KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: 'Not-So-Fit Bit?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Not-So-Fit Bit?'" by Chris Wildt .

Here's today's health policy haiku:

A SHORTAGE OF GRINS

Diet of sucrose.
Lack of dental coverage.
Future without smiles.

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Health Law Issues And Implementation

Federal Exchange Tallied About 2.5 Million Insurance Sign-Ups So Far

Federal officials said about a million of those new enrollments took place during the week of Dec. 6 through Dec. 12., and about 1.6 million people telephoned the call center between Dec. 13 and Dec. 15.

The New York Times: Federal Health Exchange Sees Enrollment Flurry
The Obama administration said Tuesday that nearly 2.5 million people had selected health insurance plans through the federal marketplace in the first four weeks of open enrollment this fall. More than one million of those selections came in just one week, from Dec. 6 through last Friday. (Pear, 12/16)

The Wall Street Journal: Deadline Brings Millions To Healthcare.gov
The numbers significantly outstrip sign-ups through the first four weeks of last year’s enrollment period, when the site was hobbled by technical problems, and show the site is generally functional. “Our technology and call center representatives have done their job,” Mr. Slavitt told reporters Tuesday afternoon. But HHS officials also said the site and its supporting infrastructure had at times struggled with volume. (Radnofsky and Armour, 12/16)

The Associated Press: Surge In Health Law Sign-Ups
Tuesday's numbers were partial, really just a subtotal. They reflected the 37 states served by HealthCare.gov. Enrollment for states running their own websites will be reported later. And Tuesday's numbers also did not include totals from the weekend and Monday, which saw strong consumer interest. (12/16)

Politico: 2.5M Enrolled In Obamacare In A Month
The Department of Health and Human Services said Tuesday that about half of those signing up for coverage between Nov. 15 and Dec. 12 were new customers. The other half were renewing customers. Any current policyholder who missed the Dec. 15 renewal deadline will be automatically re-enrolled. This second open enrollment season will continue until Feb. 15, but individuals who wanted to get covered as of Jan. 1 had to sign up by 3 a.m. Tuesday EST. (Pradhan, 12/16)

USA Today: About 2.5M Signed Up At Healthcare.gov By Friday
Up to 500,000 people heard automated messages and left their names. They are awaiting return calls or receiving them Tuesday, said HHS principal deputy administrator Andy Slavitt on a press call Tuesday afternoon. That's out of 1.6 million people who phoned the call center over the weekend and through Monday. The website and call center "have done their jobs so far," Slavitt said. Peak volume on the website Monday was 125,000 concurrent users, he said. The site didn't run into "capacity constraints," though he acknowledged a waiting room page was used for about 90 minutes while a database was updated. (O'Donnell, 12/16)

McClatchy: HealthCare.gov Enrollment Approaches 2.5 Million In First Month
Nearly 2.5 million people selected a health plan on the HealthCare.gov website as of midnight on Friday, Dec. 12, the Obama administration announced Tuesday. After the 2015 open enrollment period began on November 15, consumer activity on the website began to peak as the December 15 deadline neared to purchase health insurance that begins on New Year's Day 2015. (Pugh, 12/16)

NBC News: Millions More Sign Up for Obamacare Health Insurance
Last year, just under 7 million people signed up on the exchanges. They'll be automatically re-enrolled unless they decline to be. Several million more people got health insurance, often for the first time, in the more than 20 states that agreed to expand the Medicaid state-federal health insurance plan for people with low incomes. (Fox, 12/16)

DC Exchange Glitch Puts Some At Risk Of Temporarily Losing Insurance

Meanwhile, in Maryland, exchange officials report that more than 100,000 people have newly enrolled in health plans; and, in Chicago, some residents will face increasing out-of-pocket costs as well as Obamacare premium hikes.

The Washington Post: Glitch Leaves Hundreds In Limbo Seeking Insurance Through D.C. Health Exchange
As many as one in six D.C. residents who tried to sign up for health insurance through the city’s online exchange were thwarted by technology glitches ahead of a Monday sign-up deadline, D.C. officials acknowledged Tuesday. Some residents thought they had completed the application process to begin coverage in January only to receive error messages at the end. Others encountered a blank screen and couldn’t even get started. (Davis, 12/16)

The Baltimore Sun: Facing Deadline, Md. Health Exchange Enrolls More Than 100K
A day before the deadline to sign up on the Maryland exchange for health insurance that would start Jan. 1, thousands of residents risk losing their subsidies temporarily because they have not re-enrolled. Yet a month into this year's enrollment period, the exchange is running smoothly and already has signed up more than 100,000 new and returning customers, officials said Tuesday. Last year's rollout of the exchange was plagued by technological problems that made it difficult for people to sign up. (Cohn, 12/16)

The Chicago Sun-Times: Out-Of-Pocket Costs Rise In Some Chicago-Area Plans
Health insurance premiums may not be the only thing going up in 2015 under the Affordable Care Act. Out-of-pocket expenses are increasing under some plans available to Chicago-area consumers, a Chicago Sun-Times analysis of federal government data found. Twenty percent of the 125 insurance plans available in Cook, DuPage, Kane, McHenry and Will counties have higher out-of-pocket maximums in 2015 than in 2014. None of the plans decreased their maximum out-of-pocket limit. (Thomas, 12/16)

Tennessee Joins List Of GOP-Led States Seeking Medicaid Expansion Money

A statewide coalition of business, health care and civic groups has formed in Tennessee to support Republican Gov. Bill Haslam, whose expansion plan faces opposition from some GOP legislators.

Bloomberg: Tennessee To Expand Medicaid As GOP Adapts To ACA
Tennessee has moved to the forefront of a new group of Republican-led states jockeying for hundreds of millions of dollars available under Obamacare for Medicaid expansions. Governor Bill Haslam, a Republican, announced yesterday that the state would expand its Medicaid program for the poor under a “real Tennessee solution” that the Obama administration supports in principle. Indiana, Utah, Wyoming and Alaska are also considering an expansion, at least 90 percent of which would be funded by the federal government. (Wayne, 12/16)

The Associated Press: Statewide Coalition Forms To Support Tenn. Medicaid Plan
More than 80 business, health care and civic groups have formed the Coalition for a Healthy Tennessee to support Republican Gov. Bill Haslam's proposal to offer health coverage to more than 200,000 low-income Tennesseans. Haslam's "Insure Tennessee" plan would draw down federal money under President Barack Obama's health care law. It faces stiff opposition among some fellow Republicans in the Legislature, though some previous skeptics have said they are encouraged by the governor's deal with the federal government. (12/17)

Other stories look at developments in the expansion debate in Wyoming -

Wyoming Public Media: Legislative Committee Endorses Alternative Medicaid Expansion Bill
A legislative committee has rejected the Wyoming Department of Health's proposed Medicaid Expansion plan in favor of a bill crafted by the committee. The Share plan was also endorsed by the governor. The bill approved by the committee would provide participants with a Medicaid-funded health savings account that they could use to purchase private insurance. Senator Charles Scott said that he believes that will encourage participants to be careful with their health care spending. ... The Committee vote marks the first time that the Joint Labor, Health, and Social Services Committee as endorsed a Medicaid Expansion plan. (Beck, 12/16)

Casper Star-Tribune: Legislators Tangle Over Final Medicaid Waiver Approval
A provision that would give the Wyoming Legislature final approval on a negotiated Medicaid waiver was voted down during Tuesday’s Medicaid debate by a committee of lawmakers. ... The question arose after Sen. Jim Anderson, R-Casper, proposed an amendment [to a bill] to install final legislative approval of rule-making from the Centers for Medicare and Medicaid Services and the state Health Department. ...[Health Department Director Tom] Forslund said passage of the bill would give the department authority to submit a formal waiver application. The move is the next step in gaining federal approval for Medicaid expansion in the state. Tuesday’s final approval amendments would set the process back, Forslund said. (Graph, 12/16)

Health Law Will Reduce Ethnic, Racial Divides In Coverage, Urban Institute Says

But African-Americans aren't seeing as much improvement as Latinos and American Indians because many live in states that have not expanded Medicaid, according to the Urban Institute.

Politico Pro: ACA Could Reduce, But Not End, Coverage Disparities, Study Finds
Disparities in the uninsured rate of Latinos and American Indians versus whites will narrow under Obamacare, but blacks won’t experience that effect to the same degree unless more states expand Medicaid, according to a new Urban Institute projection of the law’s impact two years from now. (Winfield Cunningham, 12/16)

Meanwhile, Brandeis researchers explore whether government policies can eliminate health disparities among children -

PBS NewsHour: Can Government Policies Correct Race And Ethnicity Disparities In Child Health?
When Dolores Acevedo-Garcia and Pamela K. Joshi set out to study the racial and ethnic equity of federal policies impacting child health, they didn’t expect it to be terribly difficult. After all, they figured, there are federal mandates that require agencies to collect data on race and ethnicity. But finding the data that the researchers from Brandeis University wanted to analyze was difficult. It was buried in reports or tied up in semantics. (Morris, 12/16)

Shorter Shopping Season, More Choices, Complicate Search For Health Plans

The Detroit Free Press explores some of the issues consumers must think about before choosing individual insurance plans sold through the online marketplaces. Other stories look at how the long-delayed mandate requiring large employers to offer insurance kicks in Jan. 1 and how the penalties increase for not having coverage in 2015.

The Detroit Free Press: What You Need To Know Shopping For Health Care Coverage
With twice as many choices and half the time as last year to sort them out, consumers who buy health coverage individually — those who don't get it through an employer or Medicare, for example — must be able to quickly navigate jargon and fine print. Are you willing to pay more for fewer surprises if you get sick? And with shrunken provider networks, is your doctor still covered? (Erb and Reindl, 12/16)

The Hill: ObamaCare Fines Loom For Uninsured
People without insurance are running out of time to avoid the hefty ObamaCare penalties that the IRS will be handing down in 2016. Consumers face a Feb. 15, 2015, deadline to buy insurance, after which those without coverage could be hit with fines of $325 per adult or 2 percent of family income, whichever is higher. (Viebeck, 12/17)

Feds Award States ACA 'Innovation' Grants

News outlets report on these Affordable Care Act grants, which are part of $620 million in funding provided to 11 states.

Connecticut Mirror: CT Gets $45 Million For Health Care System Redesign
Connecticut will receive $45 million in federal funds for an effort to redesign the state’s health care payment and delivery systems. The funding, announced Tuesday, is part of $620 million awarded to 11 states under the Affordable Care Act, the federal health law commonly known as Obamacare. (Levin Becker, 12/16)

Richmond Times-Dispatch: Virginia Receives First Federal Grant For Health Care Innovation
Virginia has won a $2.6 million grant to develop a state health innovation plan that will focus on disease prevention, mental health care and reducing tobacco use and obesity. The one-year grant from the Centers for Medicare & Medicaid Services is the first that Virginia has received from a federal program to foster innovative approaches to delivering health care. (Martz, 12/16)

The Denver Post: Colorado To Receive $65M Mental Health Grant
Colorado will receive $65 million of federal funds to help bring mental health treatment into primary-care doctors' offices, part of a plan to make sure more Coloradans receive mental health treatment when they need it. Gov. John Hickenlooper on Tuesday announced the grant, designed to reward state innovation, after months of work by a team of experts examining ways to improve coordination between mental health care and other medical care. Colorado will spend the money during the next four years. (Brown, 12/16)

Jeb Bush Bolsters GOP Position With Obamacare Stance

Elsewhere, The New York Times examines the new surgeon general's resolve on taking sometimes unpopular stances.

Politico Pro: Obamacare Helps Jeb Bush Mark His Place On The GOP Spectrum
Jeb Bush has used Obamacare to define his place on the spectrum of conservatism, even as he serves on the board of a major for-profit hospital chain benefiting from the health’s law’s drive to cover the uninsured. Even before Bush announced Tuesday that he would “actively explore the possibility” of a White House bid, he had called the Affordable Care Act “flawed to its core.” He’s consistently attacked the policy, while chiding some conservatives’ tactics in fighting it. ... His statements about Obamacare have at times served to appease immigration hardliners, who dislike his moderation on that issue. (Wheaton, 12/16)

The New York Times: Vivek Murthy, The New Surgeon General, Isn’t Afraid To Take A Stand
In an age when health care is a politically contentious topic and doctors often shy away from getting involved, Dr. Murthy takes positions. He is a founder of Doctors for America, a nonprofit group of 16,000 physicians and medical students whose stated mission is to improve the country’s health care system and make sure everyone has access to quality health care. The group advocated passage of the Affordable Care Act (and the election of President Obama — it was originally called Doctors for Obama, a fact that rankled Republicans and even some Democrats), training members to educate people about enrollment, organizing a bus tour in Florida and holding athletic races for fund-raising across the country. (Tavernise, 12/16)

Capitol Hill Watch

Congress Approves Tax-Free Bank Accounts For People With Disabilities

The accounts could be used to pay for education, housing and health care, among other needs. Also in news from Capitol Hill, House Democrats released a report showing how many people in each congressional district risk losing assistance if the Supreme Court upholds the challenge to premium subsidies in the health care law.

The Associated Press: Congress Agrees To Widen Federal Help For Disabled
Congress gave final approval Tuesday to the most sweeping legislation to help the disabled in a quarter century, allowing Americans with disabilities to open tax-free bank accounts to pay for needs such as education, housing and health care. The move paves the way for creation of the accounts beginning next year for as many as 54 million disabled people and their families. (Yen, 12/16)

CQ Healthbeat: House Democrats Quantify Subsidies At Risk In Health Law Challenge
Americans stand to lose $65 billion in tax credits to help purchase medical coverage if the Supreme Court upholds a challenge to the health care law's insurance subsidies, House Energy and Commerce Democrats said in a staff report Tuesday that outlines the number of people in each congressional district at risk of losing assistance. The report lists the congressional district, the name of its representative in Congress, the number of people who could lose subsidies in 2016 and the annual value of the lost aid for residents of districts in states using the federal insurance exchange healthcare.gov. Last month, the high court agreed to hear a challenge to the subsidies that help lower- and middle-income people in those 37 states buy health coverage under the overhaul (Attias, 12/16)

Marketplace

Companies Push Workers Harder To Lose Weight

The Wall Street Journal looks at how businesses are experimenting with more aggressive and personalized approaches to encourage employees to lose weight. Meanwhile, CVS projects strong earnings growth as a result of specialty drugs and acquisitions.

The Wall Street Journal: Memo To Staff: Time To Lose A Few Pounds
The boss thinks you could stand to lose a few. Seeking to make a dent in the intractable problem of obesity — a condition affecting roughly one-third of U.S. adults and costing companies more than $73 billion a year, according to researchers from Duke University — businesses are experimenting with new measures to encourage workers to slim down. (Weber and Silverman, 12/16)

The Wall Street Journal: CVS Sees Earnings Growth On Deals, Raises Dividend
CVS Health Corp. projected up to 16% earnings growth for the next year, driven by gains in specialty drugs and acquisitions. The drugstore, which changed its name to CVS Health in September as it sold its last tobacco products, also approved a new $10 billion stock repurchase program and boosted its quarterly dividend by 27% to 35 cents a share. The boost will cost the company about an extra $90 million a quarter. (Chen, 12/16)

Justice Department Drops Drug Misbranding Case

Elsewhere, a woman accused of defrauding Medicaid to help an undocumented immigrant get prenatal care sees the case against her dismissed.

The Wall Street Journal: Justice Department Takes Rare Step Of Dropping Misbranding Case
The Justice Department has dropped a case against a Tennessee couple convicted of using misbranded drugs in their cancer clinics, a rare move that could signal unease in Washington with such prosecutions. Dr. Anindya Kumar Sen and his wife, Patricia Posey Sen, had appealed their jury convictions to the Sixth U.S. Circuit Court of Appeals, using a high-powered legal team that included former federal prosecutor Alex Little and former U.S. Solicitor General Paul Clement. (Palazzolo, 12/16)

The Associated Press: Accused Woman Of Giving Medicaid Funds For Prenatal Care To Illegal Immigrants Has Case Dropped
A federal judge has dismissed charges against a woman accused of defrauding Medicaid to help women in the country illegally get prenatal care after evidence in the case was lost. Dennison was accused of defrauding the government of more than $1 million over five years by advertising her clinic's services in the Hispanic community, then telling her staff to coach immigrants on getting prenatal care through the Baby Your Baby program if they didn't have a valid Social Security number. Dennison maintains her innocence and says a former medical assistant helped the women get around the law. The assistant has pleaded guilty to a single charge in the case and was cooperating with the government, according to court documents. (Whitehurst, 12/16)

State Watch

State Highlights: Calif. Group Cites Privacy Concerns In Call For Database Boycott; Ga. Hospitals Face Tough Times

A selection of health policy stories from California, Georgia, Virginia, Missouri, New York, Massachusetts, Colorado and Missouri.

Bloomberg: California Retiree Health Expense Climbs 11%
California increased its projected cost for providing health care to retired workers by 11 percent to $72 billion, Controller John Chiang said. Chiang, a Democrat, called on lawmakers to set aside money into an investment fund so that earnings can cover some of the costs that grew $7.2 billion in the fiscal year that ended June 30. The $72 billion represents present day costs for future benefits. “The price tag associated with providing health care to retired state workers has quietly grown to rival or even eclipse the funding gap associated with public pensions,” Chiang said in a statement. “If we continue to do nothing, we will be sowing the seeds of a future crisis.” (Marois, 12/16)

The Associated Press: Missouri Proposes Health Care Coverage For Eating Disorders
Health care plans would have to cover eating disorder treatments under proposed Missouri legislation. State Sen. David Pearce of Warrensburg recently filed a bill requiring coverage for diagnosis and medically necessary treatment of the disorders. Coverage would include specialist services recommended by a patient's treatment team. Under the measure the Department of Insurance would be required to make an annual report to lawmakers regarding those insured and treated for eating disorders. (12/17)

The Associated Press: Appeals Court Overturns Sex-change For Inmate
A divided federal appeals court on Tuesday overturned a ruling ordering Massachusetts prison officials to provide taxpayer-funded sex-reassignment surgery for an inmate convicted of murder. Michelle Kosilek, born Robert Kosilek, is serving a life sentence for killing spouse Cheryl Kosilek in 1990. Kosilek has waged a protracted legal battle for the surgery she says is necessary to relieve the mental anguish caused by gender-identity disorder. In 2012, U.S. District Judge Mark Wolf became the first judge in the country to order sex-reassignment surgery as a remedy for an inmate's gender-identity disorder. Courts around the country have found that prisons must evaluate transgender inmates to determine their health care needs, but most have ordered hormone treatments and psychotherapy, not surgery. (Lavoie, 12/16)

The Denver Post: Former Jefferson County Inmate Awarded $11M After Stroke
Kenneth McGill's face was drooping, his voice slurred and one side of his body numb in 2012 when he told a nurse at the Jefferson County Jail that he was having a stroke. A U.S. District Court jury has awarded McGill $11 million after finding Monday that Correctional Healthcare Companies and its employees at the jail were deliberately indifferent to his medical needs when he had a stroke. Sixteen hours had passed before McGill received treatment. The Jefferson County commission, Sheriff Ted Mink and the nurse were named in the 42-page lawsuit. The county would have to pay only if the company fails to do so, and the county would not be held liable for the $7.6 million in punitive damages, said McGill's lawyer, Anna Holland Edwards. (McGhee, 12/16)

Reuters: Colorado Inmate Who Suffered Stroke Awarded $11M By Jury
A federal jury has awarded $11 million to a Colorado jail inmate who was left permanently disabled after he said he was denied treatment for 16 hours after suffering a stroke, court documents showed on Tuesday. Kenneth McGill, 46, alleged in a lawsuit that he sustained “major permanent disabilities” as a result of delayed medical treatment he received in 2012 while being held at the Jefferson County jail in suburban Denver. Following a 10-day trial in U.S. District Court in Denver, jurors on Monday found the county’s contract healthcare provider, Correctional Healthcare Companies Inc, liable for his injuries. (Coffman, 12/16)

Editorials And Opinions

Viewpoints: Playing Politics With Ebola Hyperbole; The Value Of Comparing Health Plans; E-Cigs

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

Los Angeles Times: PolitiFact's Liars Of The Year: The Politicians Who Played The Ebola Fear Card
Members of Congress, mostly Republicans, warned that Ebola could be carried into the country by immigrants arriving illegally or even terrorists, and demanded a ban on travelers entering the United States from the affected countries. Governors scrambled to draft quarantine regulations, producing a showdown between Gov. Chris Christie of New Jersey and a nurse he tried to confine to a tent. (The nurse won.) And now? The crisis is all but forgotten. We've moved on. (Doyle McManus, 12/16)

Los Angeles Times: Mr. Waxman Leaves Washington
It was a Republican who once paid Democrat Henry Waxman the rough compliment of being "tougher than a boiled owl." Many of the big things Waxman helped to make into law in his four decades in Congress took bipartisan work, the kind that has all but disappeared in Washington: tobacco regulation, easier access to generic drugs, increased food labeling and safety, cleaner air and water, AIDS healthcare and Obamacare. But that's not why Waxman — a vastly influential legislator and among the last of Congress' 1974 "Watergate baby" generation — is retiring. He figures he has a lot of tread left on his tires, but he wants to drive down roads other than the ones leading to Capitol Hill. (Patt Morrison, 12/16)

Bloomberg: Obamacare Is Only Human
It turns out that most people who enrolled in health insurance for 2014 through HealthCare.gov didn't bother going back to the site to shop around for better prices for 2015. That means they will pay higher premiums than necessary. It also raises a separate question: What's the point of having options if so few people use them? (Christopher Flavelle, 12/16)

The Seattle Times: How You Can Find The Best Quality Health Care — For Free
Open enrollment is important. It should be the time people choose the health plan they believe would help them become healthier. Instead, many purchasers make a decision based entirely on how big a dent they’ll see in their wallets, despite the fact that consumers have tools to help them understand which plans provide the highest quality and which do not. For the first time in the health industry’s history, there are numerous objective quality measures available if purchasers are willing to take a little time and look for them. (Scott Armstrong and Patricia Smith, 12/16)

The Charlotte Observer: A GOP Push To Expand Medicaid
Tennessee Gov. Bill Haslam ... is showing political courage to do what’s right – and to attract millions in federal dollars for his state’s struggling hospitals. It’s the kind of path [N.C. Gov. Pat] McCrory has indicated he might be willing to take, and Haslam’s example should help McCrory stay open-minded amid pressure from his right. Haslam has been negotiating with the Obama administration for months to craft a Tennessee-specific Medicaid expansion proposal. It includes some co-pays and some premiums not typically required under Medicaid. Such alterations to Obamacare’s approach has turned past opponents – such as Tennessee Lt. Gov. and Senate speaker Ron Ramsey – into potential supporters. The state’s two Republican U.S. senators also support Haslam’s proposal. (12/16)

The Wall Street Journal: Paid Maternity Leave Is Good For Business
I was Google ’s first employee to go on maternity leave. In 1999, I joined the startup that founders Larry Page and Sergey Brin had recently started in my garage. I was four months pregnant. At the time the company had no revenue and only 15 employees, almost all of whom were male. Joining a startup pregnant with my first child was risky, but Larry and Sergey assured me I’d have their support. This month, I’ll go on maternity leave once again—my fifth time—joining the nearly 5,000 women who have done so since I joined Google. And though I’m now CEO of YouTube (which is owned by Google), I’ll be entitled to the same benefits as every single woman at the company who has a baby: 18 weeks of paid maternity leave. (Susan Wojcicki, 12/16)

The New York Times: Tortured By Psychologists And Doctors
One of the most disturbing revelations in the Senate report on the Central Intelligence Agency’s interrogation program was the deep complicity of psychologists and doctors in torturing suspected terrorists. We already knew from earlier reports that health professionals had facilitated the torture by advising the interrogators when their brutal tactics might inadvertently kill a prisoner. (12/16)

USA Today: E-Cigarettes Cloud Progress On Teen Smoking: Our View
E-cigarettes, once seen as a harmless alternative to tobacco smoking, are beginning to look more like a new gateway to addiction. This year, for the first time, more teens used electronic cigarettes than traditional ones: 17% of high school seniors used the devices, vs. 14% who smoked cigarettes. Kids in eighth and 10th grades favored them 2-to-1 over traditional smokes, according to an eye-opening University of Michigan survey released Tuesday. (12/16)

USA Today: Rally Behind E-Cigarettes: Opposing View
E-cigarettes aren't threatening the progress of continued smoking reduction. They are helping even hard-core cigarette smokers quit. If society gives equal treatment to these two very different products with dramatically different health risks, we will undermine e-cigarettes' promise as powerful harm reduction tools. (Jeff Stier, 12/16)