KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

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Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Jet Drag?'" by Roy Delgado.

Here's today's health policy haiku:


It’s time for a short
Break to enjoy the season.
Happy Holidays!

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Health Law Issues And Implementation

Affordable Care Act Sign-Ups Near 6.4 Million

With about seven weeks to go until the end of open enrollment, almost 2 million new customers have signed up for coverage and another 4.5 million policyholders either re-enrolled or were automatically renewed in their policies in the 37 states that participate in the federal exchange.

Los Angeles Times: Enrollment For Obamacare Jumps With 2 Million New Sign-Ups
Enrollment in health insurance through the Affordable Care Act is increasing rapidly, with more than 2 million people so far signing up for coverage for the first time, figures released Tuesday show. In addition to the new enrollments, which surpass last year's sign-up rate, several million more people have been re-enrolled in plans in the law's second year of expanding coverage. (Levey, 12/23)

The Wall Street Journal: Affordable Care Act Sign-Ups Near 6.4 Million
Almost 6.4 million people selected a health-care plan on the federal marketplace or were automatically re-enrolled in the first month of the Affordable Care Act’s open-enrollment season this fall, Health and Human Services Secretary Sylvia Mathews Burwell said Tuesday. That figure compares with about 5.4 million people who had selected plans using the federal exchange in the original enrollment period of Oct. 1, 2013, through March 31, 2014. High consumer demand in mid-December helped boost the total, which includes about 1.9 million new consumers who obtained private coverage through the federal exchange, Ms. Burwell told reporters. (Armour, 12/23)

The Associated Press: Officials Cite Progress On Health Care Enrollment
The second sign-up season under President Barack Obama's health care law is off to a good start but has a way to go to make it a success, administration officials said Tuesday. Health and Human Services Secretary Sylvia M. Burwell said 1.9 million new customers have picked a plan as of Dec. 19 through the federal insurance market that serves 37 states. Another 4.5 million have renewed existing coverage, with most automatically re-enrolled. The numbers don't include states running their own insurance exchanges, including California and New York. The administration will release a full 50-state report next week, Burwell said. (Alonso-Zaldivar, 12/24)

USA Today: Two Million New Enrollees Signed Up On
About 6.4 million people chose a health plan or were automatically reenrolled on the federal site through Dec. 19, the Department of Health and Human Services said Tuesday. ... HHS Secretary Sylvia Burwell estimated that the percentage of people who shopped around for a new plan rather than automatically reenrolled was in "the mid to high 30s." That's something the department has repeatedly urged people to do. Burwell said the number was higher than she expected as "most people let what happens go," she said. (O'Donnell, 12/23)

Politico: HHS Reports 6 Million Signups So Far For Obamacare Next Year
Nearly 6.4 million people were enrolled in the federal Obamacare marketplace one month into the 2015 signup season, a pace that Health and Human Services Secretary Sylvia Mathews Burwell on Tuesday called a good start. “People are shopping for coverage and people are signing up,” Burwell said at a news conference where she personally announced the latest numbers. “We still have a ways to go and a lot of work before Feb. 15, but we do have an encouraging start,” she added. (Haberkorn and Pradhan, 12/23)

Modern Healthcare: ACA Enrollment Hits 7.1M In State, Federal Exchanges
Nearly 6.4 million have obtained health insurance coverage through as of Dec. 19. Of that, 1.9 million are new sign-ups while the remainder are manual and automatic re-enrollees, HHS Secretary Sylvia Mathews Burwell announced Tuesday. When combined with the more than 750,000 people who have signed up on state-based exchanges over the first month of open enrollment, total sign-ups have surpassed 7.1 million. The federal agency plans to release a complete monthly report with additional state and federal sign-up figures next week, Burwell said during her news briefing. (Dickson, 12/23)

The Fiscal Times: Obamacare Signs Up 7.4 Million Ahead Of The New Year
Looks like 2015 is shaping up to be a good year for Obamacare. That’s because enrollment in the law’s federal and state health exchanges is surging ahead of the New Year. So far, more than 6.4 million people have selected policies on the federal exchange, administration officials said on Tuesday. (Ehley, 12/23)

With Time Running Out For Jan. 1 Coverage, Some Get Deadline Break

And in North Carolina, a charity is offering to pay premiums for some low-income residents.

WBUR: Health Connector Extends Payment Deadline
Massachusetts residents signing up for health insurance through the state have a few more days to make their first payment, but must still enroll before midnight tonight to guarantee their coverage begins Jan. 1. (Nickish, 12/23)

The Oregonian: Cover Oregon, Feds Won't Say If Some Have Extended Deadline For Jan. 1 Coverage
For months, Cover Oregon was telling the public to apply for health insurance tax credits on by Dec. 15 to ensure uninterrupted coverage in January. For weeks, TV ads repeated the message. But now it appears the state exchange may have been giving out the wrong deadline -- and Cover Oregon enrollees have more time.... the real deadline for those consumers who enrolled through Cover Oregon [appears to be ] Dec. 31. (Budnick, 12/23)

The Charlotte Observer: Feds Offer Break To Health Insurance Shoppers Hung Up On Hold
Half a million health insurance shoppers who faced delays reaching a federal help line earlier this month are getting a little extra time to start their new year with coverage. Dec. 15 was the deadline for choosing policies on the Affordable Care Act marketplace that take effect Jan. 1. ... “Since the large volume of calls prior to December 15 led to longer wait times in Week 5, the call center collected the contact information for nearly half a million consumers,” the report released Tuesday says. “We began contacting these consumers on December 16 and, if they select a plan, their coverage can still begin on January 1.” (Helms, 12/23)

Raleigh News & Observer: Triangle United Way Commits $1M To Buy Health Insurance For Durham County's Neediest
The United Way of the Greater Triangle is offering $1 million in financial assistance to help low-income residents obtain health insurance at no monthly cost. The unusual approach, funded by an anonymous donor, will pay monthly insurance dues that are not covered by federal subsidies under the Affordable Care Act. For many low-income households, that could be about $50 to $100 a month - amounts that have proved too expensive for some financially struggling families in the first year of the Affordable Care Act. (Murawski, 12/23) N. J. Medicaid Fiasco: Thousands Stranded Without Coverage, No Fix In Sight
The meltdown of the federal government’s website tied to the Affordable Care Act has been well documented. But in New Jersey, something far worse was happening as the state expanded Medicaid access under Obamacare, an NJ Advance Media investigation has found. ... an estimated 11,000 people are still trapped in a tangle of digital red tape and a bureaucratic maze. These families are unable to enroll in the state’s Medicaid program, ... New Jersey has yet to announce any permanent solution. (O'Brien, 12/23)

Public Health And Education

FDA Proposes Easing Lifetime Ban On Blood Donations By Gay Men

However, men who have had sex with other men in the past year are still not allowed to donate. Scientists say modern screening methods for HIV make the lifetime ban unnecessary.

The Wall Street Journal: FDA To Lift Lifetime Ban On Blood Donations From Gay Men
The Food and Drug Administration reversed a decades-old ban on gay and bisexual men donating blood, concluding that modern blood screening makes the ban unnecessary. ... The change won’t occur immediately. First, the agency will publish a draft guidance in 2015, followed by a comment period, said Peter Marks, deputy director of the FDA’s center for biologics evaluation and research. After that — perhaps in 2015, depending on the comments — the guidance will become final. (Burton, 12/23)

The New York Times: FDA Easing Ban On Gays, To Let Some Give Blood
The Food and Drug Administration announced Tuesday that it would scrap a decades-old lifetime prohibition on blood donation by gay and bisexual men, a major stride toward ending what many had seen as a national policy of discrimination. However, the agency will continue to ban men who have had sex with a man in the last year, saying the barrier is necessary to keep the blood supply safe, a move that frustrated rights groups that were pushing for the ban to be removed entirely. (Tavernise, 12/23)

The Washington Post: FDA To Propose Altering Ban On Gay And Bisexual Men Who Want To Donate Blood
The Food and Drug Administration plans to lift its lifetime ban on blood donation for men who have had sex with other men, and will propose replacing it with a one-year ban after homosexual activity, the agency announced Tuesday. Gay rights groups, which have long advocated a change to the ban, largely decried the announcement, saying that expecting gay blood donors to remain celibate for a year is not reasonable or medically necessary. (Zauzmer, 12/23)

Los Angeles Times: FDA To Ease Longtime Ban On Blood Donations From Gay Men
Though less visible than the struggle to allow gays to serve openly in the military or the effort to legalize same-sex marriage, the campaign to end the 31-year ban on blood donation has become an important cause for those who see it as homophobic and unfair. The FDA was caught between the civil rights of prospective gay donors and its mandate to protect public health. The FDA’s decision came a few weeks after a panel of independent experts concluded that imposing a waiting period, or deferral, of one year on those donors would not endanger the safety of the nation’s supply of donated blood. That panel relied heavily on the experience of Australia, which in 2000 adopted a one-year deferral policy for men who have had sex with men. (Healy, 12/23)

USA Today: FDA Favors Ending Blanket Ban On Gay Blood Donors
The U.S. Food and Drug Administration on Tuesday recommended dropping its blanket ban on blood donations from gay and bisexual donors in favor of a less restrictive policy. The proposed policy change, which will be offered for public comment next year, would allow gay men to donate blood if they had not engaged in sex with another man for at least a year. (Stanglin, 12/23)

PBS NewsHour: LGBT Advocates Say FDA Gay Blood Donor Policy Revision Is Long Overdue, But ‘Not Enough’
LGBT advocates have already spoken up, saying that while the announcement was long overdue, it represents only a modest step toward a completely non-discriminatory law. “Ultimately, it’s not enough,” said Ryan James Yezak, founder of the National Gay Blood Drive. “The reason people are so frustrated is that this is the announcement after 31 years, and this is all that’s being done.” “But I think the frustration is reactionary,” Yezak said, adding that it was important to note that the process is incredibly complicated and time-consuming. (Barajas, 12/23)

The Hill: LGBT Groups, Lawmakers: FDA's Move On Blood Ban Not Enough
LGBT advocacy groups are condemning the federal government’s new plans to allow gay men to donate blood only if they have been celibate for one year, calling the policy a “de facto lifetime ban.” The Food and Drug Administration drew praise Tuesday when it announced plans to ease a 31-year-old prohibition on blood donations from gay and bisexual men, which has been widely described as medically unwarranted. (Ferris, 12/23)

Costly, New Hep C Drugs Pose Dilemma For Prisons

The Constitution guarantees prisoners the same medical care that's standard in the community, reports NPR. The trouble is, that standard of care changed practically overnight for those with hepatitis C, which is more common among inmates than among the general public. Meanwhile, Bloomberg News examines the market fallout of the deal between Express Scripts and AbbVie.

NPR: Costly Hepatitis C Drugs Threaten To Bust Prison Budgets
Drug maker AbbVie won FDA approval ... for a new hepatitis C treatment that combines several drugs and can cure the disease in a matter of weeks or a few months. The news caps a year of medical milestones for the estimated 3.2 million Americans (including 12 to 35 percent of prisoners) who are chronically infected with this viral liver disease. Yet most of the hepatitis C drugs to hit the market this year cost tens of thousands of dollars. That puts them out of reach for many inmates and threatens to break prison health care budgets. (Gourlay, 12/24)

Bloomberg: Biotech Investors Bail Out After Gilead Drug Price Fight
The biotechnology sector is having its worst day since April as investors fear health insurers and companies that manage patient’s drug benefits will put new pressure on how much the industry can charge for breakthrough treatments. The selloff, prompted by Express Scripts Holding Co.'s announcement yesterday that it would block its U.S. patients from getting Gilead Sciences Inc.’s $1,100-a-pill hepatitis C medicine, sent the Nasdaq Biotechnology Index down 4.6 percent, the biggest one-day drop since April. (Chen, 12/23)

Ebola Doctor Makes Tough Choice To Save The Lives Of Two Colleagues

Los Angeles Times: Ebola Doctor's Dilemma: Two Patients, And Drugs Enough For One
Dr. Lance Plyler prayed. He had a choice to make. Two colleagues at a hospital in Liberia, Dr. Kent Brantly and Nancy Writebol, were battling the deadly Ebola virus. The air ambulance had turned back with a mechanical problem, and Plyler feared they wouldn't survive much longer. Against the odds, the medical missionary from North Carolina had managed to find some of the last available supplies of a promising new drug, ZMapp, in neighboring Sierra Leone. A Styrofoam box containing three frozen vials of straw-colored fluid was flown to the border, canoed across a river and put on a plane to Monrovia, the Liberian capital. But there was enough to treat only one person. The developers were insistent: It would take all three doses to knock out the virus. "Whatever you do," they told him, "don't split the course." (Alexandra Zavis, 12/23)

Veterans' Health Care

Judge Upholds Firing Of VA Health Care Chief In Phoenix

The federal administrative judge says former director Sharon Helman received more than $13,000 in trips and gifts from a health industry lobbyist.

The New York Times: Firing Of V.A. Clinic Chief Is Upheld Over Gifts, Not Wait Lists
A federal administrative judge has upheld the dismissal of the director of the Veterans Affairs health care system in Phoenix for accepting more than $13,000 in airline tickets and other gifts from a consultant for the health care industry, for failing to disclose some of the gifts and for placing a high-ranking doctor on administrative leave for providing Senator John McCain with information about patient suicides. The former director, Sharon Helman, had also been implicated in the falsification of the hospital’s waiting lists for care, a problem at Phoenix and other veterans’ hospitals that roiled the Department of Veterans Affairs this year and led to the resignation of the department’s secretary, Eric K. Shinseki. But the administrative judge, Stephen C. Mish, concluded that the department had not provided sufficient evidence to justify firing Ms. Helman for the manipulation of waiting lists, which concealed delays in providing care to veterans. (Oppel, 12/23)

Arizona Republic: Records: Phoenix VA Chief Helman Took Gifts In Secret
As Arizona military veterans waited months for doctor appointments in a broken health-care system, then-Phoenix VA hospital Director Sharon Helman went on a weeklong vacation to Disneyland secretly financed by an industry lobbyist, according to an administrative-law judge and documents obtained by The Arizona Republic. E-mail records and receipts examined by Chief Administrative Judge Stephen C. Mish indicate that Helman also got free concert and airline tickets and other perks from lobbyist Dennis "Max" Lewis, her previous boss. Based on that revelation, Mish on Monday upheld Helman's firing by the VA and rejected her appeal. (Wagner, 12/23)

Weekend Reading

Longer Looks: Cold Medicine; Next Year's Health Challenges; Prenatal Testing

Each week, KHN's Shefali Luthra finds interesting reads from around the Web.

The Atlantic: The Cold-Medicine Racket
One in four people, when buying an over-the-counter medicine to treat a headache, will go for a brand name product. Unless that person is a pharmacist. In that case, according to research from the National Bureau of Economic Research, they'll almost certainly buy a generic version. The pharmacists know, and trust, that the drugs are identical. (James Hamblin, 12/19)

Boulder Weekly: Deported To Death
Enrique’s story in the U.S. began like many immigrant stories: illegal border crossings and a dream of a better life. Today, his story is uncertain. It’s unclear if Enrique is still alive. What is known is how his time in the United States came to an end. He was deported more or less, but not by our government and not after he had exhausted the usual legal remedies of appeal or his right to request asylum. Enrique was sent back to his home country by a corporation by way of a process known as medical repatriation, or medical “deportation.” He was not sent back because he could get better care in Guatemala. He was sent back so the corporation could save money by not continuing to treat his serious condition. As the population of undocumented persons living in the U.S. has grown, so has this dangerous practice of corporate “deportation” by hospitals. It is an unsavory practice hidden in the shadows that has only come to light in recent years. (Cassie Moore, 12/18)

Vox: 5 Health Challenges The World Will Face In 2015
What comes next for the future of the world's health? Unfortunately we don’t have an evidence-based crystal ball. But these are the issues reason would suggest will set the world's health agenda next year. (Julia Belluz and Steven Hoffman, 12/23)

The Wall Street Journal: What I Learned From A Dying Patient
I had a patient recently whose death was particularly harrowing. Thirty-nine years old. Ph.D. scientist. Brilliant. She was sent to the ICU team as a “fascinoma,” meaning a person with a constellation of problems the doctors couldn’t figure out. This woman had been physically fine until two months earlier, and now she was growing progressively shorter of breath, had a little blood in her urine and had pain in her toes, which were turning blue and red in the cold. (E. Wesley Ely, 12/19)

The Atlantic: The Unexpected Home Of Unintended Pregnancy
Delaware has the highest rate of unintended pregnancy in the nation by some measures .... By the time girls arrive at [Delaware Adolescent Program Inc., a network of three schools for pregnant teenagers and those who have recently given birth], their lives are too complicated for the standard health-class self-esteem pep talks. For them, it’s time to get down to brass tacks—like how to stretch a skimpy food budget as a single mom. ... Even the most dedicated teen mother might say she wishes she’d delayed her pregnancy by a few years. Reducing unplanned pregnancy is something Republicans and Democrats can agree upon. On the plus side for conservatives, there’s no need for a woman to consider having an abortion if the unwanted pregnancy never happens in the first place. And unintended pregnancies cost Delawareans alone $52 million a year, since many such births are covered by Medicaid. (Olga Khazan, 12/22)

Mother Jones: Is Male Birth Control Around The Corner?
For nearly a century, we've had reason to believe that "the pill" for men might be possible: In the 1920's, scientists discovered how to control sperm production in rats by manipulating their pituitary glands, and in the 1990's the World Health Organization published evidence that hormonal interventions to regulate fertility in men could be effective and reversible. But two decades later, researchers say they still don't have enough funding to produce a male version of the pill, even as drug companies continue to pump money into the already mature market for female contraceptives (and a private foundation set aside $75 million in 2008 to find a non-surgical way to sterilize cats and dogs.) (Samantha Michaels, 12/23)

FiveThirtyEight: New Prenatal Tests Aren't Perfect — But They're Close
For a large share of pregnant women, testing for Down syndrome and other chromosomal abnormalities is a standard part of prenatal care. This testing has gotten quite a bit of negative press in the last few days. In particular, news reports have questioned the value and accuracy of new technologies that claim to detect problems at a high rate with a simple blood test. (Emily Oster, 12/22)

The Wall Street Journal: The Making Of A Flu Vaccine
The WHO has spent more than six decades monitoring flu. Flu virus, which primarily infects the upper respiratory tract, is responsible for up to an estimated 500,000 deaths globally each year, the WHO says, including up to 50,000 people in the U.S., according to the CDC. While vaccines for measles or polio are nearly 100% effective, immunizations against flu work moderately at best, topping out around 60% in the general population. Some years, like this one, they do far worse, experts say. (Shirley S. Wang, 12/22)

Health Policy Research

Research Roundup: Reenrollment; Patients' Understanding Of Risk; Coverage For HIV

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: Health Policy Brief: Reenrollment
During the second round of open enrollment for the Affordable Care Act's insurance Marketplaces, insurers and policy makers have a new challenge: keeping last year's enrollees in the system. ... Open enrollment began November 15 and thus far has been going much more smoothly than the first open enrollment. ... Enrollees who do not shop around and are automatically renewed may be surprised with their new premium. ... In recognition of the price sensitivity of enrollees, HHS is rethinking the automatic re-enrollment process for future open enrollment periods. (Goodell, 12/22)

Commonwealth Fund: Analysis Finds No Nationwide Increase In Health Insurance Marketplace Premiums
A new analysis of the Affordable Care Act’s health insurance marketplace costs finds that, nationwide, marketplace premiums did not increase at all from 2014 to 2015, though there were substantial average premium increases in some states and declines in others. ... The 0 percent change in average premiums is unprecedented when compared with historic trends in both the individual insurance market and employer-based health insurance. Prior to the passage of the Affordable Care Act, from 2008 to 2010, premiums grew an average 10 percent or more per year in state individual insurance markets. (Gabel et al., 12/22)

UCLA Center For Health Policy Research: The State Of Health Insurance In California: Findings From The 2011/2012 California Health Interview Survey
This biennial report uses data from the 2011-12 California Health Interview Survey (CHIS) ... The report found that, despite continuing job growth, employer-provided health benefits continued to erode for many Californians. The data also show continued lack of health access to and use of medical services by adult Latinos in the state. ... Specifically, the authors found that nearly half (47.4 percent) the 6.9 million people still uninsured in 2011-2012 were in families with a full-time worker. Latinos had the highest levels of uninsurance, 28.4 percent, and lowest share of employer-based insurance, 33.9 percent. (Charles et al., 12/22)

Kaiser Family Foundation/ PerryUndem Research and Communication: Health Insurance Coverage For People With HIV Under The Affordable Care Act: Experiences In Five States
[A]ntiretroviral therapy (ART) is not only critical for the health and longevity of people with HIV, it has also been shown to significantly reduce the risk of HIV transmission. However, the majority of people with HIV in the U.S. are not yet engaged in care and not on ART. Improving access to health coverage is one key component to addressing this gap. (Kates, Dawson, Undem and Perry, 12/19)

JAMA Internal Medicine: Patients’ Expectations Of The Benefits And Harms Of Treatments, Screening, And Tests
Reports of individuals’ (either patients or the general public) expectations about the likely benefit or harm of various interventions are fragmented across the literature. We aimed to systematically review all studies that had quantitatively measured patient or public expectations of the benefit and/or harm of any medical treatment, test, or screen. ... Participants rarely had accurate expectations of benefits and harms, and for many interventions, regardless of whether a treatment, test, or screen, they had a tendency to overestimate its benefits and underestimate its harms. (Hoffmann and Del Mar, 12/22)

American Journal of Managed Care/Rand Corp.: Paying For Telemedicine
[D]espite ... prospective advantages, telemedicine has been adopted in only limited circumstances, such as for reading radiology reports and remote phone or video visits for minor health issues. To promote adoption, some have advocated for telemedicine services to be reimbursed by health plans and many states have issued "parity laws" that force payers to reimburse some forms of telemedicine services at a level equal to in-person care. In this perspective, we explore why health plans are reluctant to cover most telemedicine services as part of current payment arrangements and explain why newer payment models offer greater potential for its expanded and more effective use. (Rudin, Auerbach, Zaydman and Mehrotra, 12/12)

Heritage Foundation: Measuring Choice And Competition In The Exchanges: Still Worse Than Before The ACA
This Heritage Foundation analysis reviews state-level insurer participation in the exchanges for 2015 in federally facilitated and state-based exchanges in all 50 states and compares those results with insurer participation in states in the pre-ACA individual market. ... The exchange market is 21.5 percent less competitive based on a comparison of the number of participating exchange insurers across all 50 states in 2015 with the number of carriers in the individual market in 2013. (Senger, 12/22)

Here is a selection of news coverage of other recent research:

The Wall Street Journal: Is Long-Term-Care Insurance for You?
According to researchers at Georgetown University and Pennsylvania State University, about 70% of individuals 65 and older will need some kind of long-term care—whether at home or in an assisted-living facility or nursing home. But how many of them should purchase a long-term-care insurance policy? That number, it turns out, is far lower—at 19% of men and 31% of women, according to a new study by researchers at Boston College’s Center for Retirement Research. (Women live longer on average, and so they’re statistically more likely to incur long-term-care costs.) Most “individuals should not buy insurance,” write the authors of the paper, which was published in November. (Tergesen, 12/23)

Bloomberg: More Contraception Means Fewer Abortions, Study Finds
More access to long-acting contraception methods resulted in fewer abortions, a study of Iowa women found, adding a new facet to the debate over abortion rights and political efforts to restrict them. According to a study of more than 500,000 Iowa medical records, from 2005 to 2012, the abortion rate in the state fell by 22 percent, according to research to be published in the medical journal Contraception. The fall in abortions coincided with two trends in the Midwestern state. While number of abortion facilities actually increased -- from 9 to at least 18 during the study period, the number of patients at family planning agencies using long-acting contraceptives, such as intrauterine devices, or IUDs, rose to 15 percent, from less than 1 percent. (Deprez, 12/23)

CQ Healthbeat: Study Finds E-Cigarettes Used More Than Tobacco Cigarettes By Teens
Teen use of e-cigarettes now surpasses use of tobacco cigarettes, according to a University of Michigan study that documents how quickly the products have made inroads in the lives of adolescents. The Monitoring the Future study, now in its 40th year, surveys 40,000 to 50,000 students in about 400 secondary schools across the country. It found 17 percent of 12th graders reported using e-cigarettes in the past 30 days, compared to 14 percent who reported use of a tobacco cigarette. (12/16)

The Wall Street Journal: Taking Measure Of Growth Charts
When it comes to measuring babies and young children, a growing body of research—controversial though it is—says one size fits all. Traditionally, nations have assessed children’s health by comparing weight and other measurements against growth charts generated from previous births. That’s fine if a country’s population is healthy. But if it isn’t, indicators of poor growth—such as lower birth weights—may be regarded as acceptable norms. (McGinty, 12/19)

Reuters: Cigarette Smoking Costs Weigh Heavily On Health Care System
Of every $10 spent on healthcare in the U.S., almost 90 cents is due to smoking, a new analysis says. Using recent health and medical spending surveys, researchers calculated that 8.7 percent of all healthcare spending, or $170 billion a year, is for illness caused by tobacco smoke, and public programs like Medicare and Medicaid paid for most of these costs. ... Over 18 percent of U.S. adults smoke cigarettes and about one in five deaths are caused by smoking, according to the CDC. (Kennedy, 12/19)

State Watch

State Highlights: Health Costs And State Budgets; Medicaid Pay Cuts Could Hurt Patients

A selection of stories that affect states and local communities around the country, with reports from Massachusetts, Arizona, Texas, Iowa, Minnesota, South Carolina and Kansas.

The Washington Post: GAO: Without Draconian Cuts, States Face Decades-Long Fiscal Crisis
The economic recession that blasted huge holes in state and local government budgets and rapidly rising health care costs are combining to create a long-term budget crisis for states that is so bad it would require massive tax hikes or spending cuts, according to a new government watchdog report. ... rising health-related costs borne by state and local governments, especially those incurred by government employees and retirees, are putting pressure on state budgets. State and local Medicaid expenditures and employee-related costs both grow faster than the gross domestic product, the GAO said. It estimated health-related costs will grow from about 3.9 percent of GDP this year to 7.4 percent by 2060. (Wilson, 12/22)

Kaiser Health News: As Docs Face Big Cuts In Medicaid Pay, Patients May Pay The Price
Andy Pasternak, a family doctor in Reno, Nev., has seen more than 100 new Medicaid patients this year after the state expanded the insurance program under the Affordable Care Act. But he won’t be taking any new ones after Dec. 31. That’s when the law’s two-year pay raise for primary care doctors like him who see Medicaid patients expires, resulting in fee reductions of 43 percent on average across the country, according to the nonpartisan Urban Institute. (Galewitz, 12/23)

The Boston Globe: Doctor For Poor Chosen As Mass. Health Commissioner
The health department has been mired in controversy since 2012, when a drug analyst with the agency tampered with evidence and jeopardized tens of thousands of criminal convictions. That was quickly followed by a meningitis outbreak traced to a compounding pharmacy regulated by one of the department’s boards, and then the agency found itself in the cross hairs again because of the problem-plagued rollout of the state’s medical marijuana law. (Lazar, 12/23)

Arizona Central-Republic: Study: $1,600 Price Swing For Same Blood Test In Arizona
A medical services provider in Tempe charges less than $15 for a common blood test called a comprehensive metabolic panel. Just over 20 miles away, another medical-services provider in Mesa charges more than $1,630 for the exact same test, according to a study released by Hospital Pricing Specialists, a California-based firm that surveys prices for medical products and services. (Giblin, 12/23)

The Texas Tribune: Health Chief Says He Was Misled On No-Bid Deal
Texas Health and Human Services Commission chief Kyle Janek said Tuesday he was misled in briefings on a no-bid, $110 million deal handed to an Austin company for unproven software to detect Medicaid fraud. Janek said the Office of Inspector General, the commission’s audit arm, should have alerted him that its contract with 21 Century Technologies Inc., also known as 21CT, “proceeded outside the normal channels” for approval. (Langford and Smith, 12/23)

The Des Moines Register/USA Today: MERS Research Improperly Conducted At Iowa College
A University of Iowa scientist has been sanctioned for launching work on the deadly MERS virus without school approval and outside of the proper laboratory setting. The school also is being accused of improperly withholding forms that could help the public assess whether any of the deadly agent imported from a collaborator in Spain was stolen, lost or released. (Clayworth, 12/23)

MinnPost: Family Caregivers Often Asked To Perform Medical Tasks With Little Or No Training
In recent years, individuals who provide late-in-life care to a family member have been increasingly asked to take on complex nursing and medical tasks that were once performed only in hospitals and nursing homes by trained professionals — procedures such as cleaning wounds, operating feeding tubes and giving drug injections. Yet, despite the difficulty and importance of these tasks, family caregivers are frequently given little if any hands-on training about how to safely and effectively do them. In addition, many older caregivers — often the spouse of the person needing care — have their own health issues that make performing such tasks very problematic. (Perry, 12/23)

The Associated Press: Charleston Pharmacy Owner Faces Federal Charges
A Charleston pharmacy and its owner face federal health care charges. Trivillian's Pharmacy is charged in an information with health care fraud and misbranding drugs. Owner and operator Paula Butterfield is charged in an information with making a false statement in a health care matter. Trivillian's is accused of dispensing compounded drugs and generic drugs and billing Medicare and Medicaid for brand name drugs, which are more expensive. (12/23)

The Kansas Health Institute News Service: Peer Support Key To Helping Returning Vets Overcome Mental Health Problems
Sitting in a Junction City coffee shop with his laptop and a pile of textbooks splayed on a table, Will Stucker looks like any other college student, if a bit older than average. But Stucker, 38, has taken a different path to college than most of his classmates at Emporia State University. His path took him to South Korea and Kuwait, then to a tank rolling toward Baghdad, then to an armored Humvee on the streets of a small town in Iraq where insurgents repeatedly tried to kill him — and two of them almost succeeded. Then, finally, to a Department of Veterans Affairs hospital in Topeka, where counselors helped him work through the post-traumatic stress disorder (PTSD) he came home with. (Marso, 12/23)

Editorials And Opinions

Viewpoints: 'Rip Off' For Red States; Doctors And Abortion; Anti-Vaccine Movement Waning

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

Vox: Red States Are Using Obamacare To Rip Themselves Off
For a bill that passed without a single Republican vote, Obamacare sure treats red states well. The law takes more money from blue states than from red states and it spends more money in red states than in blue states. It is, as Alec MacGillis wrote in the Washington Post at the time, "a rare triumph of principle over parochialism." But before you think Democrats the only ones capable of putting principle before party, consider what has happened since the law's passage. Republicans have been busily remaking Obamacare into a subsidy from red states to blue ones. (Ezra Klein, 12/23)

Los Angeles Times: Doctors Shouldn't Be Compelled To Give Anti-Abortion Lectures To Patients
A federal appeals court made the right decision this week when it struck down a key provision in a North Carolina law requiring doctors to perform ultrasounds on women seeking abortions and then both show and describe the sonogram images to them. The U.S. 4th Circuit Court of Appeals in Richmond, Va., wisely found the provision to be an unconstitutional violation of the free-speech rights of doctors. (12/23)

Los Angeles Times: Finally, The Anti-Vaccine Movement Is Losing Steam
For the first time in years, there has been a slight uptick in the number of kindergartners who started the school year with all their recommended vaccinations, the state reported Tuesday. This is good news for California, where the anti-vaccine movement has thrived over the last decade despite its basis in a thoroughly discredited study and public statements by a few celebrities who are neither scientists nor medical experts. (12/23)

The Washington Post: Bloody Good Move By The FDA
The Food and Drug Administration will recommend that men who have sex with men (i.e. gay men) be allowed to donate blood. Without question, this is good news. But only up to a point. Instead of the lifetime ban that has been in place since 1983, the so-called deferral period is now one year. In other words, if you are a man who has had sexual contact with another man in the past 12 months, you still can’t give blood. This change would put the United States’ policy on par with policy in Australia, Japan and Great Britain. (Jonathan Capehart, 12/23)

The Washington Post: Reginald Latson’s Case Points To A Major Problem In U.S. Prisons
Neli Latson has a music player. Also, he can order snacks from the canteen and leave his cell for several hours a day. This is good news, or what passes for it, in the life of Reginald Latson, a 23-year-old with autism and an IQ of 69 who goes by the nickname of Neli. It is good news because, for more than a year, he has been held in solitary confinement in a Virginia prison. Except: Latson should not be in prison at all. ... Latson should be in a secure residential treatment facility, and Virginia’s mental health officials support this outcome even as its corrections system incarcerates him. (Ruth Marcus, 12/23)

JAMA Pediatrics: High-Value, Cost-Conscious Medical Education
Health care professionals must balance the harms and costs of tests and treatments against the potential benefits in order to provide high-value, cost-conscious care. Clinical researchers, in turn, identify the diagnostic tests, treatments, delivery systems, and clinical pathways that will provide an evidence-based foundation for patient care. Unfortunately, despite a growing recognition of the economic stressors in medical education systems and an awareness that instructional approaches vary in their effectiveness, the paradigm of value has been applied in only a limited fashion to medical education. (David A. Cook and Thomas J. Beckman, 12/22)