First Edition: August 18, 2016

Kaiser Health News: Obamacare Marketplace Shakeout Rocks Arizona, Southeast 
Some of the Affordable Care Act’s insurance marketplaces are in turmoil as the fourth open enrollment season approaches this fall, but what’s ahead for consumers very much depends on where they live. Competition on these exchanges will be diminished next year when three of the nation’s largest health insurers — Aetna, UnitedHealthcare and Humana — will sell individual plans in many fewer markets. So too will several Blue Cross and Blue Shield plans in various states. That’s on top of the 16 nonprofit co-ops that have closed since January 2015. (Galewitz, 8/17)

Kaiser Health News: People With Obamacare Plans Filled More Prescriptions, But Had Lower Costs
The 2010 health law was meant to expand insurance coverage so that Americans could get medical care they would otherwise go without — and not spend a fortune doing so. Though it’s still early, new evidence suggests this scenario is playing out. Research published online by Health Affairs Wednesday examines what happened when people got insurance through the law — either with a private plan purchased via the online marketplaces or through Medicaid, the state-federal program for low-income people. The study specifically focuses on how many medical prescriptions they filled. (Luthra, 8/17)

Kaiser Health News: Genetic Insights About Health Risks Limited By Lack Of Diversity, Study Finds
For consumers, the idea of getting a genetic test to determine risks for hereditary diseases is becoming an increasingly common proposition, but new research suggests that sometimes the accuracy of those results may depend on what ethnicity you are. Take, for instance, hypertrophic cardiomyopathy, one of the most common hereditary heart diseases. ... African Americans have traditionally been considered at higher risk for the disorder. But a study out Wednesday in the New England Journal of Medicine concluded that common ways to determine that level of risk may be skewed because studies have traditionally had low numbers of black participants. (Tan, 8/17)

California Healthline: Sen. Hernandez Pulls Bill On Drug Price Transparency
After being approved by a key committee last week, a bill that would have required drug companies to justify treatment costs and price hikes was pulled by its author on Wednesday. Sen. Ed Hernandez (D-West Covina) said that he introduced the bill “with the intention of shedding light on the reasons precipitating skyrocketing drug prices.” But amendments by an Assembly committee last week make it difficult to accomplish this goal, he said in a statement. “The goal was transparency, making sure drug companies played by the same rules as everyone else in the health care industry,” he said. (Ibarra, 8/17)

Huffington Post: Aetna CEO Threatened Obamacare Pullout If Feds Opposed Humana Merger
The big health care news this week came from Aetna, which announced on Monday it was dramatically scaling back participation in the Affordable Care Act ― thereby reducing insurer competition and forcing customers scattered across 11 states to find different sources of coverage next year. ... the move also was directly related to a Department of Justice decision to block the insurer’s potentially lucrative merger with Humana, according to a letter from Aetna’s CEO obtained by The Huffington Post. (Cohn and Young, 8/17)

Reuters: Aetna Warned It Would Cut Obamacare If Humana Deal Was Blocked
In the July 5 letter, Aetna Chief Executive Officer Mark Bertolini said it would have to cut back because it would be some time before the company recouped the investment it had made in this market over the past 2-1/2 years. "Our ability to withstand these losses is dependent on our achieving anticipated synergies in the Humana acquisition," Bertolini wrote. (Humer, 8/17)

The Wall Street Journal: Aetna Warned U.S. Before Exiting Health Exchanges
The public emergence of the bluntly worded letter, from Aetna’s Chief Executive Mark T. Bertolini, has led critics to question the motives behind the insurance company’s recently disclosed pullback from the insurance exchanges. It also has added a layer to a broader debate over the causes and cures for the red ink the exchanges are generating for insurers. (Wilde Mathews and Armour, 8/17)

The Washington Post: Aetna Warned It Would Drop Out Of Obamacare Exchanges If Its Merger Was Blocked
Rep. Frank Pallone Jr. (N.J.), ranking Democrat on the Energy and Commerce Committee, issued a statement Tuesday saying he was "troubled by reports this announcement could be in retaliation" to the Justice Department's decision. Earlier this month, after Aetna announced in an earnings call this month that it was reevaluating its participation in the exchanges, Sen. Elizabeth Warren (D-Mass.) wrote on Facebook: "The health of the American people should not be used as bargaining chips to force the government to bend to one giant company’s will." (Johnson, 8/17)

NPR: Aetna CEO To Justice Department: Block Our Deal And We'll Drop Out Of Obamacare
The change in tack for Aetna is also noteworthy because Bertolini was talking up the business potential of the exchanges as recently as April, when he said during a call with analysts and investors that the exchanges were "a good investment," despite the losses incurred. At the time, Bertolini said that Aetna was "committed to working constructively with the administration and lawmakers to find solutions that can improve this program, stabilize the risk pool, and expand product flexibility, all with the goal of creating a sustainable program that makes health care more affordable and accessible for all consumers." Now, the company appears to be taking its ball and going home. (Hensley, 8/17)

Los Angeles Times: Pullback From Obamacare By Aetna, Other Insurers Puts Pressure On Upcoming Enrollments
Recent decisions by giant health insurers to pull back from Obamacare exchanges across the country could make this fall’s enrollment period crucial to the program that has helped millions of people gain health coverage. “We won’t know until the next open enrollment, are we still moving forward or are we stalled or moving backward?” said Gary Claxton, director of the nonprofit research group Health Care Marketplace Project at Kaiser Family Foundation. “If the market grows, then I think many insurers will find a way to be part of it. “The next couple of months are a moment of truth,” he said. (Petersen and Sisson, 8/17)

The Wall Street Journal: Aetna’s Healthy Perspective On Obamacare
The trend of health insurers pulling back from public exchanges raises concern for the future of the Affordable Care Act. It is far less of a worry for investors. Aetna announced plans earlier this week to withdraw from 11 of the 15 states in which the insurer currently offers public exchange plans to individuals. ... Regardless of motivation, Aetna has chosen to exit an unprofitable business. The company said it lost $200 million in pretax income from the exchange business in the second quarter and expects to lose more than $300 million this year. (Grant, 8/17)

The Wall Street Journal: The Unstable Economics In Obama’s Health Law
Barack Obama’s signature health-care law is struggling for one overriding reason: Selling mispriced insurance is a precarious business model. Aetna Inc. dealt the Affordable Care Act a severe setback by announcing Monday it would drastically reduce its participation in its insurance exchanges. Its reason: The company was attracting much sicker patients than expected. Indeed, all five of the largest national insurers say they are losing money on their ACA policies and three, including Aetna, are pulling back from the exchanges as a result. The problem isn’t technical or temporary; it’s intrinsic to how the law was written. (Ip, 8/17)

The New York Times: As Insurers Balk, U.S. Makes New Push To Boost Health Care Act
Facing high-profile withdrawals from online insurance exchanges and surging premiums, the Obama administration is preparing a major push to enroll new participants into public marketplaces under the Affordable Care Act. The administration is eyeing an advertising campaign featuring testimonials from newly insured consumers, as well as direct appeals to young people hit by tax penalties this year for failing to enroll. But as many insurers continue to lose money on the exchanges, they say the administration’s response is too late and too weak. (Pear and Abelson, 8/17)

Politico: Obamacare's CEO Talks Insurer Recruitment After Aetna's Pullback
Aetna's sudden decision to quit most of its Obamacare insurance markets was the latest mess in the health law's rockiest stretch in almost three years. It's Kevin Counihan's job to clean it up. Counihan, CEO of the federal insurance marketplace, told POLITICO's "Pulse Check" podcast that Aetna's flip-flop — the company announced Monday it will exit from 69 percent of counties it now serves through Obamacare, just three months after committing to stay and even expand — doesn't alter the administration's strategy. (Diamond, 8/18)

The Wall Street Journal: Clinton Pushed From Left And Right On Health Care
Aetna Inc.’s decision to scale back participation in the Affordable Care Act’s exchanges is putting new pressure on Hillary Clinton over health care, a onetime signature issue that has taken a back seat in her presidential campaign. The pressure is coming from the right but also the left. Liberals say the Aetna decision shows the need for a government-run option to compete with the private insurance companies, or even for a single-payer, Medicare-for-all program, as Sen. Bernie Sanders proposed again this week. (Meckler, 8/18)

The Washington Post's Fact Checker: Trump’s Claim That Clinton Lacks The ‘Physical Stamina’ To Be President
Two days in a row, in prepared speeches, Trump asserted that that his rival Clinton lacks “mental and physical stamina” to do the job as president. That’s surely no accident, but a campaign official did not respond to a query about why the GOP presidential nominee was making this claim. We assume Trump’s rhetoric is related to a not-so-quiet campaign among right-leaning news entities to highlight “concerns” about Clinton’s health, often shared on social media with #HillarysHealth. Our colleague David Weigel has already taken a good look at the smorgasbord of junk science being used to promote such claims. (Kessler, 8/18)

The New York Times: Six Years Into Obama’s Health Care Law, Who Are The Uninsured?
Roughly 20 million more Americans have health insurance now than when President Obama’s health care law was passed in 2010. But as Mr. Obama prepares to leave office, there are still about 24 million adults with no coverage, according to a survey by the Commonwealth Fund, a health research group. That translates to an uninsured rate of about 13 percent, down from 20 percent in 2013. Who are the remaining uninsured? (Goodnough, 8/18)

Los Angeles Times: Fewer Californians Were Uninsured In 2016, But Medical Costs Remain A Concern For Many
Nearly three-quarters of Californians who didn’t have health coverage before the Affordable Care Act are now insured, yet many are still concerned about their medical expenses, according to a report released Thursday. A Kaiser Family Foundation survey tracking the state’s uninsured population found that 72% of those without insurance in 2013 had a health plan in 2016. That’s a small increase from the 68% who had coverage last year and 58% the year prior. (Karlamangla, 8/18)

Los Angeles Times: Obamacare Patients Filled More Prescriptions But Paid Less For Drugs, Study Finds
Patients who gained health coverage through the Affordable Care Act are filling significantly more prescriptions while paying less for their drugs, according to a new study that credits the health law and adds to evidence of its benefits for previously uninsured Americans and those with chronic conditions such as asthma, diabetes and high blood pressure. The innovative study is based on more than 1 billion pharmacy transactions from 2013 and 2014, which allowed researchers to look at how a sample of nearly 7 million patients were paying for drugs before and after the health law’s historic coverage expansion. (Levey, 8/17)

The Associated Press: White House Announces $17 Million To Curb Opioid Use
The Obama administration has announced that it will spend $17 million to help law enforcement agencies deal with the increase in heroin and opioid abuse. At the same time, the administration is using the announcement to encourage Congress to meet President Barack Obama's call for $1.1 billion in new funding to help states expand access to treatment. (8/17)

The Associated Press: 26 Heroin Overdoses Over 4 Hours In 1 West Virginia City
Officials in a West Virginia city are warning people about an especially dangerous batch of heroin after authorities responded to 26 overdoses in within a four-hour span. The rash of overdoses came Monday in the city of Huntington, which sits in Cabell County along the Ohio River in the western part of the state. Gordon Merry, the county's EMS director, said at a news conference Tuesday that the heroin the users had taken was laced with a strong substance, but authorities aren't sure what it is. (8/17)

The Washington Post: The Latest Overdose Outbreak Shows Just How Dangerous The Heroin Epidemic Has Gotten
The Charleston Gazette-Mail reports that police in Huntington, W.Va., responded to 26 heroin overdose cases in a span of four hours on Monday evening. To get a sense of the scale of the outbreak, consider this: Huntington is a small city with a population of about 49,000 people, according to the Census Bureau. An overdose outbreak of similar magnitude in New York City (population 8.4 million) would affect more than 4,400 people. The cases overwhelmed first responders in Huntington. (Ingraham, 8/17)

Los Angeles Times: Scientists Design A Drug That Relieves Pain Like An Opioid Without Some Dangerous Side Effects
What if you could design a drug that has all the pain-relieving power of morphine but none of its dangerous or addictive side effects? Scientists have spent years trying to do just that, and on Wednesday, they unveiled one of their most promising compounds yet — a chemical concoction they dubbed “PZM21.” When tested in mice that were placed on a hot surface, PZM21 offered nearly as much pain relief as morphine and lasted for up to three hours. That’s “substantially longer” than morphine or other experimental drugs, the scientists wrote in the journal Nature. (Kaplan, 8/17)

NPR: In Search Of An Opioid That Offers Help Without The Risks
Now scientists are trying to create opioid painkillers that give relief from pain without triggering the euphoria, dependence and life-threatening respiratory suppression that causes deadly overdoses. That wasn't thought possible until 2000, when a scientist named Laura Bohn found out something about a protein called beta-arrestin, which sticks to the opioid receptor when something like morphine activates it. When she gave morphine to mice that couldn't make beta-arrestin, they were still numb to pain, but a lot of the negative side effects of the drug were missing. They didn't build tolerance to the drug. (Chen, 8/17)

NPR: Florida Keys Opposition Stalls Tests Of Genetically Altered Mosquitoes
The fight against the Zika virus has a new weapon: the genetically engineered mosquito. It's recently been approved by federal regulators and may soon be available in parts of the U.S. that are confronting the virus, like Puerto Rico and Miami. The Florida Keys do not have a Zika problem at the moment, but on Aug. 5 the Food and Drug Administration approved trial releases of these mosquitoes in the Keys. But because of the vocal opposition of people there, the local mosquito control board hasn't yet approved the trials, instead putting it on the November ballot as a nonbinding referendum. (Allen, 8/17)

Los Angeles Times: As A Drug Pricing Transparency Bill Stumbles In Sacramento, The Battle Turns To November's Ballot
An effort to shed more light on prescription drug prices sputtered in the Legislature on Wednesday, dealing a setback to a burgeoning national movement to rein in healthcare expenses by curbing the cost of medication. The decision by state Sen. Ed Hernandez (D-West Covina) to yank his bill from consideration after it was watered down in an Assembly panel marks an abrupt end to what promised to be the marquee lobbying battle of the legislative session, pitting Capitol heavyweights such as labor groups and health insurers against drug manufacturers. The measure’s demise is a significant victory for pharmaceutical companies, but not a full reprieve. (Mason and Bollag, 8/17)

The Associated Press: Judge Invalidates Patent For Johnson & Johnson Rheumatoid Arthritis Drug
A cheaper version of Johnson & Johnson's top-selling drug, the expensive rheumatoid arthritis treatment Remicade, could be available in the United States two years early after a federal judge ruled that a key patent on the drug is invalid. Johnson & Johnson said Wednesday it planned to appeal a summary judgment issued by the District of Massachusetts federal court in a high-stakes patent fight with rival drugmaker Pfizer Inc. The appeal process could take a year or more, Johnson & Johnson said. (Johnson, 8/17)

The Wall Street Journal: Court Says Pfizer’s Biosimilar Of J&J’s Remicade Doesn’t Infringe Patent
Pfizer Inc.’s lower-priced version of Johnson & Johnson’s blockbuster autoimmune disease drug Remicade doesn’t infringe a patent, a federal court ruled on Wednesday, potentially clearing the way for the drug’s sale in October. J&J said it would appeal the decision and affirmed its sales projections. Remicade, first approved for sale in the U.S. in 1998, is J&J’s largest product by sales, accounting for $6.56 billion in sales last year, including $4.5 billion in the U.S. The drug’s two lead indications are inflammatory bowel disease, including Crohn’s disease and ulcerative colitis, and rheumatoid arthritis and associated indications. (Armental, 8/17)

The New York Times: Genetic Tests For A Heart Disorder Mistakenly Find Blacks At Risk
Genetic tests for an inherited heart disorder are more likely to have incorrect results in black Americans than in whites, according to a new study that is likely to have implications for other minorities and other diseases, including cancer. Mistakes have been made because earlier research linking genetic traits to illness did not include enough members of minority groups to identify differences between them and the majority white population or to draw conclusions about their risks of disease. (Grady, 8/17)

NPR: Study Of Sudden Cardiac Death Exposes Limits Of Genetic Testing
People in the healthy comparison groups in these studies were white; whereas some people in the studies with HCM apparently had some African ancestry. As a result, some of the gene variants flagged as being linked to the illness simply represented racial differences between the groups and had nothing to do with HCM. That problem would likely have been avoided if the original scientists had added four or five African Americans to the control group, Kohane says. It turns out that two of these variants commonly identified in African Americans actually don't pose a health risk at all. (Harris, 8/17)

NPR: Does Childhood Abuse Condemn Women To An Early Death?
It's increasingly clear that bad experiences during childhood are associated with long-lasting health effects, including higher rates of heart disease, diabetes and depression. And childhood abuse in particular has been associated with psychiatric problems and chronic diseases years down the line. But whether that translates to a higher risk of early death for abuse survivors isn't well studied. According to research published Wednesday, there is an association between reports of childhood abuse and premature death, but only in women. And because of the nature of the study, the link isn't definitive. (Hobson, 8/17)