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Morning Briefing

Summaries of health policy coverage from major news organizations

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Tuesday, Sep 27 2016

麻豆女优 Health News Original Stories 2

  • Expert Panel Recommends Expansion Of Services With No Cost Sharing For Women
  • Election Buzz: With Pot On The Ballot, States Weigh How To Police Stoned Drivers

Health Law 2

  • House To Vote On Measure To Help Consumers Who Lost Coverage When Co-Ops Collapsed
  • Medicaid Expansion Advocates Look To The Election To Press Their Cause

Campaign 2016 1

  • Health Plans From Both Trump And Clinton Would Add To Federal Deficit

Capitol Watch 1

  • As Zika Money Debate Dominates Capitol Hill, Other Health Priorities Pushed To Backburner

Marketplace 2

  • Transgender Surgery Demand Spikes Amid Growing Support From Medical Community
  • Doggone It: Spiking Costs, Inefficiencies At Veterinarian's Office Mirror U.S. Health Care System

Public Health 4

  • Its People Are Dying At Alarming Rates, But This City Just Can't Make A Dent In Its Opioid Crisis
  • A Medical Mystery Solved: 'I Didn鈥檛 Know How To Convince Them This Is Not In My Head'
  • Despite $127M Lawsuits, Scientists Say Still No True Link Between Talc, Ovarian Cancer
  • In Training To Handle Calls Involving Mentally Ill, Atlanta Police Learn To See Bigger Picture

State Watch 2

  • Medicaid Managed Care Official Sees Growing Role For Plans On Health Law Marketplaces
  • State Highlights: In Wash., Fifth Patient Diagnosed With Legionnaires; Former Ohio State Doctor Scores Age Discrimination Settlement

Editorials And Opinions 1

  • Viewpoints: House Calls -- A Better Idea Than Ever; Is The FDA Tightening Hold On Generics?

From 麻豆女优 Health News - Latest Stories:

麻豆女优 Health News Original Stories

Expert Panel Recommends Expansion Of Services With No Cost Sharing For Women

The list of preventive services that insurers must cover without a co-pay could grow to include mammograms for younger women, testing that follows an irregular screening and birth control for men. ( Michelle Andrews , 9/27 )

Election Buzz: With Pot On The Ballot, States Weigh How To Police Stoned Drivers

Blood tests for marijuana aren't an accurate measure of impairment for drivers, and there isn't an easy roadside sobriety test for pot yet. The five states where recreational marijuana is on the ballot may be looking to Colorado for its experiences with the DUI problem soon. ( Stephanie O'Neill, Southern California Public Radio and Ben Markus, Colorado Public Radio , 9/27 )

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Summaries Of The News:

Health Law

House To Vote On Measure To Help Consumers Who Lost Coverage When Co-Ops Collapsed

In other news related to the health law and marketplace coverage, media outlets report on Blue Cross Blue Shield movements in Tennessee, Texas and five other states.

The House on Wednesday will consider a bill that would exempt people who lost their insurance coverage because a co-op closed from the Affordable Care Act鈥檚 individual mandate. The measure seeks to help consumers of three co-op insurance plans who have had their coverage interrupted this year because the co-op through which they purchased insurance failed mid-year. The Ways and Means Committee approved the measure by voice vote earlier this month. Republicans say people whose coverage is stopped because their insurer closes their doors shouldn鈥檛 be fined for not having coverage the rest of that year. (McIntire, 9/26)

BlueCross BlueShield of Tennessee sent shock waves Monday across Tennessee with the company's decision to exit the Obamacare exchange in Nashville, Memphis and Knoxville, a move that highlights persistent volatility in the young health insurance marketplace. (Fletcher, 9/26)

Blue Cross Blue Shield will continue to offer health insurance plans in all 254 counties in Texas in 2017, the company said in a statement Monday. According to the statement, BCBS has worked closely with state and federal regulators to finalize participation and will offer products both on and off the Obamacare exchange. (Rice, 9/26)

Salaries and bonuses were up across the board last year for top leaders at Health Care Service Corp., the Blue Cross and Blue Shield insurer in five states. The top 10 executives cumulatively earned $56.7 million in 2015鈥攖he same year in which HCSC suffered substantial losses in the Affordable Care Act exchange markets. (Herman, 9/26)

Medicaid Expansion Advocates Look To The Election To Press Their Cause

Some people hoping to see more states expand their Medicaid programs under the health law think the opposition may be lighter after this campaign.

Supporters of Obamacare鈥檚 Medicaid expansion want to capitalize on the first year of a post-Barack Obama presidency, hoping that a change in the White House will inject new life into efforts that have languished. Nineteen states predominantly controlled by Republicans have yet to embrace the Obamacare program, leaving roughly 3 million low-income individuals without health insurance. Yet there are some signs that opposition is splintering. (Pradhan, 9/26)

Democratic candidate for governor Mike Weinholtz took some tough shots at Republican Gov. Gary Herbert in what will likely be their last debate Monday, but the governor said he has Utahns on his side. ... Throughout the debate, Weinholtz called for the state to do more on a range of topics, including expanding Medicaid coverage under the Affordable Care Act and preserving public lands. The chairman of CHG Healthcare, who has pumped $2.5 million of his own money into the race, criticized the governor for what he said was a "punt" to the Legislature on Medicaid expansion. (Riley Roche, 9/26)

The major Republican and Democratic candidates running for the U.S. Senate divide along party lines when asked whether they support Gov. John Bel Edwards鈥 decision to allow the working poor to qualify for Medicaid. The four Republicans oppose the Democratic governor鈥檚 decision, while the two Democrats support it, according to a survey of the candidates by The Advocate. (Bridges, 9/26)

Campaign 2016

Health Plans From Both Trump And Clinton Would Add To Federal Deficit

However, the effect the proposals would have on the number of uninsured in the country differs dramatically.

The health care policy proposals of Hillary Clinton and Donald Trump would have dramatically different impacts on the uninsured rate in the United States and on out-of-pocket health care costs. But they share one trait: Both would add to the federal deficit, according to a study released Friday. (Mershon, 9/27)

In other election news聽鈥

Based on rate increases proposed to North Carolina鈥檚 Department of Insurance, state residents who have signed up for Obamacare could face a 19 percent to 25 percent jump in the cost of their health coverage for 2017, Republican Sen. Richard Burr says. (Gordon, 9/26)

Capitol Watch

As Zika Money Debate Dominates Capitol Hill, Other Health Priorities Pushed To Backburner

In other news on the virus spread, Florida officials face questions about millions in federal emergency funds it has not yet used while three more cases are reported in the Miami area. Research efforts are also in the news.

Public health groups are disappointed Congress has dragged out funding to fight the Zika virus and neglected other health priorities. But a coalition of health groups that have lobbied for Zika funding is satisfied with Senate Majority Leader Mitch McConnell鈥檚 (R-Ky.) bill extending funding for the federal government and hope lawmakers will soon address other health care priorities. (Harper, 9/27)

Over the past months, as local governments strained their budgets to pay for the fight against Zika, Florida has left largely untapped a $27 million emergency preparedness fund from the Centers for Disease Control and Prevention and $8.4 million in federal grants 鈥 both of which can be used by the state to combat the virus. State officials insist nearly all of the money is simply part of Florida鈥檚 usual allocation from the CDC and doesn鈥檛 count as extra cash to help with anti-Zika efforts. (Chang, 9/26)

Three more locally transmitted cases of the mosquito-borne Zika virus were reported聽Friday聽in Miami-Dade County as the overall number of such cases climbs toward 100. The Florida Department of Health said the three new cases are linked to an investigation into the spread of the disease in Miami Beach. In all, Florida has reported 95 locally transmitted cases of the virus, which is particularly dangerous to pregnant women because it can cause severe birth defects. (9/26)

When the International Congress of Entomology decided four years ago to hold its meeting in Orlando, the Zika virus was hardly on anyone's radar... Since early this year, there have been more than 3,300 travel-related cases of Zika infection in the United States and more than 19,700 local cases in U.S. territories. Researchers still aren't sure what catapulted the virus from obscurity to a major public health threat. Maybe the virus mutated, or maybe the area Northeast of Brazil, with large population and lack of good sanitation, provided it with an optimal environment to replicate and spread to rates that it hadn't before. (Miller, 9/26)

Sanofi SA said on Monday the U.S. Department of Health and Human Services (HHS) approved $43.18 million in funding to accelerate the development of a Zika vaccine, as efforts to prevent the infection gather momentum. The funding from the HHS' Biomedical Advanced Research and Development Authority (BARDA) will be used for mid-stage trials, expected to begin in the first half of 2018, and for manufacturing, the French drugmaker said. (Grover, 9/26)

Marketplace

Transgender Surgery Demand Spikes Amid Growing Support From Medical Community

The procedure was once nearly unattainable as people had to go to private-practice plastic surgeons or even out of the country.

Surgery is becoming more available for transgender people as a growing number of academic centers and hospitals offer the procedure and insurance companies provide coverage. Stacey Parsons, a 45-year-old from Kent, Ohio, had genital surgery in August at Cleveland Clinic, which last year launched a transgender-surgery-and-medicine program. For years the procedure was unattainable for Ms. Parsons because it costs upward of $20,000 and was rarely covered by insurance. (Reddy, 9/26)

However, in Ohio, a woman is going to court because her insurer refused to cover the procedure聽鈥

A Cincinnati woman today sued the Cincinnati public library and the corporate parent of Anthem Blue Cross and Blue Shield for refusing to cover her sex-reassignment surgery. The insurer's refusal violates the Affordable Care Act's guarantee of coverage for medically necessary treatment, and the employer's requirement under federal law to treat employees equally, regardless of gender, says Rachel Dovel's lawsuit, filed in U.S. District Court in Cincinnati. If the case proceeds, it could be the first establishing or denying an insurer's requirement to cover transgender surgery under the Affordable Care Act, better known as Obamacare. (Koff, 9/26)

Public library employee Rachel Dovel sued her employer Monday after repeated pleas for the library to cover聽transgender transition surgery failed. ...聽She is asking the court to order the library to cover the cost of her gender reassignment surgery; prohibit Anthem from selling insurance plans that exclude coverage for transition-related care; and prohibit the library from carrying insurance that excludes coverage for transition-related care. And she is asking for damages. (Coolidge, 9/26)

Doggone It: Spiking Costs, Inefficiencies At Veterinarian's Office Mirror U.S. Health Care System

Meanwhile, KHN reports on new recommendations for the preventive services that should be free for women. And in insurance news, Kaiser Permanente ranks highest among providers in Georgia and a Washington health system comes to an agreement with Premera Blue Cross.

Healthcare spending on pets has been growing strongly, and it offers some insight into what's happening in the U.S. human health system, Stanford University's Liran Einav and Atul Gupta and Massachusetts Institute of Technology's Amy Finkelstein write. (Smialek, 9/27)

The list of preventive services that women can receive without paying anything out of pocket under the health law could grow聽if proposed recommendations by a group of mostly medical providers are adopted by federal officials聽later this year. The draft recommendations, which are open聽for public comment until Sept. 30, update the eight recommended preventive services for women. (Andrews, 9/27)

For the 12th straight year, Kaiser Permanente is Georgia鈥檚 top-rated commercial health plan, according to the National Committee for Quality Assurance... Kaiser鈥檚 4.5 score for its HMO was followed by 3.5 for these plans: Aetna HMO/Point of Service (POS), Blue Cross and Blue Shield of Georgia HMO/POS, Cigna PPO, Connecticut General PPO, and UnitedHealthcare PPO. The Kaiser Medicare plan in Georgia was followed by an Aetna plan scoring 4.0. (Miller, 9/26)

Providence Health & Services and Premera Blue Cross have ironed out a new health-insurance contract, averting a disruption that could have affected more than 500,000 people in Washington. (Aleccia, 9/26)

Public Health

Its People Are Dying At Alarming Rates, But This City Just Can't Make A Dent In Its Opioid Crisis

Huntington, W.Va., has taken steps to curb the epidemic that's holding the city in its grasp. But barriers prevent the residents from getting the best treatment. Meanwhile, CNN offers a look at how drug deaths are spiking across the country.

This city, where the rate of drug overdose deaths is nearly 10 times the national average, has done more than most to fight the heroin and prescription painkiller epidemic. ... But instead of getting better, Huntington鈥檚 opioid problem is getting worse. (Vestal, 9/26)

Drugs are the leading cause of accidental death in this country. Fatal overdoses surpassed shooting deaths and fatal traffic accidents years ago. For perspective on how fast drug deaths have risen, Anderson said, consider the sharp rise in heart disease in the early half of the 20th century. It took about 50 years for the rate of heart disease to double. It took drug deaths a fraction of that time. (Christensen and Hernandez, 9/24)

In other news on the opioid crisis聽鈥

Physicians, pharmacists and in some states, police, will have access to new or enhanced, state-wide prescription drug databases that will be funded by $8.8 million in new grants from the Justice Department. The grants will go to 20 agencies in 19 states, including Alabama, Kentucky, Ohio, South Dakota, Florida and Utah. (Conn, 9/26)

The County Council on Monday night voted unanimously to join a new regional prescription drug monitoring program aimed at reducing the abuse of OxyContin and other painkillers. The program, already set to include St. Louis County and St. Louis, will get around the Legislature鈥檚 failure to set up a statewide monitoring network. Missouri is the only state in the country without a statewide program. (Schlinkmann, 9/26)

At a recent town hall meeting in Raleigh, state officials rolled out hard numbers on the state鈥檚 epidemic of prescription and illegal drugs, drawing a clear picture of its impact on government and law enforcement. (Goldsmith, 9/27)

Senate Majority Leader Mitch McConnell's proposal to keep the government funded included one below-the-radar addition: funding to combat the opioid epidemic. While senators in both parties support addressing the issue, the move had some Democrats crying foul. The Kentucky Republican unveiled last week a draft continuing resolution to fund the government through Dec. 9, after spending talks stalled between Senate leaders. His proposal included $37 million in annual funds for implementing the Comprehensive Addiction and Recovery Act, or CARA, which became law in July. (Bowman, 9/26)

A Medical Mystery Solved: 'I Didn鈥檛 Know How To Convince Them This Is Not In My Head'

A chance meeting on a hiking trail leads to the restoration of a normal life for one woman who suffered from intense pain every time she ate. In other news, testosterone's bad rap might have a silver lining, patients' fitness levels come under scrutiny before surgery, scientists make strides toward identifying CTE in living victims and more.

The medical team encircled Mackenzie Hild鈥檚 bed, their somber expressions reflecting the gravity of the news they were about to impart to the Harvard sophomore and her mother, newly arrived from California. 鈥淲e鈥檝e done all these tests, and they鈥檙e all normal,鈥 Hild recalls one doctor at the renowned Boston hospital telling them. To treat Hild鈥檚 life-threatening weight loss, which the 19-year-old claimed was the result of searing abdominal pain triggered by eating, doctors were sending her to an inpatient center specializing in eating disorders. (Boodman, 9/26)

Testosterone, the big daddy (if you will) of male hormones, has gotten a bit of a bad reputation, what with it being linked to bluster, aggression, violent offending and a whole raft of behaviors at which men do seem to best women consistently. But in humans, new research suggests that鈥檚 not the whole picture. The testosterone findings that have shaped our common assumptions probably fail to take account of human society鈥檚 exquisite level of social evolution. (Healy, 9/26)

Are you healthy enough to have surgery? More hospitals are asking that question before patients undergo elective procedures such as hip and knee replacements. They are identifying those at higher risk of infections and other complications due to diabetes, heart disease and anemia鈥攐r simply being sedentary and out of shape. And they are steering them to 鈥減re-habilitation鈥 programs that include medical treatments, diets and exercise regimens to improve their chances of a successful surgery. (Landro, 9/26)

One of the frustrations of researchers who study chronic traumatic encephalopathy, the degenerative brain disease linked to repeated head hits, is that it can be detected only in autopsies, and not in the living. Researchers, though, have been trying to solve this problem in two primary ways: by identifying biomarkers linked to the disease that show up on imaging tests in certain locations in the brain, and by trying to locate in the blood the protein that is the hallmark of the disease. (Belson, 9/26)

Two often-overlooked medications might help millions of Americans who abuse alcohol to quit drinking or cut back. Public health officials, building on a push to treat people who abuse opioids with medications, want physicians to consider using medications to treat alcohol addiction. The drugs can be used in addition to or sometimes in place of peer-support programs, they say. (Yasinski, 9/26)

The first three聽months of pregnancy, a time聽that parenting magazines and Hallmark cards often聽portray as magnificent聽and carefree, can actually be a聽wretched experience for many women. As many as 90 percent of mothers-to-be experience some degree of nausea and vomiting, and scientists have long speculated about what, from an evolutionary standpoint,聽the function of all that unpleasantness聽might be. The leading theory has to do with food. (Cha, 9/26)

People who have reached their later years may think it's primarily a time to relax, not to increase their physical activity. Not so. Previous research has suggested that exercise can improve memory and reverse muscle loss in older adults, among other benefits. And a study out Monday finds that a regular program of physical activity reduces the time spent with mobility-limiting disability. (Hobson, 9/26)

Despite $127M Lawsuits, Scientists Say Still No True Link Between Talc, Ovarian Cancer

Two plaintiffs who sued Johnson & Johnson were awarded millions each, but research finds little evidence to back up the decisions. 鈥淟ord knows, with the amount of powder that鈥檚 been applied to babies鈥 bottoms, we would鈥檝e seen something鈥 if talc caused cancer, says Dr. Hal C. Lawrence III.

Two lawsuits ended in jury verdicts worth $127 million. Two others were tossed out by a judge who said there wasn鈥檛 reliable evidence that the talc in Johnson & Johnson鈥檚 iconic baby powder causes ovarian cancer. So who鈥檚 right? And is baby powder safe? Most research finds no link or a weak one between ovarian cancer and using baby powder for feminine hygiene, a practice generations of American mothers have passed on to their daughters. Most major health groups have declared talc harmless. (Johnson, 9/26)

In other news聽鈥

The death rate from ovarian cancer declined in the United States by 16 percent from 2002 to 2012, among the largest reductions in the world. The rate in the United States, 4.85 per 100,000, puts it roughly in the middle of a list of 47 countries whose rates and trends were described recently in a study in Annals of Oncology. (Bakalar, 9/26)

In Training To Handle Calls Involving Mentally Ill, Atlanta Police Learn To See Bigger Picture

At first, many officers had to be ordered to attend. But they say they walked away with a better understanding of how to de-escalate situations involving someone with a mental illness. Advocates say there's still more work to do.

Agencies continue to work with the Georgia Bureau of Investigation and the National Alliance of Mental Illness to train officers how to recognize those suffering from mental illness, problems of addiction and diseases such as Alzheimer鈥檚 and autism.聽In 2004, a group from NAMI approached the GBI about bringing a national program to agencies across Georgia, Director Vernon Keenan said. He talked about the course during a recent event at Brookhaven police headquarters for NAMIWalks, a nationwide fundraising and mental health awareness program. (Eldridge, 9/25)

Meanwhile, Congress passes a measure to fund training for first responders聽鈥

The House on Monday approved a bill that would require the Substance Abuse and Mental Health Services Administration to reauthorize mental health first aid training programs. The chamber approved H.R. 1877, the Mental Health First Aid Act of 2015, by voice vote. The bill would reauthorize a grant program that trains individuals who are likely to be a first responder to a patient experiencing mental illness, such as teachers of police officers. (McIntire, 9/26)

State Watch

Medicaid Managed Care Official Sees Growing Role For Plans On Health Law Marketplaces

Jeff Myers tells The Hill, "It seems to me that the exchange products that work best are ones that, rather than just open up a giant network and provide lots of services, really look at, are there services that we can open up and drive that will improve health outcomes and reduce cost?鈥 News outlets also report on Medicaid developments in Kansas and Nebraska.

[Jeff] Myers is the top advocate for insurers under Medicaid managed care, where states will contract with a private company to run their Medicaid programs. ... And the model is growing: Nearly 55 million people 鈥 about three-fourths of all Medicaid enrollees 鈥 are now covered under managed care, a sharp increase even in the past three years, according to a new report from PricewaterhouseCoopers. ... The [health law] marketplaces, also called exchanges, have been plagued this year by insurers dropping out or hiking premiums due to financial losses. But some insurers with experience in the Medicaid business are faring better. And that鈥檚 no coincidence, Myers says. One point helping those insurers is having a narrower network, i.e., fewer doctors to choose from. But more important, Myers said, are other programs to help low-income sick people make the most of their insurance. (Sullivan, 9/27)

Several Kansans are scheduled to meet Tuesday with federal officials and counterparts from across the country to discuss issues related to the privatization of state Medicaid programs. Two Kansas legislators 鈥 Democratic Sen. Laura Kelly of Topeka and Republican Rep. Chuck Weber of Wichita 鈥 are expected to attend the meeting in Baltimore, along with Rocky Nichols, a former legislator who now heads the Disability Rights Center of Kansas, Janet Williams, the chief executive of Communityworks Inc., a home health agency based in Overland Park, and Mike Oxford, director of the Topeka Independent Living Resource Center. (McClean, 9/26)

The president of the Kansas Dental Association said he has stopped taking patients from two of the state鈥檚 three KanCare insurance companies because of a 4 percent Medicaid reimbursement cut initiated by Gov. Sam Brownback鈥檚 administration. (Marso, 9/26)

The Nebraska Department of Health and Human Services could owe the federal Centers for Medicare and Medicaid Services up to $32 million in reimbursements for provider payments that were not allowed over a two-year period. (Young, 9/27)

State Highlights: In Wash., Fifth Patient Diagnosed With Legionnaires; Former Ohio State Doctor Scores Age Discrimination Settlement

Outlets report on health news from Washington, Ohio, Minnesota, Connecticut, California, New York and Massachusetts.

A fifth patient has been diagnosed with Legionnaires鈥 disease at the University of Washington Medical Center, days after health officials said the deadly outbreak appeared to be contained. (Aleccia, 9/26)

Ohio State University Wexner Medical Center will pay $100,000 as part of a settlement unveiled Monday to a former doctor who alleged age discrimination in a 2015 lawsuit filed in the Ohio Court of Claims. In 2004, Dr. Nathan C. Hall became an assistant professor in the OSU College of Medicine's radiology department. Within two years, he was promoted to division chief of nuclear medicine and molecular imaging. In his lawsuit, Hall states that he met or exceeded the productivity expectations outlined in his employment agreement as well as received positive performance reviews until Dr. Richard D. White was appointed to department chair in 2010. (Forchesato, 9/26)

Negotiators for Allina Health and the nurses union resume contract talks today 鈥 three weeks after more than 4,000 hospital nurses went on strike over health benefits. A federal mediator called negotiators back to the bargaining table last week, but that doesn't mean the two sides are ready to cut a deal. Both Allina and the Minnesota Nurses Association have been loathe to make the first move in resuming contract negotiations after a 22-hour bargaining session in early September. (Benson, 9/27)

Two Connecticut regulators last week upheld a controversial state tax on hospitals' net patient revenue, opening the door for dozens of hospitals to take their challenge to court. (Teichert, 9/26)

Foster youth advocates and Bay Area legislators on Monday told a panel of state officials that the alarming conclusions of a recent state audit highlighting California鈥檚 weak oversight of psychiatric drugs for foster kids could be solved if Gov. Jerry Brown signs three pieces of key legislation into law this week... The audit, released Aug. 23, mirrored many findings of this newspaper鈥檚 series 鈥淒rugging Our Kids鈥 that disclosed the state鈥檚聽dependence on psychotropic medications聽to control troubled children in聽the state鈥檚 foster care system and the failure to track how the drugs are prescribed. Beall said that one solution is his own Senate Bill 1291, which would require better transparency and tracking of mental health services for foster kids in every California county. (Seipel, 9/26)

A doctor who trained for two years at the psychiatric unit of a New York hospital said in a lawsuit Monday that poor adolescent patients were routinely provoked into acting out, then restrained and drugged, extending their hospitalization and Medicaid payments. Dr. Alfred Robenzadeh said that supervisors at Westchester Medical Center in Valhalla retaliated against him when he tried to address what he says was chronic patient abuse that increased the severity of diagnoses, with usual two-week inpatient stays often extended days or weeks. He alleges the practice defrauded Medicaid. (9/26)

Medical Properties Trust will buy Steward Health Care鈥檚 hospital properties for $1.2 billion and take a $50 million stake in the company...聽Steward, the largest for-profit hospital operator in Massachusetts, was created in 2010 when Cerberus Capital Management bought the former Caritas Christi network of Catholic hospitals. It said it will return the New York-based firm鈥檚 original investment, though Cerberus will continue to hold a majority stake. (Dayal McCluskey, 9/26)

For the past 11 months, Cleveland officials say they've been at work rebuilding a beleaguered program meant to respond to children poisoned by lead. Yet homes that city health workers knew contained hazardous levels of the toxin still linger in neighborhoods, posing a potential threat to young children and pregnant women. Right now, the city knows about more than 300 properties that it should have evacuated and posted signs warning of lead hazards. (Dissell and Zeltner, 9/26)

More than 1,500 former patients of Seattle Pain Centers have sought help in Washington emergency rooms since the chain of clinics was closed abruptly in July 鈥 and hundreds more have swamped local hospital programs. (Aleccia, 9/26)

California voters favor reforming the state parole system, but are more closely divided about slapping a two-buck-a-pack tax on cigarettes, a new Field Poll shows. And voters also favor extending a tax on the wealthy that they first approved in 2012, the poll shows. The new poll shows what could be a softening of voters鈥 appetite for a new tobacco tax to fund health care and tobacco prevention efforts, as the deep-pocketed opposition rolls out a heavy ad campaign attacking the measure as a tax grab for special interests. (Peele, 9/26)

In five states this fall 鈥 California, Arizona, Nevada, Maine and Massachusetts 鈥 voters will be deciding whether marijuana should be legal for recreational use. And any of those states that do legalize marijuana will have to wrestle with the question of how to enforce laws against聽stoned drivers. It has been legal to smoke pot for fun in Colorado since January 2014, and the state modeled its聽marijuana driving-under-the-influence law on the one for alcohol. If a blood test shows a聽certain聽level of聽THC, the mind-altering compound in marijuana, the law says you shouldn鈥檛 be driving." (O'Neill and Markus, 9/27)

A Massachusetts physician should not have had his medical license suspended for allowing nurse practitioners in his office to certify patients for medical marijuana use, according to a state administrative law judge. Regulators in May suspended the license of Dr. John C. Nadolny, medical director of Canna Care Docs, a practice with eight Massachusetts locations that specialize in screening and approving patients for marijuana use. The Board of Registration in Medicine had ruled that Nadolny was an immediate threat to public safety, saying his office improperly used nurse practitioners to certify that thousands of patients were eligible to receive medical marijuana. (Lazar, 9/26)

Editorials And Opinions

Viewpoints: House Calls -- A Better Idea Than Ever; Is The FDA Tightening Hold On Generics?

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

Surah Grumet used to be a family doctor at a clinic in the Bronx. 鈥淚t always felt like I was trying to catch up,鈥 she said. 鈥淚 was always falling behind, and it was so stressful. And it was really hard to bring up my two girls, to be there for them, and still be able to practice medicine the way that I wanted to.鈥 Now, she lives in a suburb of Raleigh, N.C. She still practices medicine, but has no office or clinic. Instead, she works with a Durham-based practice called Doctors Making House Calls. (Rosenberg, 9/27)

The anaphylactic political shock over EpiPen prices continues, and last week a House committee dragged in the company CEO. But some outrage should land on the Food and Drug Administration, which won鈥檛 approve a generic stinger that would end Mylan鈥檚 monopoly power. Instead, the agency is finishing regulation that will restrict competition precisely as patients are demanding cheaper medicines. (9/26)

These [hospital star] ratings were designed by the federal government to help individuals, family members and caregivers compare hospitals in what they believed to be an easily understandable manner. We respect the efforts of agencies such as CMS to create transparency and accessibility around hospital ratings, and we believe strongly that individuals deserve to have information about the quality and safety of an institution. But the data that drive ratings 鈥 and the manner in which the data are聽reported 鈥 must be meaningful and fairly reflect the performance of the institution and quality of care. (Joseph Kerschner and Janis Orlowski, 9/26)

Although healthcare and payment policies aimed at improving the strength and longevity of the Medicare program are easy for providers, taxpayers, and lawmakers to stand behind, when those policies fall short 鈥 disrupting the care of patients who need it the most 鈥 there鈥檚 no time to delay in finding a solution. (Dan Stark, 9/26)

The bold admission by athenahealth CEO Jonathan Bush that electronic health records (EHRs) 鈥渋nflict enormous pain on our nation鈥檚 providers and care teams, turning caregivers into box-checkers and inadvertently limiting the private sector from innovating鈥 caught my attention. Those are strong words from the head of a company that makes a widely used EHR. ... While Bush鈥檚 company is trying to design ways to decrease the amount of time that clinicians spend working on the EHR, here鈥檚 a more immediate and practical solution: medical scribes. Let these trained professionals interact with the EHR while doctors interact with their patients. (Jared Pelo, 9/27)

The drug war has shaped the thought that addicts and users need to spend time in jail and learn a lesson. Trauma, life crisis or isolation is what leads to an unhealthy bond with behaviors that become addictive (like gambling, sex, checking your phone) 鈥 and with drugs. ... Time to redirect the legacy of this shameful drug war and mandate public health and law enforcement tax dollars are effective, transparent and about improving outcomes. (Barbara Boylan, 9/26)

At some point, most of us have been prescribed an opioid-based pain medication such as hydrocodone (Vicodin) or oxycodone (OxyContin, Percocet). Doctors and dentists often prescribe these painkillers after major surgery or dental work, or a bad fall or other accident. With all the talk about the opioid crisis, should we view these medications with newfound fear and suspicion? The short answer is 鈥渘o鈥濃攁s long as you use them responsibly, as your doctor directs. (Andy Carter, 9/27)

In the Sept. 4 Herald Leader, Dr. Rae Brown of the University of Kentucky beautifully describes the inadequate treatment of the current opioid epidemic in Kentucky. I agree completely that there is 鈥渘o safe opioid dose, no safe opioid agent and no safe patient.鈥 However, he makes some very strong statements like 鈥渕edical treatment is the only treatment demonstrated to be effective,鈥 implying that there are no others, and that medical manipulation with other addicting substances is the best treatment. There are a few long-term studies suggesting medical treatment may be helpful, just like there are few long-term studies documenting that 12-step programs work. (Dr. Gordon Hyde, 9/25)

Many of my friends and classmates here in the United States care about making the world a better place, and they try to make purchases that reflect their values. Some have become vegetarians to save animals or fight climate change. Others buy cruelty-free cosmetics, fair-trade coffee or conflict-free diamonds. Yet I鈥檝e noticed at parties and festivals that some of these same people pop Ecstasy or snort cocaine. They think this drug use is a victimless crime. It鈥檚 not. Follow the supply chain and you鈥檒l find a trail of horrific violence. (Mario Berlanga, 9/27)

Gov. Terry Branstad is desperate for good publicity about his privatization of Medicaid management. The problem: Iowans are not contacting the media to share positive experiences. Instead, numerous people have come forward with horror stories since the governor handed over administration of the government program to three for-profit insurers on April 1. (9/26)

Profiteering in the drug business has been generating outrage for months now. Gilead Sciences and Mylan have been taking the heat for huge increases in the prices, respectively, for聽their hepatitis-C cures and injectors to fend off life-threatening allergic reactions. But at least we can say this about them: Their products work. That may not necessarily be true聽about some of the drugs for which Chicago-based Novum Pharma has raised prices as much as 40-fold. Two of the three topical gels for dermatological conditions distributed by Novum are listed by the Food and Drug Administration as only 鈥減ossibly effective.鈥 That鈥檚 one of the lower classifications in the FDA鈥檚 roster, coming below 鈥渆ffective鈥 and 鈥減robably effective.鈥 (Michael Hiltzik, 9/26)

Suppose that a million or more members of the US Armed Forces and veterans were suffering from an epidemic that could not be prevented, treated or cured 鈥 and 20 of them were dying from it every day. Would we address it as a national emergency, mobilizing resources, coordinating research, and insisting on answers? They are 鈥 but we aren鈥檛. It鈥檚 time for that to change. Nearly 350,000 service member and veterans have been diagnosed with traumatic brain injury (TBI) since 2001. Even more have post-traumatic stress disorder (PTSD). Twenty veterans commit suicide every day, most of them as a direct result of these conditions. PTSD, TBI, and suicide represent an all-out epidemic. (Magali Haas, 9/26)

The latest research to shake up the fitness and health industry shows that wearing a fitness tracker to monitor your level of activity does not contribute to weight loss. With obesity rates affecting a third of the United States population, this comes as dismal news to those hoping that this billion-dollar industry would begin to make a dent in those statistics. ... Using fitness trackers can be an excellent source of data for many people and this study shouldn鈥檛 dissuade those finding it helpful to stop using them but the missing piece that many need to succeed is a connection between what those numbers mean and how they can affect the bigger picture of their overall health. Learning how daily nutrition fits in with step count and how stress or travel can derail a routine are important components that are individualized for each person. A health coach can stitch together a picture of health and work with an individual to find the right pieces and materials to achieve it. (Jennifer Gibson, 9/23)

When it comes to passive smoking the old saying "Your rights end where mine begin" is uncomfortably relevant. Yes, you have the right to smoke. What you do to your body is your choice. You know how lethal it is. You know the health risks, the financial costs, and all the other 1,001 negative consequences of your addiction. (Scott Stevens, 9/25)

That new freestanding emergency center in your neighborhood might look like just an urgent care facility, but it is not. Freestanding emergency centers are equipped for full emergency care, and they offer patients an alternative to crowded hospital emergency rooms. There is no evidence that freestanding emergency centers produce poorer patient outcomes than hospital-based ERs. Nor is there any data suggesting patients are more at risk by seeking treatment at a freestanding facility. (Nick Peters, 9/26)

The recent revelation that Harvard scientists were paid off to downplay sugar鈥檚 harms in the 1960s shows how the food industry shockingly manipulated nutrition science for decades. Yet the news media has given the sugar industry too much credit. The real story about how sugar got a pass 鈥 while dietary fat and cholesterol were blamed for heart disease 鈥 reveals that other industries played a role, as did, surprisingly, many of the country鈥檚 leading scientists. (Nina Teicholz, 9/26)

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