First Edition: March 13, 2017

Kaiser Health News: By Law, Hospitals Now Must Tell Medicare Patients When Care Is ‘Observation’ Only
Under a new federal law, hospitals across the country must now alert Medicare patients when they are getting observation care and why they were not admitted — even if they stay in the hospital a few nights. For years, seniors often found out only when they got surprise bills for the services Medicare doesn’t cover for observation patients, including some drugs and expensive nursing home care.The notice may cushion the shock but probably not settle the issue. (Jaffe, 3/13)

Kaiser Health News: HMO Doctors Take Pains To Slash Opioid Prescriptions
On a summer afternoon in 2009, eight Kaiser Permanente doctors met in Pasadena to review the HMO’s most prescribed drugs in Southern California. Sun blasted through the windows and the room had no air conditioning, but what unsettled the doctors most were the slides a pharmacist was presenting. “We were doing so much work treating people with hypertension and diabetes, we thought those drugs would be on the list,” said Dr. Joel Hyatt, then Kaiser’s quality management director in Southern California. (Quinones, 3/13)

California Healthline: Proposed Law Would Require All California Children To Be Screened For Lead
Growing national concern about lead poisoning in children has prompted a California lawmaker to introduce legislation to ensure that all of the state’s kids are tested for the toxic metal. The bill, introduced by Assemblyman Bill Quirk (D-Hayward), would change the state’s Health and Safety Code to require testing for all children aged six months to 6 years. (Ibarra, 3/13)

The Washington Post: Trump Said No Americans Would Lose Coverage Under Obamacare Repeal. Paul Ryan Won’t Make That Promise.
House Speaker Paul D. Ryan (R-Wis.) said Sunday that he doesn’t know how many Americans would lose coverage under his proposal to revise the Affordable Care Act, which is under fire from fellow Republicans, AARP and virtually every sector of the U.S. health-care industry. (Snell, 3/12)

The Associated Press: Republicans Brace For Downbeat CBO Analysis Of Health Bill
Republicans pushing a plan to dismantle Barack Obama’s health care law are bracing for a Congressional Budget Office analysis widely expected to conclude that fewer Americans will have health coverage under the proposal, despite President Donald Trump’s promise of “insurance for everybody.” House Speaker Paul Ryan said he fully expects the CBO analysis, set to be released as early as Monday, to find less coverage since the GOP plan eliminates the government requirement to be insured. (Yen, 3/13)

Politico: Budget Referee May Call Foul On Obamacare Repeal
The fate of Obamacare may lie in the hands of a number-crunching Republican appointee whose bottom line might single-handedly blow up the GOP quest to repeal and replace it. Congressional Budget Office Director Keith Hall was handpicked two years ago by top Republicans in Congress— including now Health and Human Service Secretary Tom Price — to lead a nonpartisan office that will soon release its estimate of how many Americans the Republican health care bill will cover and whether it shrinks or balloons the federal deficit. (Pradhan, 3/10)

Reuters: Agency's Analysis Of Republican Health Bill May Sharpen Resistance To Measure
House of Representatives Speaker Paul Ryan, the Republican healthcare plan's top backer in Congress, acknowledged on NBC's "Meet the Press" program on Sunday that the CBO projections would likely show a decline in insurance coverage because the legislation would drop an Obamacare provision mandating that Americans obtain health insurance or pay a fine. "The one thing I'm certain will happen is CBO will say: 'Well, gosh. Not as many people will get coverage,'" Ryan said. "You know why? Because this isn't a government mandate." (3/13)

The New York Times: The G.O.P.’s High-Risk Strategy For Health Law Repeal
President Trump and House Republicans are pressing forward with a high-risk strategy to repeal and replace the Affordable Care Act, disregarding the views of medical professionals and potentially imperiling the party’s political future in conservative states where many voters stand to lose their health care. The effort could cause upheaval in an already roiled insurance market next year, as Republicans face voters for the first time with Mr. Trump in the White House — though that turmoil would happen only if the plans manage to clear a divided Senate. (Pear and Kaplan, 3/11)

The Washington Post: Sleeper Issue Of Medicaid’s Future Could Prove Health-Care Plans’ Stumbling Block
As House Republicans hurtle toward shifting the nation’s health-care system onto a more conservative path, nearly lost so far in the roiling debate over their plans is the profound impact they would have on insurance for the nation’s poorest and most vulnerable residents. The proposed American Health Care Act would break with the government’s half-century-old compact with states in helping to finance Medicaid, which covers 68 million low-income people, including children, pregnant women and those who are elderly or disabled. (Goldstein and Eilperin, 3/12)

The Wall Street Journal: Lawmakers Debate Fate Of Medicaid
The Republican push to overhaul the Affordable Care Act showed signs of bogging down Friday over the fate of Medicaid, as governors from states that expanded the program under the law faced off against conservative lawmakers who want to cut it back. Republican governors from the 16 states that expanded Medicaid intend to produce their own proposal for preserving some aspects of the Medicaid expansion, according to people familiar with the plan. It is expected to clash with a House GOP proposal that would freeze federal funding in 2020 for states that expanded Medicaid and bring other steep cuts. But the 16 governors don’t appear to be in agreement, one of these people said. (Hackman, Armour and Hughes, 3/11)

The Washington Post: GOP Infighting Over Health Care, Other Issues Belies Victory
Less than 24 hours after Donald Trump had won the White House, House Speaker Paul Ryan triumphantly proclaimed the start of a new era of Republican leadership that would “hit the ground running.” Six weeks into Trump’s administration, Republicans are running — just in different directions. As congressional leaders move forward with efforts to undo former President Barack Obama’s health care law, conservative activists and GOP lawmakers are slamming the proposal as “Obamacare lite,” ‘’Obamacare 2.0” and “RINOcare” — RINO standing for Republicans In Name Only, a term of derision. (Lerer and Beaumont, 3/13)

Politico: Conservatives Escalate Threats To Tank Obamacare Repeal
So much for President Donald Trump's charm offensive with conservatives. Conservative Hill leaders warned on Sunday that they won’t support the House GOP Obamacare alternative as it’s written, saying they’ll let the bill fail if they don’t get concessions. (Bade, 3/12)

The Associated Press: Conservatives Want Health Bill Changes, House Leaders Resist
Conservative Republicans demanded tougher changes Friday in insurance requirements and Medicaid than the House GOP health care bill proposes and warned they’d oppose the legislation if it isn’t reshaped. The White House signaled an openness to negotiate, but there was resistance from House leaders. (Fram, 3/10)

The Washington Post: Will Obamacare Repeal Break The Freedom Caucus? It Depends On Trump.
The internal Republican battle over replacing the Affordable Care Act has become the GOP’s first chance to break the House Freedom Caucus, the bloc of more than two dozen conservative lawmakers who have frustrated leadership for two years. And President Trump is likely to play a leading role. (Weigel, DeBonis and Snell, 3/11)

Politico: Ryan: Disaster If GOP Health Care Reform Fails
“I believe we can get 51 votes out of the Senate,” Ryan told host John Dickerson on CBS’ “Face the Nation.” “Look, this is what the legislative process looks like. When you are going through a deliberative legislative process, not ramming and jamming things but going through all the committees, going through the entire process — people are going to try and negotiate.” Ryan downplayed the opposition to the House bill as typical “negotiations and compromises.” (McCaskill, 3/12)

Reuters: Republican Senators Wobble On House Obamacare Plan
If the Republicans' plan to dismantle most of Obamacare is approved later this month by the U.S. House of Representatives, where it cleared initial hurdles last week, it would go next to the Senate, where its fate is uncertain. At least nine Republican senators have expressed concerns about the plan, which is moving forward in the House without a clear assessment of its impact on the federal budget or how it would impact the level of health insurance among Americans. (3/13)

Politico: Another Key Republican Senator Knocks GOP Obamacare Plan
Sen. Dean Heller panned House Speaker Paul Ryan's bill to repeal and replace Obamacare during a closed meeting with constituents on Saturday, according to audio obtained by POLITICO. The remarks by Heller, the most vulnerable GOP senator on the ballot next year, are another sign of the difficult prospects the House bill faces in the other chamber. Already, more than a half-dozen senators have criticized the bill, and Republicans can afford to lose only two votes. (Everett, 3/12)

Politico: Paul: GOP Lacks Votes To Begin 'Real' Negotiations On Health Care
Sen. Rand Paul said Sunday that Republicans lack sufficient votes to even begin “real” negotiations on House leaders’ Obamacare replacement plan. “We are still in the pre-negotiation period,” the Kentucky Republican told host John Dickerson on CBS’ “Face the Nation.” (McCaskill, 3/12)

The Associated Press: Health Law’s Woes, Real Or Perceived, Drive Call For Repeal
President Donald Trump and Republican leaders say drastic action is needed because the Obama-era health care overhaul is a disaster, with soaring premiums and insurers bailing out. It’s true that major parts of the 2010 law are clearly troubled, but others are working fairly well.The risk is that the GOP’s “rescue mission” will inflict collateral damage on what’s working and cause new problems. Or that promised solutions might disappoint. (Alonso-Zaldivar, 3/12)

The Associated Press: Some Parts Of ‘Obamacare’ Are Working Fairly Well
President Donald Trump and Republican leaders say drastic action is needed because the Obama-era health care overhaul is a disaster, with soaring premiums and insurers bailing out. It’s true that major parts of the 2010 law are clearly troubled, but others are working fairly well.The risk is that the GOP’s “rescue mission” will inflict collateral damage on what’s working and cause new problems. Or that promised solutions might disappoint. (Alonso-Zaldivar, 3/13)

The Associated Press: Pence Appeals For Complete GOP Support For Health Overhaul
Vice President Mike Pence appealed for total GOP congressional support for a White House-backed health overhaul during a brief visit Saturday to Kentucky, where the Republican governor and junior senator are among the plan’s skeptics. “This is going to be a battle in Washington, D.C. And for us to seize this opportunity to repeal and replace Obamacare once and for all, we need every Republican in Congress, and we’re counting on Kentucky,” Pence said at an energy company where business leaders had gathered. (Thomas, 3/11)

The Washington Post: Pence Relies More On Charm Than Oratory To Push The GOP Health-Care Plan In Kentucky
Vice President Pence was in full charm mode Saturday when he touched down here for a visit to try to sell the Republican health-care plan in a state that has a complex relationship with former president Barack Obama’s Affordable Care Act. Just a day earlier, Kentucky’s Republican Gov. Matt Bevin had told reporters that while he is eager to overhaul Obama’s health plan, he found himself skeptical of the initial Republican proposal and more in line with the views of Sen. Rand Paul (R-Ky.), who has been an outspoken opponent of the bill. (Parker, 3/11)

The Wall Street Journal: Trump Administration Officials Defend GOP Health Bill Amid Party Disagreement
Trump administration officials sought to buck up support for House Republican plans to overhaul the Affordable Care Act on Sunday amid vocal dissension within the party about the measure. “We strongly support the plan,” Health and Human Services Secretary Tom Price said on NBC’s Meet the Press, adding it would bring coverage to more people without raising costs. “I firmly believe nobody will be worse off financially in the process that we’re going through.” (Harrison and Harris, 3/12)

Politico: Price On Obamacare Replacement: ‘Nobody Will Be Worse Off Financially’
Health and Human Services Secretary Tom Price said Sunday that “nobody will be worse off financially” after Republicans in Congress repeal and replace Obamacare. “I firmly believe that nobody will be worse off financially in the process that we’re going through, understanding that they’ll have choices that they can select the kind of coverage that they want for themselves and for their family, not [that] the government forces them to buy,” Price told host Chuck Todd on NBC’s “Meet the Press” in an interview that aired Sunday. “So there’s cost that needs to come down, and we believe we’re going to be able to do that through this system. There's coverage that’s going to go up.” (McCaskill, 3/12)

The Associated Press: Tax Credits Work Differently In ‘Obamacare’ And GOP Plan
Republicans hate “Obamacare,” so House GOP leaders freak out whenever their health care bill is compared to President Barack Obama’s law. But one reason some conservatives are branding the bill “Obamacare Lite” comes down to the tax credits to help consumers buy insurance. Both tax credits target people who don’t get health insurance from their employer or from the government. They are both available to people even if they don’t make enough money to owe any federal income tax. And they are both entitlement programs — if you meet the criteria, you are entitled to the benefit. (Ohlemacher, 3/11)

USA Today: Hospitals Fear Obamacare Repeal May Create Financial Strain
The Republican plan to overhaul Obamacare could have a dire impact on hospital finances, some health care experts warn, creating serious concerns about patient safety and health care quality. Josh Sharfstein, a pediatrician and former top health official for the city of Baltimore and the state of Maryland, says the impact of the Affordable Care Act (ACA) goes far beyond expanding health insurance coverage to millions of Americans so they can get the treatment they need. That insurance reimbursement also helps keep hospitals afloat, he says. (O'Donnell, 3/12)

The Associated Press: Hospitals Worry About Caring For Newly Uninsured In GOP Plan
When Colorado expanded Medicaid coverage under former President Barack Obama’s health care law, the largest provider in the Denver region hired more than 250 employees and built a $27 million primary care clinic and two new school-based clinics. Emergency rooms visits stayed flat as Denver Health Medical Center directed many of the nearly 80,000 newly insured patients into one of its 10 community health centers, where newly hired social workers and mental health therapists provided services for some of the county’s poorest residents. Demand for services at the new primary care clinic was almost immediate. (Kennedy, 3/12)

The Associated Press: House GOP Health Bill Would Cut Women’s Services
Women seeking abortions and some basic health services, including prenatal care, contraception and cancer screenings, would face restrictions and struggle to pay for some of that medical care under the House Republicans’ proposed bill. The legislation, which would replace much of former President Barack Obama’s health law, was approved by two House committees on Thursday. (Jalonick, 3/10)

The New York Times: Republican Health Plan Could End Insurance Coverage Of Abortion
“There’s no reason insurers would sell any plans that cover abortion because everyone would be wanting to use these tax credits,” said Adam Sonfield, a senior policy manager for the Guttmacher Institute, a research center that works to promote access to abortion. (Zernike, 3/10)

The Associated Press: For Kentucky Voters, A Familiar Fight: Trump Vs. Paul
Duard Rutledge voted for Donald Trump and Rand Paul for the same reason: They’re not afraid of a fight. That’s why the 66-year-old retired Toyota worker wasn’t worried to see Kentucky’s junior senator getting in the way of the Republican plan to replace Obama’s health care law. “When you get two thoroughbreds, they are high strung,” he said. “But if you get them headed the right way they can both win the race.” (Beam, 3/10)

The New York Times: Trump Keeps Low Profile After Praising Health Care Overhaul
President Trump praised House Republican leaders on Friday for their plan to overhaul the Affordable Care Act, but otherwise kept a conspicuously low profile, with a newfound silent treatment of the news media. The president’s meeting with House leaders came the day after Anthem, one of the nation’s largest health insurers, offered strong support for the Republican plan, which has been denounced by other providers and which conservatives have vowed to reject. (Thrush and Abelson, 3/10)

The Wall Street Journal: Donald Trump Plays Background Role In Health-Care Battle
The course of Donald Trump’s presidency will be defined by his ability to seal a deal to rework the U.S. health-care system, but so far he has outsourced the job of hammering out the details to about a dozen Republican leaders and White House advisers while he serves in the background as a pitchman. (Radnofsky and Bender, 3/10)

The Washington Post Fact Checker: President Trump, The King Of Flip-Flops
There is no rule that politicians must remain consistent in their policies. Circumstances change, both economically and politically, and a skillful politician certainly can adjust his or her positions accordingly. But politicians need to explain to voters why they changed their minds. At The Fact Checker, we award an Upside-Down Pinocchio when a politician shifts position on a policy without acknowledging that they did so. (Kessler, 3/13)

Politico: Democrats To Turn Obamacare Attacks Against GOP In 2018
The past four election cycles, Democrats have been battered and bruised by political attacks over Obamacare. Now, they say, the time has finally arrived to take the fight to Republicans. (Everett and Caygle, 3/12)

The Associated Press: Familiar Democratic Name Kennedy Fights GOP On Health Care
A familiar name from Massachusetts, Rep. Joe Kennedy III, is carrying his family legacy into a new era, battling Republicans who want to undo Barack Obama’s health care law. Kennedy, the 36-year-old grandson of the late Sen. Robert F. Kennedy and great-nephew of the late Sen. Ted Kennedy and President John F. Kennedy, has been a low-key presence in the House since he was first elected in his Boston-area district in 2012. He emerged last week as a major Democratic voice against the Republican health care bill, delivering several speeches in a committee’s all-night session that have been viewed millions of times on the internet. (Jalonick, 3/13)

The Wall Street Journal: GOP Health Plan Risks Backlash From Seniors
House Republicans’ health-care proposal is running into a new political problem: opposition from older people. One day after House GOP leaders unveiled their plan to repeal and replace the Affordable Care Act, AARP, the politically potent advocacy group for Americans over 50 years old, came out in opposition. (Peterson and Hackman, 3/11)

Los Angeles Times: Trump Voters Would Be Among The Biggest Losers In Republicans' Obamacare Replacement Plan
Americans who swept President Trump to victory — lower-income, older voters in conservative, rural parts of the country — stand to lose the most in federal healthcare aid under a Republican plan to repeal and replace the Affordable Care Act, according to a Times analysis of county voting and tax credit data. Among those hit the hardest under the current House bill are 60-year-olds with annual incomes of $30,000, particularly in rural areas where healthcare costs are higher and Obamacare subsidies are greater. (Levey, 3/12)

The Wall Street Journal: GOP Health Plan Would Hit Rural Areas Hard
The House Republican effort to overhaul the Affordable Care Act could hit many rural areas particularly hard, according to a new analysis, sharply increasing the cost for some residents buying their own insurance.In extreme cases, the amount a consumer might owe for a plan could exceed that person’s annual income. In Nebraska’s Chase County, a 62-year-old currently earning about $18,000 a year could pay nearly $20,000 annually to get health-insurance coverage under the House GOP plan—compared with about $760 a year that person would owe toward premiums under the ACA, an analysis by Oliver Wyman showed. (Wilde Mathews and Chinni, 3/13)

NPR: Millennial With Parkinson's Wonders What The GOP Health Plan Would Mean
Many millennials have their hands full now, as they launch into adulthood — jobs, homes and partners. But 33-yr-old Ford Inbody is already thinking about a time when he won't be able to work. He has Parkinson's disease. Every night after work, he and his wife Cortney walk their two dogs through their neighborhood in Overland Park, Kan. For now, going out for an evening's stroll is easy. But many of their evening conversations revolve around a time they know is coming — when these walks will be more difficult. (Smith, 3/10)

Los Angeles Times: The Life-And-Death Stakes Of An Affordable Care Act Repeal In One Of L.A. County's Poorest, Sickest Regions
Nurses and doctors rush through hallways, readying exam rooms. The clinic in Lancaster hasn’t yet opened for the day, but staff members know that once patients start filing in they won’t stop. In less than two hours, it will be standing-room only in the waiting areas. Eight years ago, the Antelope Valley Community Clinic was a mobile van that offered check-ups and employed fewer than 10 people. Today it’s a health system with two clinics, two vans and 235 employees, and treats 500 patients a day. (Karlamangla, 3/10)

NPR: Medical Bills Once Made Him Refinance The Farm, So He's Watching The Obamacare Replacement Closely
Darvin Bentlage says his health insurance plan used to be the same as all the other cattle farmers in Barton County, Mo.: Stay healthy until he turned 65, then get on Medicare. But when he turned 50, things did not go according to plan. "Well, I had a couple of issues," he says. He's putting it mildly. (Sable-Smith, 3/12)

The Washington Post: Trump To Select Scott Gottlieb, A Physician With Deep Drug-Industry Ties, To Run The FDA
President Trump announced late Friday that he will nominate Scott Gottlieb, a conservative physician and businessman with deep ties to the pharmaceutical industry, to be commissioner of the Food and Drug Administration. If confirmed, Gottlieb would bring a strong pro-industry, deregulatory approach to an agency that Trump has criticized as being overly restrictive. But he is also likely to support one of the agency's basic functions: to ensure that drugs are proven safe and effective before they are sold. (McGinley and Johnson, 3/10)

The Associated Press: Trump’s Choice For FDA Has Ties To Wall Street, Drug Makers
Gottlieb, 44, is no stranger to the FDA — he served as a deputy commissioner under President George W. Bush. While he has frequently criticized the FDA for unnecessary regulations and urged changes to get safe and effective drugs onto the market faster, he generally has supported its overall mission. (Superville and Neergaard, 3/11)

NPR: Trump Picks Dr. Scott Gottlieb For FDA Commissioner
An internist and hospitalist, Gottlieb has played leading roles in various government health agencies, including as deputy commissioner for medical and scientific affairs at the FDA during the George W. Bush administration. Before that, he was a senior policy adviser at CMS working on the implementation of Medicare's then-new drug coverage for seniors. (Neel, 3/10)

The New York Times: F.D.A. Official Under Bush Is Trump’s Choice To Lead Agency
The selection of Dr. Gottlieb, 44, who served as a top official at the agency during the administration of President George W. Bush, drew praise from industry executives, who had previously expressed concerns that another top contender, Jim O’Neill, held radical views that would have gutted standards for drug approval trials and testing. “I think Scott is science-based, he’s patient-focused, he’s got strong management skills and he’s intellectually tough, so he will use all of that to make sure the F.D.A. and industry are all acting in the interests of patients,” said Dr. Leonard S. Schleifer, the chief executive of Regeneron Pharmaceuticals. (Thomas, 3/10)

The Washington Post: Why Critics Say A Texas Bill Lets Anti-Abortion Doctors Lie To Pregnant Women
An ultrasound technician had just told Rachel Tittle that she was carrying a baby girl when things went terribly wrong. She was 20 weeks pregnant at the time and couldn't wait to become a mother. That's when a doctor walked into her examination room and delivered the news that still haunts her six years later. “They told me my baby's abdomen was full of fluid — and if nothing changed very soon, it was going to stop her heart,” Tittle told The Washington Post, recalling the 2011 incident. “It was a horrible, horrible experience.” (Holley, 3/11)

The Washington Post: Employees Who Decline Genetic Testing Could Face Penalties Under Proposed Bill
Employers could impose hefty penalties on employees who decline to participate in genetic testing as part of workplace wellness programs if a bill approved by a U.S. House committee this week becomes law. In general, employers don't have that power under existing federal laws, which protect genetic privacy and nondiscrimination. But a bill passed Wednesday by the House Committee on Education and the Workforce would allow employers to get around those obstacles if the information is collected as part of a workplace wellness program. (Sun, 3/11)

The New York Times: How Healthy Are You? G.O.P. Bill Would Help Employers Find Out
The bill, the Preserving Employee Wellness Programs Act, introduced by Representative Virginia Foxx, a Republican from North Carolina and the chairwoman of the House Committee on Education and the Workforce, would also significantly increase the financial costs faced by someone who does not join a company wellness program. The bill, which is under review by other House committees and has yet to be considered by the Senate, has already provoked fierce opposition from a wide range of consumer, health and privacy advocacy groups, as well as by House Democrats. Critics claim it undermines existing laws aimed at protecting an individual’s personal medical information from use by employer and others. (Abelson, 3/10)

The Washington Post: As Opioid Overdoses Rise, Police Officers Become Counselors, Doctors And Social Workers
The nation’s opioid epidemic is changing the way law enforcement does its job, with police officers acting as drug counselors and medical workers and shifting from law-and-order tactics to approaches more akin to social work. Departments accustomed to arresting drug abusers are spearheading programs to get them into treatment, convinced that their old strategies weren’t working. They’re administering medication that reverses overdoses, allowing users to turn in drugs in exchange for treatment, and partnering with hospitals to intervene before abuse turns fatal. (Zezima, 3/12)

The Associated Press: Feds Override California To Aid Inmates With Drug Overdoses
A federal judge overrode a California state law on Friday to help combat a growing problem of inmates dying from drug overdoses.U.S. Judge Thelton Henderson of San Francisco approved waiving state law to allow licensed vocational nurses to administer the overdose antidote naloxone, which can reverse respiratory failures from opioid overdoses. (Thompson, 3/10)