration is trying to undo right now.” (Helaine Olen, 7/31)