First Edition: April 23, 2019

Kaiser Health News: Sparse Treatment Options Complicate Cancer Care For Immigrants In South Texas
Edgar carries a red folder bulging with paperwork, bills and medical records. Before his lung cancer diagnosis in September, he had about $11,000, he said, money he was saving to purchase a used truck and to pay an immigration attorney to pursue legal residency. By February, it was gone, and Edgar was relying on friends and family to cover doctor appointments, food and other basics. His treatment had been complicated by a collapsed lung. “I’m not able to work — I’m breathing with just one lung,” said the 50-year-old painter, who asked to be identified by only his first name because he’s an undocumented immigrant from Mexico. (Huff, 4/23)

The Wall Street Journal: Trump Administration Launches Program To Rein In Medicare Costs
The Trump administration is launching a program to offer new ways of paying primary-care doctors, including flat monthly payments to physicians and higher payments for medical practices specializing in the chronically ill, as a way to lessen the costs of Medicare’s usual fee-for-service system. Seema Verma, the Medicare administrator under President Trump, said the flat-fee method and other payment alternatives could be a path for the Medicare payment system to achieve better outcomes for patients instead of the current fee-for-service method that creates “perverse incentives to offer more care.” (Burton, 4/22)

The Associated Press: Medicare, Social Security Face Shaky Fiscal Futures
The financial condition of the government's bedrock retirement programs for middle- and working-class Americans remains shaky, with Medicare pointed toward insolvency by 2026, according to a report Monday by the government's overseers of Medicare and Social Security. It paints a sobering picture of the programs, though it's relatively unchanged from last year's update. Social Security would become insolvent in 2035, one year later than previously estimated. (Taylor, 4/22)

The New York Times: Social Security And Medicare Funds Face Insolvency, Report Finds
Meanwhile, Medicare’s hospital insurance fund is expected to be depleted in 2026 — the same date that was projected a year ago. At that point, doctors, hospitals and nursing homes would not receive their full compensation from the program and patients could face more of the financial burden. “Lawmakers should address these financial challenges as soon as possible,” the trustees of the program wrote. “Taking action sooner rather than later will permit consideration of a broader range of solutions and provide more time to phase in changes so that the public has adequate time to prepare.” (Rappeport, 4/22)

Reuters: Medicare Hospital Fund Reserves Likely To Be Exhausted In 2026: U.S. Report
U.S. healthcare costs are expected to be a hot topic during the 2020 presidential campaign, with uncertainty around possible cost-cutting solutions already weighing on healthcare stocks this year. Senator Bernie Sanders, among a large field of contenders for the Democratic presidential nomination, has unveiled a "Medicare-for-All" plan that would eliminate private insurance and shift all Americans to a public healthcare plan. (4/22)

The Wall Street Journal: Social Security Costs To Exceed Income In 2020, Trustees Say
More broadly, rising Social Security and Medicare costs are also expected to weigh on the federal budget. Both programs together account for 45% of federal spending, excluding interest payments on the national debt, and have contributed to larger deficits that are set to exceed $1 trillion a year starting in 2020. Monday’s projections “almost mislead people into a false sense of complacency, when in the meantime these are the programs that are going to drive up budget deficits,” said Brian Riedl, a senior fellow at the Manhattan Institute, a right-leaning think tank. Over the next 10 years, he estimates, Social Security and Medicare benefit shortfalls will account for 90% of larger budget deficits. (Davidson, 4/22)

The Wall Street Journal: Medicare B Costs For Retirees Projected To Rise
Medicare’s trustees projected Monday that the standard monthly premium in 2020 for Medicare Part B, which covers doctor visits and other types of outpatient care, will increase by $8.80 a month to $144.30. A final figure is expected in the fall. The increase comes after the Part B premium for most people rose modestly in 2019 to $135.50, from $134 in 2018. Even though Medicare Part A, which covers hospitalization, is free for most people 65 and older, Medicare Part B charges a monthly premium that currently ranges from $135.50 to $460.50, depending on a beneficiary’s income. (Tergesen, 4/22)

Stat: U.S. Health Officials Unveil Experiment To Overhaul Primary Care
The initiative, called CMS Primary Cares, includes five new payment options for small and large providers, allowing them to take varying levels of financial responsibility for improving care and lowering costs. It broadly seeks to change how primary care is delivered in the U.S. by rewarding doctors for improving management of patients with chronic illnesses such as diabetes and high blood pressure, and averting expensive trips to the hospital. Health and Human Services Secretary Alex Azar called the program “an historic turning point in American health care” that is projected to enroll a quarter or more of the 44 million Americans served by traditional Medicare. (Ross, 4/22)

The Associated Press: Kansas' New Governor Vetoes Mandate On Abortion 'Reversal'
Kansas' new Democratic governor on Monday vetoed a measure that would require clinics and doctors to tell their patients about a disputed treatment to stop a medication abortion after a woman has taken the first of two pills. The action by Gov. Laura Kelly, an abortion-rights supporter, sets up a confrontation with a Republican-controlled Legislature that has had solid anti-abortion majorities for more than two decades. Supporters of the abortion "reversal" bill appeared to have the two-thirds majorities needed in both chambers to override Kelly's veto once lawmakers return on May 1 from a weekslong break. (Hanna, 4/22)

The Associated Press: Tennessee Lawmakers Send Governor 'Triggered' Abortion Ban
A proposal that would effectively outlaw most abortions in Tennessee if the U.S. Supreme Court overturns Roe v. Wade is headed to the governor's desk. State lawmakers in both the House and Senate overwhelmingly advanced the legislation on Monday, with just a handful of Democrats voting against. The legislation is expected to be signed into law after newly elected GOP Gov. Bill Lee has repeatedly promised to support any bill that limits abortion in Tennessee. (Kruesi and Mattise, 4/22)

The Hill: Trump Poised To Roll Back Transgender Health Protections 
The Trump administration appears ready to roll back health care protections for transgender people, and advocates are gearing up for a fight. A proposed rule from the Department of Health and Human Services that’s expected in the coming days would make it easier for doctors, hospitals and insurance companies to deny care or coverage to transgender patients, as well as women who have had abortions. (Weixel, 4/23)

Reuters: Transgender U.S. Adults Have Higher Risk Of Poor Health
Transgender adults may be more likely to have unhealthy habits and medical issues that negatively impact their quality of life than people whose gender identity matches what it says on their birth certificates, a U.S. study suggests. Researchers examined survey data from 3,075 transgender adults as well as 719,567 adults who are cisgender, meaning their gender identity matches the sex they were assigned at birth. (4/22)

The New York Times: ICE Faces Migrant Detention Crunch As Border Chaos Spills Into Interior Of The Country
Federal immigration authorities faced with overburdened detention centers are scouring the country to find space to house migrants as the crush of asylum seekers that has overwhelmed the Southwest border spreads deep into the nation’s interior. With mounting federal initiatives to hold more and more migrants in custody, officials at Immigration and Customs Enforcement, which oversees long-term detention centers for migrants, are looking for additional space that can be rented inside existing jails, as well as fast-tracking the deportations of current detainees and releasing as many migrants as possible into the country to make room for newcomers. (Dickerson, 4/22)

Stat: PBMs, Under Fire From Trump, Spend A Record Sum On Lobbying
Lobbying disclosures filed on Monday revealed a flurry of pharmaceutical industry activity, including the largest-ever expenditure for the trade group representing pharmacy benefit managers. The Pharmaceutical Care Management Association spent a record-breaking $1.49 million on lobbying in the first quarter of 2019, the most it has ever spent in a three-month span, according to a STAT analysis of the latest lobbying disclosures. The all-time record comes as the lobbying organization is vocally opposing a Trump administration proposal to ban certain rebates from drug companies to PBMs that could fundamentally threaten the industry’s business model. (Facher, 4/23)

Stat: In Potential Blueprint For Other States, An AG Floats Proposal To Rein In PBMs
Fresh off filing a lawsuit alleging that a pharmacy benefit manager overcharged his state, Ohio’s attorney general is now proposing a series of legislative reforms that would toughen oversight of these controversial middlemen. The move by Attorney General Dave Yost comes amid escalating concern among Ohio officials over the prescription drug contracts administered by PBMs on behalf of the state Medicaid program and other agencies. In doing so, Yost appears to be suggesting a blueprint for other states that are grappling with rising drug costs and starting to scrutinize PBM business practices as one possible way to alleviate the financial strain. (Silverman, 4/22)

The Associated Press: New York Outbreaks Drive US Measles Count Up To 626
Outbreaks in New York state continue to drive up the number of U.S. measles cases, which are approaching levels not seen in 25 years. Health officials say 71 more cases were reported last week, with 68 of them from New York. That brings this year's total to 626. That is already the most since 2014, when 667 were reported for the whole year. The most before that was 963 cases in 1994. (4/22)

The Wall Street Journal: Measles Cases In U.S. Continue To Climb
New York City health officials have said they expect the number of cases to increase over the next several weeks after Passover, one of the holiest Jewish celebrations, when there are large get-togethers. Many of those who have contracted measles in the current outbreaks are children, including babies too young to be vaccinated. Some of the sick have been adults, including those who were vaccinated. (McKay, 4/22)

Reuters: U.S. Records 71 New Measles Cases In Week As Outbreak Spreads
The U.S. outbreak is part of a worldwide rise in the once nearly eradicated disease. The World Health Organization reported last week that global cases had risen nearly four-fold in the first quarter of 2019 to 112,163 compared with the same period last year. A vocal fringe of parents in the United States oppose vaccines believing, contrary to scientific evidence, that ingredients in them can cause autism or other disorders. (4/22)

The Washington Post: Measles Outbreaks: U.S. Measles Tally Rises To 626 Cases, Nearing A Record, CDC Reports
Meanwhile, the rise in measles cases prompted the Food and Drug Administration on Monday to stress the importance of the measles, mumps and rubella vaccine, saying large, well-designed studies confirmed its safety and effectiveness long ago and demonstrated it is not associated with the development of autism, false information that anti-vaccine groups have claimed for two decades. “We cannot state strongly enough – the overwhelming scientific evidence shows that vaccines are among the most effective and safest interventions to both prevent individual illness and protect public health,” Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, said in a statement. (Sun, 4/22)

Stat: As Calls For Measles Vaccination Rise, It's Crickets From The White House
When children visiting Disneyland in 2015 contracted and then transmitted measles across the country, President Barack Obama lent his voice to the containment campaign. “You should get your kids vaccinated. It’s good for them,” he told an interviewer. “There is every reason to get vaccinated. There aren’t reasons not to get vaccinated.” A few years earlier Obama was photographed getting immunized against H1N1, the flu virus that triggered the 2009 pandemic. Gerald Ford famously got vaccinated in the 1976 “swine flu” pandemic scare. Jimmy Carter and Bill Clinton created and expanded programs to immunize children against childhood diseases. White House photographers recorded Ronald Reagan getting multiple flu shots. (Branswell, 4/23)

Los Angeles Times: Measles Cases Investigated By L.A. County Public Health Officials
Los Angeles County public health officials said Monday that they’re investigating a measles cluster after reports of residents acquiring the vaccine-preventable virus. Over the past few weeks, L.A. County has four confirmed measles cases linked to one another after international travel, and an additional single case of measles after international travel. These numbers exclude Long Beach and Pasadena, which have their own health departments. (Cosgrove and Karlamangla, 4/22)

The New York Times: The Military Wants Better Tests For PTSD. Speech Analysis Could Be The Answer.
Post-traumatic stress disorder has long been one of the hardest mental health problems to diagnose because some patients try to hide symptoms while others exaggerate them. But a new voice analysis technique may be able to take the guesswork out of identifying the disorder using the same technology now used to dial home hands-free or order pizza on a smart speaker. A team of researchers at New York University School of Medicine, working with SRI International, the nonprofit research institute that developed the smartphone assistant Siri, has created an algorithm that can analyze patient interviews, sort through tens of thousands of variables in their speech and identify minute auditory markers of PTSD that are otherwise imperceptible to the human ear, then make a diagnosis. (Philipps, 4/22)

NPR: Alphabet's Google And Verily Develop AI For Health
One of the biggest corporations on the planet is taking a serious interest in the intersection of artificial intelligence and health. Google and its sister companies, parts of the holding company Alphabet, are making a huge investment in the field, with potentially big implications for everyone who interacts with Google — which is more than a billion of us. The push into AI and health is a natural evolution for a company that has developed algorithms that reach deep into our lives through the Web. (Harris, 4/22)

The Wall Street Journal: It’s Grandparents V. Parents In The Battle Over Kids’ Screens
Grandparents have long indulged their grandchildren with sweets, toys and late bedtimes, often to the dismay of the parents stuck in the middle. But concerns about screen time and cellphone usage are creating a whole new set of issues. When they hear that the grandparents are giving the children extra screen time, parents debate whether to lay down the law or let it go. Grandparents themselves are wondering: What’s the big deal? Usually, neither side wants to rock the boat too much. Grandparents don’t want to lose time with the kids and parents don’t want to lose the babysitting. (Jargon, 4/23)

The Washington Post: Smoking And Depression Apps Are Selling Your Data To Google And Facebook, Study Finds
The pitch: Health apps for users who are battling depression or want to quit smoking. The problem: Many of the apps designed to track a user’s progress are sharing the personal details they collect with third parties, like Google and Facebook, without consent. That’s according to a study published Friday in the journal JAMA Network Open. Researchers say the findings are especially important in mental health, given the social stigmas and the risks of having sensitive information shared unknowingly. (Siegel, 4/22)

The Washington Post: Autism Makes Dental Care Difficult And Expensive
When Ava Terranove began feeling oral pain last July, her parents took her to her regular dentist. The dentist determined that Ava, who has an autism-like condition, needed two root canal procedures to treat infected teeth. Because of her developmental disability, Ava, now 15, requires general anesthesia for nonroutine dental work. The dentist, like most of his peers, was not equipped to provide it. (Tuller, 4/22)

CNN: Drinking Water Linked To Fewer Sugary Drinks -- And Calories -- In Kids
Children and teens who drink water are less likely to consume sugary beverages throughout the day, according to a new study. Researchers analyzed data from 8,400 children and teens ages 2 to 19 collected between 2011 and 2016 as part of the National Health and Nutrition Examination Survey, which is administered yearly by the US Centers for Disease Control and Prevention. Parents and kids were asked to recall what the children had consumed in the previous 24 hours, and the calories were added up. (Bracho-Sanchez, 4/22)

The New York Times: Skipping Breakfast May Increase Stroke And Heart Risks
Skipping breakfast may increase your risk for cardiovascular disease. The connection, found in a study of 6,550 adults aged 65 to 75, was particularly strong for stroke. Almost 60 percent of the participants had breakfast every day, a quarter on some days, and 16 percent rarely or never. All were free of heart disease at the start of the study. Over an average 17 years of follow-up there were 2,318 deaths, including 619 from cardiovascular diseases. (Bakalar, 4/22)

CNN: How Permanent Daylight Saving Time And Later School Starts Could Affect Health
About 70 countries around the world nudge their clocks back and forth each year -- but some people want to "spring forward" permanently, citing health and other benefits. Some of those same people are also pushing for later school start times, but experts argue the benefits for tired teenagers could be canceled out by permanent daylight saving time, according to correspondence in the journal Current Biology. The authors argue that California lawmakers pushing for both policies are "confused." (Nedelman, 4/22)

The Wall Street Journal: Elizabeth Holmes Gets Delay In Trial-Date Decision
Lawyers for Theranos Inc. founder Elizabeth Holmes on Monday fought off efforts by the U.S. government to set a trial date as the two sides argued over the enormity of evidence involved in the case and the difficulty in lining up high-profile witnesses. Ms. Holmes and her former deputy, Ramesh “Sunny” Balwani, who both appeared in court on Monday, were charged last year with lying to doctors and patients about their blood-testing startup’s test results and misleading investors about the company’s financial health. In addition to 20 years in prison, they face fines of more than $2 million apiece, as well as additional restitution to victims. (Copeland, 4/22)

The Washington Post: California Police Promote Measure To Limit Fatal Shootings
Round two gets underway Tuesday in California’s fight over how best to limit fatal shootings by police through nation-leading reforms. State legislators are debating a measure that proponents said would set a national precedent by creating statewide guidelines on when officers can use lethal force and requiring that every officer be trained in ways to avoid opening fire. (Thompson, 4/23)

Los Angeles Times: Mentally Ill Homeless People Keep Going To Jail. But A Study Says L.A. County Can Fix That
On a typical day, thousands of homeless and mentally ill people are behind bars in Los Angeles County’s jails. But more than half of them would be good candidates to divert into housing with supportive services instead, according a new study from the Department of Health Services. If enough housing and services were available, nearly 3,000 people in custody at any given time would be eligible for release — either before their trials or before finishing their sentences. The study, released Monday, shows the potential to break the well-worn cycle of homelessness, incarceration and return to homelessness, said Peter Espinoza, a retired judge who heads the Office of Diversion and Reentry. (Smith, 4/22)