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Morning Briefing

Summaries of health policy coverage from major news organizations

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Tuesday, Jan 19 2016

麻豆女优 Health News Original Stories 1

  • Determining Whether A Marketplace Plan Covers Abortion Is Still Difficult

Campaign 2016 2

  • Sanders Unveils Details For Single-Payer Health Care Plan
  • Barbs Fly At Debate As Clinton, Sanders Battle Over Health Care

Capitol Watch 1

  • Ryan Vows To Have Health Care Platform Ready For Republican Nominee

Health Law 1

  • As Enrollment Period Nears Close, Advocates Ponder Why Texas Sign-Ups Lag

Marketplace 1

  • UnitedHealth Posts $720M Loss From Health Law Plans, But Tops Analysts' Profit Forecasts

Administration News 1

  • As 'Precision Medicine' Evolves, Vagueness And Hype Still Surround Concept

Women鈥檚 Health 1

  • Abortion Rights Activists Say New N.C. Ultrasound Law Is Creating State 'Stockpile' Of Sonograms

Public Health 2

  • Drug Overdoses Causing Mortality Rates Not Seen Since AIDS Epidemic
  • Survey: 40 Percent Of Physicians Report Bias Toward Certain Patients

State Watch 2

  • Neb. Lawmakers To Offer Bill To Expand Medicaid Modeled On Arkansas' Private Option
  • State Highlights: A Tuberculosis Outbreak In Rural Alabama; In California, Alzheimer's Caregivers Have Limited Options For Aid

Editorials And Opinions 2

  • Campaign Trail Views: Sanders' Health Plan Raises Questions For Progressives; Clinton's Embrace Of Planned Parenthood
  • Viewpoints: Talking About Drug Prices; How Big Data Could Focus The Cancer 'Moonshot'

From 麻豆女优 Health News - Latest Stories:

麻豆女优 Health News Original Stories

Determining Whether A Marketplace Plan Covers Abortion Is Still Difficult

Many insurers leave out information about abortion coverage on the summary of benefits and coverage. ( Michelle Andrews , 1/19 )

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Summaries Of The News:

Campaign 2016

Sanders Unveils Details For Single-Payer Health Care Plan

On Sunday, after receiving criticism from front-runner Hillary Clinton for not providing the details of his universal health care plan, Sen. Bernie Sanders outlined his vision, which would cost $1.38 trillion a year and include a 2.2 percent tax increase on all income.

Sen. Bernie Sanders of Vermont, under pressure from the Clinton campaign to explain how he would pay for his progressive policies, unveiled a universal healthcare plan on Sunday night that includes sweeping tax increases and a drastic tax hike for the wealthiest. Ahead of a nationally televised Democratic presidential debate, Mr. Sanders said that his 鈥淢edicare-for-all鈥 plan was in the spirit of Democratic presidents such as Franklin Roosevelt and Harry Truman and projected that the health savings would outweigh the higher taxes that would pay for the plan. (Alcindor and Rappeport, 1/17)

Democratic presidential candidate Bernie Sanders said Sunday that he would pay for his plan for a single-payer health-care system with a suite of new taxes, including a 2.2% 鈥減remium鈥 applied to all income, a new payroll tax paid by employers, and a variety of tax increases on the wealthiest Americans. The plan would increase government spending by a total of nearly $14 trillion over 10 years, the campaign said, and together with his other proposals, would bring federal spending to its highest level since World War II. (Meckler, 1/17)

His campaign said the plan would cost $1.38 trillion a year, but would save $6 trillion over the next decade compared to the current health care system, citing an analysis by Gerald Friedman, an economist at University of Massachusetts at Amherst. But much of the cost would be paid for through a 6.2 percent payroll tax paid by employers and a 2.2 percent "health care premium" on workers. It also relies on taxing capital gains and dividends on families earning more than $250,000 a year, eliminate deductions for wealthy Americans and raising the estate tax. The plan would also raise income taxes on Americans making more than $250,000 a year, including a top tax rate of 52 percent for those earning $10 million annually or more. (Thomas, 1/17)

Clinton's campaign had taken aim at Sanders in recent days, saying the U.S. senator from Vermont had not said how he plans to pay for his healthcare plan and that he needed to before the first party-nominating contest in Iowa on Feb. 1. (Becker, 1/17)

The plan also would be funded in part by an increase in estate taxes on wealthy Americans, as well as a change in the way capital gains and dividends are taxed, the senator said. Sanders has long argued that most families would pay substantially less out of pocket for health care under his approach. (Wagner, 1/17)

Sen. Bernie Sanders of Vermont on Sunday evening unveiled details of his plan to move the country beyond the Affordable Care Act to a universal national health care program that would cost about $13.8 trillion over the coming decade and require a sweeping increase in taxes, especially for the wealthiest Americans. (Pianin, 1/18)

Barbs Fly At Debate As Clinton, Sanders Battle Over Health Care

In the last Democratic faceoff before the Iowa caucuses, Hillary Clinton and Bernie Sanders' heated words underscore the ever-narrowing race between the two. In a series of pointed exchanges, Clinton continued her attack on Sanders' newly released "Medicare for all" health plan, while Sanders went after her ties to Wall Street.

Hillary Clinton targeted Bernie Sanders鈥檚 electoral appeal with some of her strongest language yet in a debate on Sunday night, seizing on Mr. Sanders鈥檚 recent policy shifts on universal health care and gun control to try to undercut his image as an anti-political truth teller. ... With Mr. Sanders gaining on her before the Feb. 1 Iowa caucuses, Mrs. Clinton cast herself as the defender of Mr. Obama鈥檚 record and Mr. Sanders as playing into Republican hands with proposals like replacing the Affordable Care Act with a single-payer plan, which Mr. Sanders describes as 鈥淢edicare for all.鈥 (Healy and Chozick, 1/17)

Health care emerged as a major dividing line, placing the future of President Barack Obama's health care law in the spotlight. Just two hours before the debate, Sanders released a proposal that would create a "Medicare for all" health care system funded by higher taxes on middle class families and the wealthy. Clinton warned that reopening the health care debate would put Obama's health care law at risk. (Thomas, 1/17)

On the debate stage, Clinton positioned herself as the more pragmatic defender of the Affordable Care Act. 鈥淲hen you鈥檙e talking about health care, the details really matter,鈥 Clinton said, 鈥渁nd therefore we have been raising questions about the nine bills that [Sanders] introduced over 20 years.鈥 ... 鈥淲e finally have a path to universal health care,鈥 Clinton said. 鈥淲e鈥檝e accomplished so much. I do not want to see the Republicans repeal it, and I do not want us to start over again with a contentious debate. I want us to defend and build on the Affordable Care Act and improve it.鈥 Sanders, raising his voice, shot back at Clinton: 鈥淲hat her campaign was saying -- Bernie wants to end Medicare, Medicaid -- that is nonsense.鈥 (Karni, 1/17)

Sanders denied he'd tear down Obamacare, noting that he had a role in drafting it and he voted for it. But he said he wants to build on it, and bring down the cost of health care which is still leaving the newly insured with big expenses. He also pointed out that nearly six years after Obamacare was enacted, around 29 million people are still uninsured. (Debenedetti, 1/17)

The harshest exchanges Sunday, as on the campaign trail in recent days, were over health care, and Mr. Sanders鈥檚 plan for a single-payer national health-care plan. Mrs. Clinton鈥檚 argument against his plan was essentially a political one: it isn鈥檛 smart, she said, to start over again at a time when the Affordable Care Act remains under attack from Republicans. She noted that even during the 2009-10 health-care debate, when Democrats had large majorities in both houses of Congress, there wasn鈥檛 sufficient support for a public option to compete with private health-insurance plans. (Meckler, Nicholas and McCain Nelson, 1/17)

With raised voices, interruptions and wonky examinations of one another鈥檚 voting records and policies, Sanders and Clinton battled over who had the more progressive or more workable solutions. Their exchanges were the most combative and personal of the campaign so far, reflecting the newly potent threat Sanders poses to Clinton in her second White House run. (Gearan and Rucker, 1/17)

At Sunday night's NBC News Democratic debate, Hillary Clinton and Bernie Sanders sparred over health care and guns, two policy issues that have become central to their campaigns. Is what they said true? (Caldwell, 1/18)

[Hillary] Clinton and [Vermont Sen. Bernie] Sanders took most of the time on the debate stage, finally coming face to face over issues at the heart of their increasingly combative campaigns -- gun control, health care and Wall Street reform.(Condon, 1/18)

Clinton's demand of loyalty to the president, and desire to retain her lofty standing among African American voters, was central to a lengthy dispute over healthcare. The national front-runner has proposed tweaking Obama's landmark healthcare law to improve it. Sanders, the Vermont senator whose support is greatest among white and young voters, has proposed moving to a fully government-funded plan that, he announced just before the debate, would be paid for by taxes on all but the poorest Americans. (Decker, Halper and Mehta, 1/18)

Sanders, a self-described democratic socialist, is exciting liberal activists by championing a proposal where the government supplies healthcare in what鈥檚 known as a single-payer system, an elusive ideal that many on the left have demanded for more than half a century. Clinton argues that Obama鈥檚 hard-fought healthcare law, often called Obamacare, should be defended and improved. She has called for new consumer protections to lower the cost of prescription drugs and safeguard patients from surprise medical bills and limited insurance networks. The divergent views epitomize the differences between the candidates 鈥 Clinton as a battle-hardened realist, with Sanders the uncompromising crusader 鈥 and the healthcare debate has become one of the most rancorous parts of an increasingly competitive primary. (Megerian and Levey, 1/15)

Capitol Watch

Ryan Vows To Have Health Care Platform Ready For Republican Nominee

House Speaker Paul Ryan, R-Wis., says Republicans in Congress will craft a five-point agenda looking at national security, the economy, health care, poverty and the Constitution. In other Capitol Hill news, Rep. John Kline of Minnesota is opening an inquiry over the deaths of drug-dependent newborns.

Ryan promised it would be a specific policy outline, despite the caucus鈥檚 inability to forge consensus for years on complicated issues, such as alternatives to the Affordable Care Act. 鈥淏elieve you me, the people of this country will know who we are and what we stand for when this is done, and they will be given a choice in 2016,鈥 Ryan said. (Kane, 1/15)

It was unclear, for instance, whether Republicans will actually present a plan to replace the current health care law that has been their central policy punching bag since they took over the House. Republican leaders in the House and Senate demurred on whether they would write and vote on a bill this year. But members were concerned by a presentation of polling data, some Republicans said, that found that while the health care law remained unpopular with many people, Democrats had a double-digit lead over their party on the issue of health care. (Steinhauer and Herszenhorn, 1/15)

The chairman of a U.S. House committee that oversees child abuse issues opened an inquiry Friday into whether the federal government is failing to enforce a law meant to protect thousands of babies born dependent on drugs each year. The inquiry, launched by Representative John Kline of Minnesota, comes in response to a Reuters investigation last month that identified 110 examples of children who were exposed to opioids while in the womb and later died preventable deaths after leaving the hospital. No more than nine states comply with a 2003 law that calls on hospitals to alert social workers whenever a baby is born dependent on drugs, the news agency found. (Schiffman and Wilson, 1/16)

Health Law

As Enrollment Period Nears Close, Advocates Ponder Why Texas Sign-Ups Lag

The Dallas Morning News examines why Texas is not as successful as Florida in signing up people for health insurance. Also in the news is a look at hospitals' efforts to get into insurance networks and a reminder to consumers that penalties for not having a plan will rise in 2016.

When it comes to signing people up for Obamacare, Florida is crushing Texas. And it鈥檚 not even close. ... Advocates, leaders of outreach and enrollment organizations in both states and others who closely follow the health law speculated that Florida may be outperforming Texas in sign-ups for three major reasons. The Sunshine State is more compact. It fielded a bigger, centrally managed army of trained helpers. And its GOP leaders haven鈥檛 imposed as many roadblocks as Texas鈥 leaders have. (Garrett, 1/17)

According to the consultant group McKinsey, about half of the plans available are in so-called 鈥渘arrow networks,鈥 which is a complicated way of saying not all doctors and hospitals are included. That can be tricky for consumers. And it can be tricky for hospitals who 鈥 in some instances 鈥 must find ways to convince insurers that they will be cost-effective partners. (Gorenstein, 1/18)

With less than two weeks of open enrollment left, Covered California is reminding consumers that they will face increased penalties for not having health insurance this year. ... This year, the penalty is $695 per adult and $347 per child up to a family cap of $2,500 or 2.5% of household income, whichever is greater. Last year's penalty was $325 for adults, with a $975 maximum or 2% of household income. (Sisson, 1/19)

Marketplace

UnitedHealth Posts $720M Loss From Health Law Plans, But Tops Analysts' Profit Forecasts

The biggest U.S. insurer got a boost from its pharmacy benefit management business, but the company will evaluate in the first half of this year whether it will continue to offer Obamacare plans in 2017.

UnitedHealth Group Inc., the U.S.鈥檚 biggest health insurer, posted fourth-quarter earnings that topped analysts鈥 estimates as profit surged at its technology and consulting business, helping overcome losses from Obamacare plans. The insurer, which first disclosed in November that it expected losses in the Obamacare markets, recorded $720 million in losses from health insurance products sold through new markets set up under the Patient Protection and Affordable Care Act. United Health has said it may pull out of Obamacare next year. (Tracer, 1/19)

UnitedHealth Group Inc reported a better-than-expected quarterly profit, helped by strength in its Optum pharmacy benefit management business. Revenue from the company's Optum business, which also offers healthcare data and analytics and technology services, rose 70 percent to $21.9 billion in the fourth quarter ended Dec. 31. (1/19)

Administration News

As 'Precision Medicine' Evolves, Vagueness And Hype Still Surround Concept

Doctors meet in Philadelphia to discuss the future of precision cancer medicine. Meanwhile, Obama administration policy developments on patient access to medical records, gun control steps and NIH's cancer database all make headlines.

When President Obama announced his "precision medicine" initiative a year ago, the White House spotlighted Emily Whitehead as an example of patients who have already benefited from an approach most people have never heard of. The central Pennsylvania girl, now 10, was near death in 2012 when researchers at Children's Hospital of Philadelphia engineered her own immune system's T cells to recognize and attack her leukemia cells. Though Emily's therapy was custom made, it didn't take into account individual differences in her genetic makeup, lifestyle, or environment - which is how the president's initiative and the National Institutes of Health define precision medicine. (McCullough, 1/17)

The Obama administration is tearing down barriers that make it difficult for patients to get access to their own medical records, telling doctors and hospitals that in most cases they must provide copies of these records within 30 days of receiving a request. ... In new guidelines, issued this month, the administration says doctors and hospitals cannot require patients to state a reason for requesting their records, and cannot deny access out of a general concern that patients might be upset by the information. (Pear, 1/16)

When President Obama recently outlined steps to reduce gun violence, mental-health advocates applauded his proposal to spend $500 million to aid access to care for the mentally ill. Advocates, however, are divided over whether proposals to ease the sharing of information with the FBI鈥檚 background-check system breach patient rights. (Nutt, 1/14)

Most experts believe that one important element of Vice President Biden's cancer "moonshot" has to be a major database that researchers and clinicians can access to help them develop new therapies or treat patients. Both the American Society of Clinical Oncology and the American Association for Cancer Research have launched such projects, as have some big academic cancer centers. And Thursday, during a teleconference with reporters to discuss President Obama's State of the Union call for a stepped-up war on cancer, the National Cancer Institute's acting director, Douglas R. Lowy, stressed that his agency is nearing completion on an effort of its own. (Bernstein, 1/14)

Women鈥檚 Health

Abortion Rights Activists Say New N.C. Ultrasound Law Is Creating State 'Stockpile' Of Sonograms

But proponents contend that the law offers stronger oversight of the state's prohibition of abortion after 20 weeks. Meanwhile, thousands turn out for a "March for Life" event in Chicago.

Ultrasounds have long been a flash point in the battle over abortions. But under a new law in North Carolina, doctors in the state must now submit ultrasound images, along with fetal measurements, to state authorities when performing abortions past a certain point in a pregnancy. The law, which was implemented Jan. 1, is meant to ensure abortion providers comply with previously established legislation that prohibits the procedures past 20 weeks of pregnancy. But critics of North Carolina鈥檚 new law say it is a gross violation of women鈥檚 privacy. (Bever, 1/16)

Thousands braved bitter cold temperatures for a "March for Life" in downtown Chicago on Sunday, five days before the 43rd anniversary of the U.S. Supreme Court's Roe v. Wade decision legalizing abortion nationwide. Demonstrators held yellow balloons with "life" printed on them as organizers passed around rosary beads and others danced to music to keep warm in temperatures that hovered just above 0 degrees Fahrenheit. (Young and Wisniewski, 1/17)

In other reproductive health rights news, KHN's Michelle Andrews looks at how tough it is to tell if a marketplace plan covers an abortion聽鈥

As the third open enrollment period winds down on the health insurance marketplaces, one thing hasn鈥檛 changed much since the online exchanges opened: It鈥檚 still often hard to find out whether a plan covers abortion services. (Andrews, 1/19)

Public Health

Drug Overdoses Causing Mortality Rates Not Seen Since AIDS Epidemic

In 2014, the overdose death rate for whites ages 25 to 34 was five times its level in 1999, and the rate for 35- to 44-year-old whites tripled during that period. Meanwhile, the research backs using medications to treat drug addiction, but clinics are not offering them to their patients; health insurers are taking steps to help battle the growing epidemic; and doctors look to treatments other than opioids to deal with chronic pain.

Drug overdoses are driving up the death rate of young white adults in the United States to levels not seen since the end of the AIDS epidemic more than two decades ago 鈥 a turn of fortune that stands in sharp contrast to falling death rates for young blacks, a New York Times analysis of death certificates has found. The rising death rates for those young white adults, ages 25 to 34, make them the first generation since the Vietnam War years of the mid-1960s to experience higher death rates in early adulthood than the generation that preceded it. (Kolata and Cohen, 11/16)

Physicians and brain researchers say that drugs such as buprenorphine, methadone and naltrexone are the most effective anti-addiction weapons available. Nevertheless, more than two-thirds of U.S. clinics and treatment centers do not offer the medicines. Many refuse to admit people who are taking them. The result is that hundreds, perhaps thousands, of Americans are dying unnecessarily, victims of an epidemic that killed more than 28,000 people in 2014 鈥 more than homicides and almost as many as highway fatalities. (Vestal, 1/18)

CeltiCare Health Plan, is one of several health insurance companies taking new steps to deal with the nation鈥檚 growing opioid epidemic. CeltiCare has about 50,000 members in Massachusetts and mostly manages care for low-income patients on Medicaid. (Becker, 1/19)

A whopping 100 million Americans suffer from chronic pain, and to manage that pain long-term, 5 million to 8 million use prescription opioids. According to the Centers for Disease Control Policy, West Virginia is among the states that prescribe the most painkiller prescriptions, 138 per 100 people. But it was not always that way. A generation ago, doctors were wary about the use of opioids to manage common pain problems. That began to change in the 1990s as drugs such as OxyContin 鈥 touted to be less addictive 鈥 were introduced. Painkillers first used only for extreme cases, such as cancer patients near the end of life, became commonly prescribed for many types of chronic pain. (Stuck, 1/17)

Meanwhile, investors see an untapped market in the addiction treatment field聽鈥

When King of Prussia developer Brian O'Neill convinced a New York private equity firm to back his fledgling Recovery Centers of America, he capitalized on one key trend: The long stigmatized field of addiction treatment has become one of health care's hottest investment sectors. Federal changes boosting access to care for alcoholics and drug addicts as well as people with mental illness, and growing attention to deaths from prescription painkillers and heroin, are luring investors to buy into addiction treatment. (Brubaker, 1/15)

Survey: 40 Percent Of Physicians Report Bias Toward Certain Patients

Doctors reported that factors such as emotional problems, weight, intelligence, language barriers and attractiveness determined how they viewed a patient. Other media outlets examine if a yearly physical is necessary, a new procedure for cataract blindness, and organ transplant numbers.

If you are overweight, have emotional problems or have difficulty with English, there's a good chance your doctor could be judging you because of it. That troubling finding comes from a [Medscape] survey conducted over email of 15,800 physicians across the United States from more than 25 specialties. (Storrs, 1/19)

Nearly two-thirds of U.S. adults say they get a physical exam every year, according to a 2014 Kaiser Family Foundation survey of 1,500 people. The federal Affordable Care Act requires insurers to cover annual physicals free of charge. In the medical community, however, experts are divided on whether there is a benefit to getting an annual exam. Some research has shown regular physicals don鈥檛 reduce rates of illness or mortality and are a waste of health-care resources. They also could be harmful, for example, when false positives result in additional, unnecessary testing. Other experts say a yearly checkup is an important part of building a physician-patient relationship and can lead to unexpected diagnoses such as of melanoma and depression. (Reddy, 1/18)

What affects 20 million people, robs the global economy of billions of dollars and can be fixed with a five-minute procedure? The answer is cataract blindness. The disease, which begins with clouding of the eyes and can lead to loss of vision without treatment, will probably afflict 12 million more people by 2020, as a shortage of skilled doctors limits access to care in developing nations, according to the Rand Corporation. (Harvey, 1/19)

Surgeons notched more than 30,000 transplants nationwide for the first time in 2015, according to the United Network for Organ Sharing. The reasons for the 5 percent jump in organ transplants are unclear, though better communication between organ-procurement agencies and hospitals might be a factor, said Dr. David Klassen, the network's chief medical officer. (Sutherly, 1/18)

In other public health news聽鈥

A federal appeals court has ruled that tobacco companies had no basis to challenge a Food and Drug Administration report on menthol cigarettes, which the industry alleged was written by experts with conflicts of interest. The decision by a three-judge panel overturns a lower court ruling that barred the FDA from using the report and ordered the agency to reform its committee of tobacco advisers. (Perrone, 1/15)

The head of the U.S. Environmental Protection Agency on Monday defended the Obama administration's handling of a crisis in Flint, Michigan with lead-contaminated drinking water. Speaking to reporters after an event at a Washington soup kitchen, EPA Administrator Gina McCarthy defended the federal government's response. (Shepardson, 1/18)

[Dr. David Goodman at Johns Hopkins School of Medicine says he's] seeing more and more adults over the age of 50 newly diagnosed with ADHD. The disorder occurs as the brain is developing, and symptoms generally appear around age 7. But symptoms can last a lifetime. For adults, the problem is not disruptive behavior or keeping up in school. It's an inability to focus, which can mean inconsistency, being late to meetings or just having problems managing day-to-day tasks. Adults with ADHD are more likely than others to lose a job or file for bankruptcy, Goodman says. They may overpay bills, or underpay them. They may pay bills late, or not at all. (Neighmond, 1/18)

State Watch

Neb. Lawmakers To Offer Bill To Expand Medicaid Modeled On Arkansas' Private Option

The Nebraska legislature has refused in three previous attempts to expand Medicaid, but a new proposal would set up a plan that uses government funds to purchase private insurance for Medicaid enrollees. Also, Ohio is looking at some changes in its Medicaid expansion program.

After three failed attempts to expand Medicaid under the federal health care law, Nebraska lawmakers will unveil a new proposal this week that would offer private coverage to thousands of low-income residents. The newest bill is modeled after the so-called private option adopted by Arkansas, which received a federal waiver to spend Medicaid dollars on private insurance. (Schulte, 1/17)

Tens of thousands of low-income Ohioans could lose Medicaid coverage under a state plan to charge premiums and impose penalties on those who miss the payments, advocates for the poor warn. ... State officials plan to ask federal regulators later this year to allow premiums to be charged to nondisabled, working-age adults on Medicaid who have incomes of less than 138 percent of the federal poverty level, or about $16,200 a year. The requirement would affect more than 1 million of the 3 million Ohioans covered by the tax-funded health insurance. (Candisky, 1/18)

Meanwhile, in news about Medicaid programs in other states 鈥

Legislation allowing the Lake County Jail to start applying for Medicaid benefits for qualifying inmates interred for 30 days or longer could save the county between $750,000 and $1 million a year. Sheriff John Buncich said House Bill 1269, approved last year, makes the Department of Correction an inmate's representative for applying for Medicaid benefits, something previously not allowed. (Napoleon, 1/16)

New Mexico lawmakers will enter the 30-day legislative session Tuesday without complete information on Medicaid 鈥 one of the largest parts of the state budget. A joint state and federal program that provides health coverage for low-income Americans, Medicaid constitutes a third of the new money state officials are requesting during this year鈥檚 session. Yet for years, lawmakers have been unable to get up-to-date information about the population served by the program, what types of health care services they receive and the effectiveness of those services. (Horwath, 1/18)

State auditors say the contractor managing mental health and substance treatment for Idaho's poor has helped reduced the use of costly Medicaid reimbursement rehabilitation services, but doing so has caused confusion and negative consequence among some providers unclear of the state's motives. Lance McCleve from Idaho's Office of Performance Evaluations told state lawmakers Monday that Medicaid spending for community-based rehabilitation, also known as psychosocial rehabilitation, ballooned from $8.3 million in 2001 to $76.1 million in 2012. (Kruesi, 1/16)

A new report on Idaho鈥檚 managed-care contract for mental health services says the state is spending less even though more people are getting services. Most of the complaints service providers have were necessary changes to the system the Department of Health and Welfare wanted to make, state auditors told the Joint Legislative Oversight Committee Monday afternoon. The changes would have happened no matter which provider the state selected. (Brown, 1/19)

State Highlights: A Tuberculosis Outbreak In Rural Alabama; In California, Alzheimer's Caregivers Have Limited Options For Aid

News outlets report on health care developments in Alabama, California, Ohio and Florida.

Marion [Ala.] is in the throes of a tuberculosis outbreak so severe that it has posted an incidence rate about 100 times greater than the state鈥檚 and worse than in many developing countries. Residents, local officials and medical experts said the struggle against the outbreak could be traced to generations of limited health care access, endemic poverty and mistrust 鈥 problems that are common across the rural South. (Binder, 1/17)

[Patt] Martin was among the 15.7 million Americans who contributed an estimated 17.9 billion unpaid hours to caring for people with Alzheimer's in 2014, according to the Alzheimer's Association. The organization says that 41 percent of those caregivers had a household income of less than $50,000, and 17 percent had to give up their jobs. Faced with physical, emotional and economic hardships, 40 percent of caregivers reported bouts of depression, the Alzheimer's Association says.(Wessel, 1/17)

County mental health officials and police are increasingly looking to urgent care centers as an alternative to jail beds or overcrowded psychiatric emergency rooms for people in the throes of a mental health crisis. There are now five such centers around the county, the newest of which opened last month, and the county plans to open four more over the next couple of years. (Sewell, 1/19)

The Cleveland Clinic has been a household name in medicine for decades. Now executives want to bring its brand to sporting goods stores, restaurant menus, and maybe even furniture retailers. The Clinic late last year filed an application with the U.S. Patent and Trademark Office to register its Go Well brand, the first step in using it to sell a wide range of consumer products. (Ross, 1/15)

A woman in need of a lung transplant died this week after her family said they tried repeatedly to have her transferred from a West Kendall medical center to Miami-Dade鈥檚 taxpayer-owned Jackson Memorial Hospital, the only facility in South Florida capable of transplanting lungs and a designated safety net for uninsured county residents. The woman鈥檚 family says Jackson Memorial officials denied her transfer first because they believed she was an undocumented immigrant, then because she was uninsured 鈥 and ultimately, after a week of denials because she was too critically ill to move. (Chang, 1/16)

Editorials And Opinions

Campaign Trail Views: Sanders' Health Plan Raises Questions For Progressives; Clinton's Embrace Of Planned Parenthood

Health policy opinions and editorials express responses to campaign trail developments.

Health reform is the signature achievement of the Obama presidency. It was the biggest expansion of the social safety net since Medicare was established in the 1960s. ... Obamacare is, however, what engineers would call a kludge: a somewhat awkward, clumsy device with lots of moving parts. ... The question for progressives 鈥 a question that is now central to the Democratic primary 鈥 is whether these failings mean that they should re-litigate their own biggest political success in almost half a century, and try for something better. My answer, as you might guess, is that they shouldn鈥檛. (Paul Krugman, 1/18)

Bernie Sanders on Sunday released his plan to reform the American health insurance system -- or, more accurately, to reinvent it from scratch. It's a plan to create a single-payer health care system, which means the government would provide everybody with insurance directly. Sanders is calling it "Medicare for All," because Medicare, which provides government-financed insurance to the elderly, is the closest thing to a single-payer system in the U.S. But that term actually understates the ambition of what he is proposing. (Jonathan Cohn, 1/17)

My column and Bernie Sanders鈥 plan crossed in the mail. But the Sanders plan in a way reinforces my point that calls for single-payer in America at this point are basically a distraction. Again, I say this as someone who favors single-payer 鈥 but it鈥檚 just not going to happen anytime soon. Put it this way: for all the talk about being honest and upfront, even Sanders ended up delivering mostly smoke and mirrors 鈥 or as Ezra Klein says, puppies and rainbows. Despite imposing large middle-class taxes, his 鈥済esture toward a future plan鈥, as Ezra puts it, relies on the assumption of huge cost savings. If you like, it involves a huge magic asterisk. (Paul Krugman, 1/18)

For decades, many liberals have dreamed of a universal health insurance system in which the federal government provides coverage to everyone and pays the cost. Known as "single-payer," it's modeled on programs in Canada and Britain, among others, as well as Medicare. Now Bernie Sanders is making that idea a centerpiece of his presidential campaign. He unveiled an outline for "Medicare for All" on Sunday. And one thing is clear: It has all the qualities of a dream. (1/18)

Last fall, the Wall Street Journal estimated Bernie Sanders' single-payer health care plan would cost the government a whopping $15 trillion over a decade. Sanders' campaign objected - loudly - over that price tag. On Sunday evening, just before the Democratic presidential debate in South Carolina, Sanders finally released details of his plan, including a headline price tag. It was $14 trillion. Sanders' chief Democratic opponent, Hillary Clinton, has long claimed his plan would have to raise taxes on the middle class. We now know it would. We also know that, by Sanders' accounting, the plan would actually put more money into the pockets of all but the very richest Americans. (Max Ehrenfreund and Jim Tankersley, 1/17)

For years, Republicans have gulled their followers with the hope that they could "repeal and replace Obamacare" even with Barack Obama wielding a veto pen. They couldn鈥檛, and pretending otherwise was a cynical political ploy. The same can be said of Bernie Sanders鈥 鈥淢edicare for all鈥 plan, unveiled Sunday just hours before the Democratic debate. Sanders thinks a single-payer government-run system is the only way to provide universal care at an affordable cost. That's not so: Many countries manage to cover everyone by other means. But the more immediate defect with his plan is that it has zero chance of being enacted. (Steve Chapman, 1/18)

This campaign [Hillary Clinton] has cast aside her husband鈥檚 formula on abortion鈥斺渟afe, legal and rare鈥濃攖hat she herself ran on in the past. The new Mrs. Clinton has moved to the absolutist position of the nation鈥檚 largest abortion provider, Planned Parenthood. Today Mrs. Clinton鈥檚 formula is safe, legal, unlimited鈥攁nd federally subsidized. We saw this new Hillary Clinton at a Planned Parenthood rally in New Hampshire this month, where she said she favored 鈥渟afe and legal abortion鈥 and denounced the Hyde Amendment, which prohibits federal funding for abortion. (William McGurn, 1/18)

Viewpoints: Talking About Drug Prices; How Big Data Could Focus The Cancer 'Moonshot'

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

Payment for treatments come from a fragmented sector that includes individual insurers, big employers, Medicare, Medicaid and others. Particular payers may cover patients for only a few years before they move to another insurer or program. As a result, the entity paying the big bill for any enrollee's hepatitis C treatment may just be saving money for someone else. That's why there's still heavy resistance from insurers to the high price of the hepatitis C drugs. (Michael Hiltzik, 1/15)

Both Bernie Sanders and Hillary Clinton are pushing for lower prescription drug prices as part of their campaigns. Debates about whether and how to reduce drug prices aren鈥檛 new. But they rarely lead to legislative success. Still, the mere threat of government price controls may have a moderating effect on drug prices. There鈥檚 strong evidence it did so as the ill-fated Clinton administration health plan was being developed in the early 1990s. Today, with the high price of drugs and proposals to address them so prominent in the news, there are early signs it may do so again. (Austin Frakt, 1/18)

In his State of the Union address on Tuesday, President Obama called for America to become 鈥渢he country that cures cancer once and for all.鈥 As a three-time cancer survivor (metastatic colon, metastatic melanoma and metastatic prostate), I can tell you that this 鈥渕oonshot,鈥 as Vice President Joe Biden first called it, is a bold goal鈥攂ut one within our grasp. ... Ironically, we鈥檙e handicapping ourselves in the war on cancer, in part because of a web of privacy regulations like the Health Insurance Portability and Accountability Act. HIPAA makes it difficult for researchers to tap into large caches of clinical and genomic data shared across multiple institutions or firms, and then share their findings more broadly. (Tom Coburn, 1/14)

TWO of our most vital industries, health care and education, have become increasingly subjected to metrics and measurements. Of course, we need to hold professionals accountable. But the focus on numbers has gone too far. We鈥檙e hitting the targets, but missing the point. ... Even some of the measurement behemoths are now voicing second thoughts. Last fall, the Joint Commission, the major accreditor of American hospitals, announced that it was suspending its annual rating of hospitals. (Robert M. Wachter, 1/16)

President Obama announced that last Tuesday鈥檚 State of the Union speech would be different: not the usual list of legislative New Year鈥檚 resolutions but a long-range look at structural challenges facing a rapidly changing nation. ... Conspicuously absent from the president鈥檚 message, though, was an issue so vital, and so unavoidable, that the president could have devoted the entire evening to it. We refer to the aging of the American population and the attendant need to support tens of millions of retirees in the coming decades without neglecting other pressing social needs. (1/16)

Starting this year, Medicare will, for the first time ever, reimburse physicians for having end-of-life discussions with terminally ill patients. In the ideal scenarios, doctors ask patients to identify how and where they want to spend those final days, and then recommend the best options. Question is, will physicians, as a result, be motivated to initiate more of these crucial conversations? Will patients? And will this long-overdue reform ultimately improve, both clinically and economically, how well the U.S. health care system delivers end-of-life care? Nobody knows for sure. But this much is certain: Many physicians have received no training along these lines. (Michael Nisco, 1/15)

Health care experts are starting to pay more attention to the violence that can envelop inner-city life. The Centers for Medicare and Medicaid Services announced $157 million in funding recently for programs that link people to social services that address issues including adequate housing, food and interpersonal violence. (Jayne O'Donnell, 1/18)

What鈥檚 behind this newfound willingness on [GOP presidential] candidates鈥 part to talk about the personal toll of addiction? New Hampshire, and the sobering statistics on drug overdoses there, is probably part of the answer. Every day, 44 people in the United States die as a result of overdose on prescription painkillers. Every day, nearly 7,000 people are treated in emergency rooms for abusing painkillers. Overdose deaths have been creeping upward since the beginning of the 21st century 鈥 especially deaths from opiate abuse. In New Hampshire, overdose deaths linked to opiate abuse have more than doubled over the past two years. (Emma Roller, 1/19)

Montgomery County, [Maryland] which consistently ranks as one of the nation鈥檚 healthiest and wealthiest counties, has significant racial health inequities. In 2014, according to the annual Infant Mortality in Maryland report, the infant mortality rate in Montgomery County stood at 4.8 per 1,000 births. Among white county residents, the rate stood at 3.6, but it was 8.3 for African Americans in the county. (Laura Jenkins, 1/15)

C-sections save lives 鈥 when needed. But the enormous variation in rates, with very little variation in outcomes, shows that a great many of them aren鈥檛 necessary. In the last 15 years, the rate of C-section has gone up by 50 percent in the United States. According to Jeffrey Ecker, chairman of the American Congress of Obstetricians and Gynecologists鈥 committee on obstetric practice, that rise 鈥渉as not been paralleled by any important fall in rates of things like cerebral palsy鈥 鈥 in other words, outcomes that C-sections are often performed to prevent. (Tina Rosenberg, 1/19)

The debate over whether it鈥檚 safer for a healthy woman to have a baby at home or in the hospital just tilted a bit in favor of hospital deliveries. The risks in both cases are very low, but a new study suggests that the risk to babies could be higher for out-of-hospital births. A study, based on data from Oregon and published in the New England Journal of Medicine in December, found that the risk of a baby dying was 3.9 per 1,000 births for deliveries at home or in birth centers, versus 1.8 deaths per 1,000 births in hospitals. (1/18)

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