First Edition: December 18, 2018

Kaiser Health News: After Her Skiing Accident, An Uphill Battle Over Snowballing Bills
Sarah Witter couldn’t get a break even though her leg had gotten several. As she lay on a ski trail in Vermont last February, Witter, now 63, knew she hadn’t suffered a regular fall because she could not get up. An X-ray showed she had fractured two major bones in her lower left leg. A surgeon at Rutland Regional Medical Center screwed two gleaming metal plates onto the bones to stabilize them. “I was very pleased with how things came together,” the doctor wrote in his operation notes. But as spring ended, the wound started to hurt more. (Rau, 12/18)

Kaiser Health News: Health Care Is Where The Jobs Are. But What Kind Of Jobs?
More Americans are now employed in health care than in any other industry. The Bureau of Labor Statistics, which tallies job creation, says that for most of this year the health sector outpaced the retail industry. Only government, on all levels, employs more people. One of the consistent features of the BLS reports is that health care has reliably added thousands of jobs to the economy each month. (Bluth, 12/18)

Kaiser Health News: What Just Happened To The ACA And What Happens Now? A Special Bonus Edition
Federal District Judge Reed O’Connor again thrust the Affordable Care Act into uncertainty with his ruling Friday that eliminating the tax penalty for not having insurance renders the entire law unconstitutional. The panelists for this special bonus episode of KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Stephanie Armour of The Wall Street Journal and Paige Winfield Cunningham of The Washington Post. (12/17)

Kaiser Health News: Watch And Listen: Court Decision Rocks ACA
Julie Rovner, KHN’s chief Washington correspondent, was featured on NPR’s “Up First” podcast Monday morning to discuss a federal judge’s ruling late Friday invalidating the Affordable Care Act. She also joined NPR’s Michel Martin on Saturday on “All Things Considered” to talk about the case. (12/17)

The New York Times: States Ask Judge To Declare Health Law Still In Effect While Ruling Is Appealed
California and 15 other states asked a federal judge on Monday to protect current health care coverage for millions of Americans while courts sort out the implications of his ruling that the Affordable Care Act was invalid in its entirety. The states, which support the health care law, said the ruling on Friday, by Judge Reed O’Connor of the Federal District Court in Fort Worth, had caused immense confusion about whether the law was still in effect, and whether consumers were still entitled to its benefits and protections. The states asked Judge O’Connor to clarify whether he meant his decision to have “any immediate legal effect.” (Pear, 12/17)

The Wall Street Journal: States Ask For Clarity On Judge’s Ruling On Affordable Care Act
The states filed a motion that asks U.S. District Judge Reed O’Connor in Texas to either clarify his ruling or grant a stay of his decision during litigation. The states also asked for permission to appeal it right away. The judge cast a cloud over the ACA’s future in a sweeping ruling that declared the ACA unconstitutional without a penalty on people forgoing health coverage. Congressional Republicans have eliminated the penalty starting for next year. Because the insurance mandate was central to the law, the whole law must be invalidated, the judge ruled. (Armour, 12/17)

The Hill: Dem AGs Begin Process Of Appealing Court Ruling That Struck Down ObamaCare
The state officials noted in their filing Monday that O'Connor's opinion created confusion about whether ObamaCare will be unenforceable once the repeal of the individual mandate takes effect Jan. 1. They also asked that he certify his opinion so it can be appealed to the Fifth Circuit. They asked for a response by Friday. “The district court’s ruling poses a dangerous threat to the healthcare of millions of Americans. We’re asking the court to make clear that the ACA is still the law and ensure that all Americans can continue to access affordable healthcare under it,” Becerra said in a statement. (Hellmann, 12/17)

The Washington Post: Trump Suggests A Supreme Court Ruling Invalidating Affordable Care Act Would Lead To Better Health Care
President Trump on Monday suggested that the Supreme Court should affirm a ruling by a federal judge in Texas that the entire Affordable Care Act is invalid, writing on Twitter that doing so “will lead to GREAT HealthCare results for Americans!” The president weighed in on the judicial process as the ruling on Friday cast great uncertainty over the U.S. health-care system, with the expectation that the case would ultimately make its way to the Supreme Court. In his tweet, Trump sought to make the case, as he first did over the weekend, that the ruling presented an opportunity for his Republican administration to work with Democrats to craft a better law than President Barack Obama’s signature achievement, which Trump continued to criticize. (Wagner, 12/17)

Politico: Why Trump Still Needs Obamacare
A Texas judge’s stunning declaration that Obamacare is unconstitutional not only kneecaps the health care law, it would also cripple President Donald Trump’s entire health care agenda. Trump wants lower drug prices, drastic action on the opioid crisis and protection for people with pre-existing conditions. Those are the parts of the law many Republicans do want to keep, but with the entire law invalidated — pending appeal — Trump and Republicans are trying to figure out how to live with a judicial ruling they kind of wanted, but didn’t want in such a big way. (Karlin-Smith, Roubein and Ehley, 12/17)

The Hill: GOP Lawmakers Distance Themselves From ObamaCare Ruling
Republicans are keeping their distance from a recent court ruling that struck down ObamaCare, as GOP lawmakers are wary of the political backlash that could ensue from scrapping the law. Many congressional Republicans remain silent after a federal judge on Friday struck down the Affordable Care Act in its entirety. And those who have spoken out largely steered clear of embracing the decision. (Sullivan, 12/17)

The Hill: Incoming Dem Chairman Vows Hearings On ObamaCare Lawsuit 'Right Away'
Rep. Frank Pallone Jr. (D-N.J.), the next chairman of the House Energy and Commerce Committee, vowed Monday to hold oversight hearings "right away" on the Trump administration's involvement in a court case over the weekend that ruled that the Patient Protection and Affordable Care Act, often called ObamaCare, was unconstitutional. Pallone will take over the chairmanship of the panel when Democrats assume the House majority next year. He said they will "get to the bottom" of the administration's decision not to defend the health-care law against a lawsuit filed by Republican attorneys general. (Hellmann, 12/17)

Reuters: U.S. Healthcare Stocks Drop After Judge Rules Obamacare Unconstitutional
Shares of U.S. health insurers, hospitals and healthcare companies fell on Monday in the aftermath of a ruling by a federal judge in Texas that the Affordable Care Act (ACA), commonly called Obamacare, was unconstitutional. Many legal experts predicted U.S. District Judge Reed O'Connor's decision on Friday eventually will be reversed on appeal considering that the law has been upheld by the Supreme Court, but the uncertainty created by the ruling drove down healthcare stocks on Monday. (12/17)

The Associated Press: Health Care Sector Roils After ACA Court Ruling
Hospital chains HCA Inc. and Tenet Healthcare Corp. dropped 7 percent and 4 percent respectively when markets opened Monday. Centene Corp., a health insurer focused heavily on the government-funded Medicaid program and the ACA’s individual insurance exchanges, fell 8 percent. Other insurers that slipped included Molina Healthcare Inc. and Anthem Inc., companies that have benefited from either the insurance exchanges or the law’s Medicaid expansion.(12/17)

Politico: Warren Bill Would Get Feds Into Generic Drug Manufacturing
Sen. Elizabeth Warren (D-Mass.), a likely 2020 presidential candidate, will release a bill on Tuesday that would effectively create a government-run pharmaceutical manufacturer to mass-produce generic drugs and bring down prices, several sources in her office told POLITICO on Monday in an exclusive preview of the legislation. The bill, dubbed the Affordable Drug Manufacturing Act, is unlikely to pass the Republican-led Senate, but it signals that a future Warren White House could try to radically revamp the federal government’s role in the pharmaceutical market in order try to lower prices. (Thompson and Karlin-Smith, 12/17)

NPR: Sen. Cory Booker Seeks Increased Transparency In Medicaid's Drug Decisions
Sen. Cory Booker, D-N.J., says he will introduce federal legislation this week that would require more transparency surrounding states' Medicaid drug decisions. The bill comes in response to a recent investigation by the Center for Public Integrity and NPR. The measure, known as the "Medicaid Drug Decisions Transparency Act," would require pharmaceutical companies to disclose their payments to pharmacists and others who serve on state Medicaid drug boards. These boards help decide which drugs Medicaid patients will be able to access easily. Currently drugmakers must only disclose perks given to doctors, such as free dinners, speaking fees and consulting gigs. In addition, the bill would increase penalties for companies that fail to comply with reporting requirements. (Whyte, 12/17)

Stat: Feds Want To Dismiss Lawsuits Alleging Nurse Programs Are Kickbacks 
In a boon to the pharmaceutical industry, the federal government moved to dismiss nearly a dozen lawsuits alleging drug makers devised schemes in which nurses were used illegally to promote their medicines and boost prescriptions, an arrangement that purportedly violated federal kickback laws. In explaining its rationale, the U.S. Department of Justice argued the company that made the allegations was a “professional” whistleblower that used “false pretenses” to gather information for the “cloned” lawsuits. The feds complained that several investors created a company to file the lawsuits and pretended to conduct research studies in order to obtain information for their allegations, according to court documents in a case involving Bayer Pharmaceuticals. (Silverman, 12/17)

Stat: Sen. Alexander, Leading Republican On Health Care, Will Not Seek Reelection
One of Washington’s most influential health policymakers, Sen. Lamar Alexander, will not seek reelection in 2020, he announced Monday. The Tennessee Republican has chaired the powerful Senate Health, Education, Labor, and Pensions Committee since 2015, where he presided over a number of high-profile health care bills, including the 21st Century Cures Act, and the Republican party’s eventually abandoned effort to repeal Obamacare. (Florko, 12/17)

CQ: Alexander Announces He Won't Seek Re-Election In 2020
“I will not be a candidate for re-election to the United States Senate in 2020. The people of Tennessee have been very generous, electing me to serve more combined years as Governor and Senator than anyone else from our state. I am deeply grateful, but now it is time for someone else to have that privilege,” Alexander said in a statement. Alexander had said he would decide by the end of the year whether he’d seek re-election. As recently as last week, it seemed his team was gearing up for him to seek a fourth term, when his pollster released a poll showing the senator with a 65 percent favorability rating among likely Republican primary voters. (Lesniewski, 12/17)

The Hill: Dems To Reframe Gun Violence As Public Health Issue
House Democrats are planning to vote next year on bills that address gun violence as a public health concern, marking the party's first steps back into a divisive debate after being in the minority for eight years. Energized by their midterm victories and a focus on gunshot victims highlighted by a growing chorus of medical professionals, Democrats say they will push for legislation to fund research on gun injuries and deaths. (Weixel, 12/14)

Reuters: J&J Moves To Limit Impact Of Reuters Report On Asbestos In Baby Powder
Johnson & Johnson on Monday scrambled to contain fallout from a Reuters report that the healthcare conglomerate knew for decades that cancer-causing asbestos lurked in its Baby Powder, taking out full-page newspaper ads defending its product and practices, and readying its chief executive for his first television interview since investors erased tens of billions of dollars from the company’s market value. (12/18)

The Hill: Johnson & Johnson Pushes Back On Asbestos Report: 'Our Talc Is Safe'
Johnson & Johnson (J&J) on Monday launched a national ad campaign defending itself following a news report that said the company knew for decades its talc baby powder contained traces of asbestos. The company took out a full-page ad in The New York Times to argue that the findings cited in a recent Reuters investigative piece are not backed by science. (Weixel, 12/17)

The Washington Post: After Migrant Girl’s Death, Democrats Seek To Question Border Patrol Agents Who Detained Her
Democrats with the Congressional Hispanic Caucus say they will tour a Border Patrol station in New Mexico on Tuesday to “investigate” the circumstances leading up to the death of a Guatemalan girl who collapsed hours after she and her father were taken into U.S. custody on Dec. 6. The congressional delegation, led by Rep. Joaquin Castro (D-Tex.), plans to visit the border crossing at Antelope Wells, where Jakelin Caal, 7, and her father, Nery Caal, entered the United States illegally as part of a group of 163 migrants. The caucus members will then visit the Lordsburg Border Patrol station, 90 miles north, where they will be joined by Customs and Border Protection Commissioner Kevin McAleenan. (Miroff, 12/17)

Reuters: U.S. Border Agents Will Not Speak To Lawmakers About Girl's Death
U.S. Border Patrol agents who detained a 7-year-old Guatemalan migrant girl who later died in federal custody will not speak with U.S. lawmakers investigating her death, the U.S. Department of Homeland Security said on Monday, citing their union membership. Members of the Congressional Hispanic Caucus on Tuesday plan to visit the New Mexico patrol station where Jakelin Caal and her father were taken on Dec. 7 to learn more about why she died the next day. (Hay, 12/17)

Los Angeles Times: A 2-Year-Old Is On Life Support In Oakland. Trump's Travel Ban Could Keep His Yemeni Mother From Saying Goodbye
The mother of a 2-year-old boy on life support in an Oakland hospital may not receive a travel ban waiver in time to say goodbye to her son, the Council on American-Islamic Relations said Monday. At a news conference in Sacramento, members of CAIR, community activists and faith leaders stood alongside the boy’s father and demanded that the Trump administration expedite the woman’s application for a waiver. (Parvini, 12/17)

The Hill: Almost 17K Arkansans Have Lost Medicaid Coverage Due To Work Requirements
Nearly 17,000 people have lost Medicaid coverage in Arkansas because they did not comply with the state’s work requirements, according to new state data released Monday. Arkansas began phasing in work requirements for Medicaid beneficiaries in August. In the first three months the requirements have been in effect, more than 12,000 people were removed from Medicaid. (Weixel, 12/17)

The Associated Press: Health Insurance On Demand? Some Are Betting On It
People with health insurance often pay for coverage they never use. A startup wants to shake that up. It's a radical idea: On-demand insurance that lets customers buy some of their coverage only if and when they need it, similar to how TV viewers might rent a new release from Amazon instead of paying every month for a pricey cable package they rarely use. This approach from Bind Benefits is one of the latest wrinkles in a yearslong push by companies and insurers to control costs and make patients smarter health care shoppers. (Murphy, 12/17)

The Hill: Three In 10 Delaying Medical Treatment Due To Costs: Gallup
About three in 10 Americans say they have delayed seeking medical treatment within the past year because of medical costs, according to a new poll published Monday. A Gallup poll found that 29 percent of respondents said they had put off treatment because of costs. About 19 percent said they delayed treatment for serious or somewhat serious conditions, according to the poll. (Burke, 12/17)

Politico Pulse Check: Surgeon General Jerome Adams
The U.S. surgeon general explains why he's issuing a rare warning on e-cigarettes and kids. (12/18)

The Associated Press: Child Abuse Climbs After Friday Report Cards, Study Says
Child abuse increases the day after school report cards are released — but only when kids get their grades on a Friday, a study in Florida suggests. The curious finding startled researchers, who had figured abuse might go up regardless of the specific day kids got their grades. But their study of reports to a child abuse hotline that included broken bones, burns and other confirmed abuse found otherwise. An increase only occurred on Saturdays after a report-card Friday. (Tanner, 12/17)

The New York Times: When Report Cards Go Out On Fridays, Child Abuse Increases On Saturdays, Study Finds
Dr. Randell C. Alexander of Jacksonville, Fla., a pediatrician who specializes in treating victims of abuse, said that for years he and his colleagues had heard children recount episodes of violence arising from unsatisfactory grades. They would see children with black eyes, marks from belts and electrical cords, and at times more serious injuries, he said. “When you say, ‘How did you get it?,’ they say it’s because of their report card,” said Dr. Alexander, an author of the study and the chief of the child protection and forensic pediatrics division of the University of Florida’s College of Medicine, Jacksonville. (Jacobs, 12/17)

The Washington Post: Raising Boys Today: Eliot’s Father Wants Him To Be The 8-Year-Old He Is, Not What Society Expects
Brian and Bonnie, who live in Raleigh, N.C., are raising their son at a turbulent time, when the boy next door could be exposed as the next perpetrator of a Me Too moment or grow into the bully in the C-suite. How, in the words of Bonnie, can they make sure to “not raise a jerk?” Such questions are close at hand but not always solvable. Especially at a time when the problems facing boys are mounting. (Joyce, 12/17)

The New York Times: Trump Officials Plan To Rescind Obama-Era School Discipline Policies
The Trump administration is planning to roll back Obama-era policies aimed at ensuring that minority children are not unfairly disciplined, arguing that the efforts have eased up on punishment and contributed to rising violence in the nation’s schools, according to documents obtained by The New York Times. (Green and Benner, 12/17)

The Wall Street Journal: Trump School-Safety Panel Targets Obama Policy On Race And Discipline
The commission, formed after the school shooting Feb. 14 that killed 17 people in Parkland, Fla., largely sidesteps making any recommendations to tighten access to firearms, falling far short of what Democrats and most education policy officials say is necessary to reduce the frequency of gun-related violence. The 177-page report, which was reviewed by The Wall Street Journal and will be released publicly Tuesday afternoon, does recommend that individual states or districts consider arming school personnel, either teachers or law-enforcement officials present in school buildings, particularly in rural areas where supplemental help would take longer to arrive. (Hackman, 12/18)

The Associated Press: As US Life Expectancy Falls, West Virginia Offers Lessons
If you want to understand why U.S. life expectancy is declining, West Virginia is a good place to start. The state is a bellwether of bad health, portending major problems years before they became severe nationally. "It seems that the worst outcomes happen here first," said Dr. Michael Brumage, a West Virginia University public health expert who formerly ran the health department in Charleston. "We're the canary in the coal mine." (12/18)

The Associated Press: Unemployment, Income Affect Life Expectancy
New government data show just how much your neighborhood can impact the length of your life. The Associated Press has analyzed life expectancy and demographic data from the National Center for Health Statistics. The AP looked at more than 65,000 census tracts. It found that certain demographic qualities —unemployment, household income, race and education — affect life expectancy in most neighborhoods. (12/18)

Stat: Recovery Experts Set Up New ‘Religion’ In Maine That May Skirt Drug Laws
The congregation lends structure to a rogue coalition of harm-reduction advocates who work to distribute thousands of syringes — possessing more than 10 is illegal in Maine — as well as hundreds of doses of naloxone. Members of the “church” don’t take that title lightly. The decision to brand the organization as a church could also provide a strange element of legal protection. If [Jesse] Harvey is arrested for his work — and he hopes he will be — he will argue that he was merely carrying out his own First Commandment: harm reduction. (Facher, 12/18)

Stat: Scientists Start To See Breast Milk As Rich Source For New Therapeutics
They’re studying how certain human milk components might ward away superbugs, treat diseases of the gastrointestinal system, improve vaccine efficacy, reduce inflammation, or kill cancer. ...But breast milk is not some kind of magical panacea. Some cancer patients have taken to drinking breast milk for therapeutic gains, though it’s highly unlikely they will see any, [Lars] Bode said. Some bodybuilders have fueled a black market for breast milk — paying high premiums to drink it in hopes of boosting their muscle mass. (Keshavan, 12/18)

The New York Times: Set It And Forget It. How Better Contraception Could Be A Secret To Reducing Poverty
When a woman of childbearing age goes to the doctor in most places, she gets standard queries about her smoking, drinking, seatbelt use and allergies. In Delaware, she is now also asked: “Do you want to get pregnant in the next year?” If her answer is no, clinics are being trained to ensure she gets whatever form of birth control she wants that very day, whether a prescription or an implant in her arm. (Sanger-Katz, 12/18)

The New York Times: Is There An Optimal Diet For Humans?
Nutrition experts have long debated whether there is an optimal diet that humans evolved to eat. But a study published this month adds a twist. It found that there is likely no single natural diet that is best for human health. The research, published in the journal Obesity Reviews, looked at the diets, habits and physical activity levels of hundreds of modern hunter-gatherer groups and small-scale societies, whose lifestyles are similar to those of ancient populations. They found that they all exhibit generally excellent metabolic health while consuming a wide range of diets. (O'Connor, 12/18)

The Washington Post: Gene-Edited Farm Animals Are Coming. Will We Eat Them?
Three cows clomped, single-file, through a chute to line up for sonograms — ultrasound “preg checks” — to reveal if they were expecting calves next summer. “Right now. This is exciting, right this minute,” animal geneticist Alison Van Eenennaam said as she waited for a tiny blob of a fetus to materialize on a laptop screen on a recent afternoon at the Beef Barn, part of the University of California at Davis’s sprawling agricultural facilities for teaching and research. The cows had been implanted a month and a half earlier with embryos genetically edited to grow and look like males, regardless of their biological gender. (Johnson, 12/17)

The Associated Press: US Defeated Trying To Rid References To Reproductive Health
The United States has faced overwhelming defeat in two attempts to eliminate references to "sexual and reproductive health" from U.N. General Assembly resolutions on preventing violence and sexual harassment of women and girls and on child, early and forced marriage. The reference to "sexual and reproductive health" was approved by nearly 190 countries at the 1994 U.N. population conference in Cairo. But the Trump administration contends the language has accumulated connotations including the promotion of abortion or the right to abortion. (12/17)

Reuters: U.S. Isolated At U.N. Over Its Concerns About Abortion, Refugees
On Monday, Washington unsuccessfully tried to remove two paragraphs from a General Assembly resolution on preventing violence and sexual harassment of women and girls. It was the only country to vote against the language, while 131 countries voted to keep it in the resolution and 31 abstained. The United States also failed in trying to remove similar language in another resolution on child, early and forced marriage on Monday, saying: "We do not recognize abortion as a method of family planning, nor do we support abortion in our reproductive health assistance." (12/17)

The New York Times: The World Needs A Urine Test For TB. But It’s Already Here.
For at least a decade, one of the most urgent needs in public health was a urine dipstick that could quickly diagnose tuberculosis in the most vulnerable population: those with advanced H.I.V. Now that test exists. It’s inexpensive and has been recommended by the World Health Organization since 2015. But it is hardly used in the countries that most need it. (Mandavilli, 12/17)

The New York Times: An Island Nation Starts An Experiment: Vaccines Delivered By Drone
In the village of Cook’s Bay, on the remote side of the remote island of Erromango, in the remote South Pacific nation of Vanuatu, 1-month-old Joy Nowai was given hepatitis and tuberculosis shots delivered by a flying drone on Monday. It may not have been the first vial of vaccine ever delivered that way, but it was the first in Vanuatu, which is the only country in the world to make its childhood vaccine program officially drone-dependent. (McNeil, 12/17)

Los Angeles Times: State Utility Regulators Delayed Implementing Law Aimed At Preventing Wildfires
Long before the Camp fire raced through Northern California, claiming at least 86 lives and all but erasing the Gold Rush town of Paradise, state law required the three big power monopolies to file detailed strategies to prevent wildfires. Under Senate Bill 1028, San Diego Gas & Electric, Southern California Edison and Pacific Gas & Electric were supposed to prepare annual wildfire mitigation plans for reducing fire threats and identify who specifically would be responsible for implementing them. (McDonald, 12/17)

The New York Times: Cuomo Moves To Legalize Recreational Marijuana In New York Within Months
Gov. Andrew M. Cuomo announced that he would push to legalize recreational marijuana next year, a move that could generate more than $1.7 billion in sales annually and put New York in line with several neighboring states. The highly anticipated proposal came in a speech in Manhattan on Monday, in which the governor outlined his agenda for the first 100 days of his third term. Mr. Cuomo framed the speech as a reflection on what Franklin Delano Roosevelt — the former president who was once a New York governor himself — would do today, mixing sweeping rhetoric about American ideals with grim warnings about the Trump administration. (Wang, 12/17)

The New York Times: Nebraska Petition Seeks Medical Marijuana Ballot Measure In 2020
As more and more surrounding states have legalized some form of medical marijuana, advocates in Nebraska say it’s time for their state to accept the reality and embrace the medicinal use of cannabis. And they want it written into the State Constitution. Two lawmakers started a petition drive last week hoping to build on legalization efforts elsewhere, including other deep red bastions like Utah and North Dakota, and put a Constitutional Amendment on medical marijuana on the state ballot in 2020. (Stack, 12/17)

Los Angeles Times: Police Investigate 'Reprehensible' Behavior Of Camp Fire Cleanup Workers Who Posted Offensive Photos 
One photo from the wreckage of the Camp fire’s devastating march through Paradise, Calif., shows the remains of a charred cat with a glass bottle sticking out of its mouth. In another, two workers pretend to go on a drive to “unknown destinations” in someone’s burned-out recreational vehicle. Some of the captions, including one that accompanied a photo of a man mimicking jumping on what’s left of a scorched trampoline in someone’s yard, included jokes: “Trampolines are stupid. BTW, it used to be called a Jumpoline until your mom got on it.” (Fry, 12/17)